Name of Vendor: ________________________________________________________________
Mailing Address: ________________________________________________________________
Telephone Number: ______________________________________________________________
Type of Outdoor Cooking Booth: ____________________________________________________
Date(s) of Event: ________________________________________________________________
Location of Event: _______________________________________________________________
I, __________________________________________ , (Print name) hereby represent and warrant
that I am the authorized agent of___________________________________________ (Print Name
of Vendor), with the authority to act on its behalf. On behalf of said vendor, I have read and
understood the
Regulations of the State Fire Marshal
as included under State of California Title
19- Public Safety- with regards to Outdoor Cooking Booths, and I agree to comply with the
Regulations at the location and on the date(s) specified above. I understand and agree that the
State of California Fire Marshal Inspector may inspect said vendor
s cooking booth at any time to
enforce the Regulations. I further understand and agree that said vendor shall be held liable for any
and all fees and costs related to mitigation of the violations of the Regulations, as determined by
the State Fire Marshal Inspector, in exercise of his/ her sole discretion.
_________________________________ ___________________________________
Signature Date
Name & Title
Please return to:
California State University, East Bay
Planning, Design and Construction ST170,
25800 Carlos Bee Blvd, Hayward, CA 94542
Email address: or fax: 510-885-3313
click to sign
click to edit
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome