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Class 2 - Bulk Storage Tank
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This form has been modified since it was saved. Please review all fields before submitting.
Full Company Name (Include DBA)
LP Gas is supplied by:
List all managers of bulk plants, mailing address and phone number
1. Name
Manages (plant)
Address
City
State
Zip Code
Phone Number
2. Name
Manages (plant)
Address
City
State
Zip Code
Phone Number
3. Name
Manages (plant)
Address
City
State
Zip Code
Phone Number
4. Name
Manages (plant)
Address
City
State
Zip Code
Phone Number
5. Name
Manages (plant)
Address
City
State
Zip Code
Phone Number
6. Name
Manages (plant)
Address
City
State
Zip Code
Phone Number
List all storage facilities, tanks and WC (Do Not Include Dispenser Tanks)
1. Plant Physical Address
City
State
Zip Code
# of Bulk Tanks
WC gal. of each
2. Plant Physical Address
City
State
Zip Code
# of Bulk Tanks
WC gal. of each
3. Plant Physical Address
City
State
Zip Code
# of Bulk Tanks
WC gal. of each
4. Plant Physical Address
City
State
Zip Code
# of Bulk Tanks
WC gal. of each
5. Plant Physical Address
City
State
Zip Code
# of Bulk Tanks
WC gal. of each
6. Plant Physical Address
City
State
Zip Code
# of Bulk Tanks
WC gal. of each
Total # of bulk tanks
Read and initial the following.
We have read the Kansas statutes and rules that regulate this license and will abide by them.
We understand that any new employee will be trained and pass CEPT or OSFM certification tests before dispensing LP Gas.
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.
We understand that all employees dispensing LP Gas are required to hold CETP or OSFM certification.
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.
Name
Title
Date
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