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STOCKTON FIRE DEPARTMENT <br /> t FIRE PREVENTION DIVISION r ry�j'I' <br /> oar (299)937-8271 - FAX(209)937-8893 S-0CK'r0N <br /> RESPONSIBLE VENDOR FORM FOR <br /> OUTDOOR COOKING GOTHS <br /> Name of Vendor: -&/( P _ <br /> Mailing Address:_ Y// emn rG{,&- 1E/ <br /> Telephone Number:_ 2-0 /Z;;;2 _7X <br /> Type of Outdoor Cooking Booth: ! �a° C ly// ( <br /> Date(s)of Function:_ <br /> Location of Function:_._._ <br /> I,_ _S (Print Name)hereb a resent and warrant that I am the <br /> authorized agent of L�9 � __.---_(Print Name of Vendor), <br /> with the authority to act on its behalf. <br /> On behalf of said vendor, I have read and understood the Fire Department's <br /> Regulations for Outdoor Cooking Booths('Regulations'), and I agree to comply with the <br /> Regulations at the location and on the date(s)specified above. <br /> I understand and agree that the City of Stockton Fire Marshal (and/or representative <br /> thereof) may inspect said vendor's cooking booth at any time to enforce the <br /> Regulations. <br /> I further understand and agree that said vendor shall be held liable for any and all fees <br /> and costs related to violations of the Regulations, as determined by the Fire Marshal, in <br /> the exercise of his/her sole discretion. <br /> READ, UNDERSTOOD,A ED:' <br /> Signature Date <br /> Name and Title -- <br /> Please return this completed form to: Stockton Fire Department <br /> Fire Prevention Division <br /> 345 N. EI Dorado Street <br /> Stockton, CA 95202 <br /> Page 10 <br />