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Class 7 - Self-serve Dispensing License
This form has been modified since it was saved. Please review all fields before submitting.
Full Company Name (Include DBA)
List all dispenser tanks, size and location
Attach list if necessary
1. Name of Business (if different)
2. Name of Business (if different)
3. Name of Business (if different)
4. Name of Business (if different)
Read and initial the following.
We have read the Kansas Statutes and rules that regulate this license and will abide by them.
We agree that all DOT cylinders, 300lbs or less, will be filled by weight, unless exempt by NFPA-58, and we will not fill any unsafe or illegal DOT cylinders and/or motor fuel containers.
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 that dispense LP Gas shall hold CEPT certification or OSFM class certificate for the assigned duties.
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.
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