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Class 2 - Bulk Storage Tank

2. Full Company Name (Include DBA)
4. LP Gas is supplied by:
6. List all managers of bulk plants, mailing address and phone number
8. 1. Name
9. Manages (plant)
11. Address
13. City
14. State
15. Zip Code
17. Phone Number
19. 2. Name
20. Manages (plant)
22. Address
24. City
25. State
26. Zip Code
28. Phone Number
30. 3. Name
31. Manages (plant)
33. Address
35. City
36. State
37. Zip Code
39. Phone Number
41. 4. Name
42. Manages (plant)
44. Address
46. City
47. State
48. Zip Code
50. Phone Number
52. 5. Name
53. Manages (plant)
55. Address
57. City
58. State
59. Zip Code
61. Phone Number
63. 6. Name
64. Manages (plant)
66. Address
68. City
69. State
70. Zip Code
72. Phone Number
74. List all storage facilities, tanks and WC (Do Not Include Dispenser Tanks)
76. 1. Plant Physical Address
78. City
79. State
80. Zip Code
82. # of Bulk Tanks
83. WC gal. of each
85. 2. Plant Physical Address
87. City
88. State
89. Zip Code
91. # of Bulk Tanks
92. WC gal. of each
94. 3. Plant Physical Address
96. City
97. State
98. Zip Code
100. # of Bulk Tanks
101. WC gal. of each
103. 4. Plant Physical Address
105. City
106. State
107. Zip Code
109. # of Bulk Tanks
110. WC gal. of each
112. 5. Plant Physical Address
114. City
115. State
116. Zip Code
118. # of Bulk Tanks
119. WC gal. of each
121. 6. Plant Physical Address
123. City
124. State
125. Zip Code
127. # of Bulk Tanks
128. WC gal. of each
130. Total # of bulk tanks
134. Read and initial the following.
136. We have read the Kansas statutes and rules that regulate this license and will abide by them.
138. We understand that any new employee will be trained and pass CEPT or OSFM certification tests before dispensing LP Gas.
140. We understand that this license is non-transferable and any change in name or ownership will be reported to the Office of the State Fire Marshal.
142. We understand that all employees dispensing LP Gas are required to hold CETP or OSFM certification.
144. By typing my name and date below, I certify that this information is true and correct. Any false or fraudulent statement or failure to comply with the rules and regulations promulgated by the Office of the State Fire Marshal or K.S.A. 55-1812 shall be cause for suspension or revocation of the license held.
146. Name
147. Title
148. Date
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150. 1. Receive an email copy of this form.
151. Email address

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152. Submit

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