State Fire Marshal, KS

Class 6 - Cylinder Exchange Cabinet

Full Company Name (Include DBA)
List all cylinder exchange cabinets and their location
Attach list if necessary
1. Name of Business (if different)
Total # of Cages
Address
City
State
Zip Code
2. Name of Business
Total # of Cages
Address
City
State
Zip Code
3. Name of Business
Total # of Cages
Address
City
State
Zip Code
4. Name of Business
Total # of Cages
Address
City
State
Zip Code
5. Name of Business
Total # of Cages
Address
City
State
Zip Code
6. Name of Business
Total # of Cages
Address
City
State
Zip Code
7. Name of Business
Total # of Cages
Address
City
State
Zip Code
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 this license does not allow the holder to fill DOT cylinders.
We understand that only a KS Class 1 Dealer License holder can furnish DOT cylinders for the exchange.
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 if any accident involving this cylinder exchange program occurs, the Office of the State Fire Marshal will be notified as soon as possible.
We understand that each manager at the cylinder exchange cabinet location shall be provided training on basic propane handling procedures to be documented and kept at the location.
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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Class 6 - Cylinder Exchange Cabinet

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