Form Center

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

     This field is not part of the form submission.

152. Submit

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