11 - Ground & Tower Lease with T-Mobile-East Water Tower-Bonham Street

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City of Paris -Water Utilities Department Property/Grounds Entrance Authorization PLEASE PRINT ALL INFORMATION LEGIBLY Name of Property to be Accessed Address of Property Company Name Company Phone Number Name of Site Supervisor Name #1 of Other Workers Name #2 of Other Workers Name #3 of Other Workers Date: Time: M /PM Company Address Name of Company Contracted from(if sub) D.L.# D.L.# D.L.# D.L.# State Phone # State Phone # State Phone # State Phone # Name #4 of Other Workers D.L.# State Phone # Name #5 of Other Workers D.L.# State Phone # Estimated Duration of Work Returning Tomorrow? Yes ❑ No ❑ Vehicle #1 Info: Make Model Color Tag# State Year Vehicle #2 Info: Make Model Color Tag# State Year Vehicle #3 Info: Make Model Color Tag# State Year Any additional personnel or vehicles should he added to another sheet. Climbing The Water Tower? Yes ❑ No ❑ Wearing Safety Equipment? Yes ❑ No ❑ Type of Work Performed Comments Access to city water facilities should always be coordinated through the Water Department at 903-784-4809 and 30 minutes to 1 hr. notice is requested. Access to facilities will be accommodated to the best of our ability and in as timely a manner as possible. Your cooperation and patience are greatly appreciated. Notification is required upon arrival to the facility at 903-784-4809. If Public Safety equipment is disabled due to illegal carrier presence all activities must cease and identification of source must be determined and eliminated before continuation of activities. No preventative maintenance of RF equipment will be performed between the hours of 0800-1000 and 1500-1800 M -F. Signature of Party or Parties Working on Property: Paris Water System Representative Signature: Date Date