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F'RF STOCKTON FIRE DEPARTMENT <br /> t FIRE PREVENTION DIVISION I I <br /> oEPT (209) 937-8271 - FAX (209) 937-8893 <br /> RESPONSIBLE VENDOR FORM FOR <br /> OUTDOOR COOKING BOOTHS <br /> Name of Vendor: 4_e�d`i(2 1 s c <br /> Mailing Address: FS..ut-74SZ1, �> <br /> Telephone Number: 7—C — <br /> Type of Outdoor Cooking Booth: <br /> Dates of Function: <br /> Location of Function: <br /> (Print Name) hereby represent and warrant that I am the <br /> authorized agnt of (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, AND AGREED: <br /> Signature Daz <br /> --p J� c..11� Gt_ S <br /> Name and itle <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 />