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1、BILL RITTER, JR. GovernorDONALD J. MARES Executive DirectorRICHARD O. PIPER Division DirectorDEPARTMENT OF LABOR AND EMPLOYMENT Division of Oil and Public Safety LP-Gas Inspection Program 633 17th Street, Suite 500, Denver CO 80202 Phone 303/318-8533 Fax 303/318-8488 E-mail oil.publicsafetystate.co.
2、us Web http:/ops.cdle.state.co.usINDIVIDUAL APPLICATION TO ADJUST AND SEAL LP-GAS METERS IN COLORADOPrint or type all information. Individuals name Street or P.O. Box Home mailing address City State ZIP Employed by Business phone Cell phone E-mail List all other states in which the undersigned indiv
3、idual is authorized to adjust LP-Gas meters: Has any state ever rescinded the undersigned individuals authorization to adjust LP-Gas meters? No Yes (PROVIDE DETAILS IF “YES”) List all manufacturers that have authorized the undersigned individual to calibrate and adjust its LP-Gas meters. Has any man
4、ufacturer ever rescinded its authorization to allow the undersigned individual to calibrate and adjust its LP-Gas meters? No Yes (PROVIDE DETAILS IF “YES”) The undersigned certifies to each of the following: 1.I have read the attached document entitled Requirements for Calibrating, Adjusting, & Seal
5、ing LP-Gas Meters in Colorado, and I agree to abide by all provisions of this document. ATTACH SIGNED COPY. 2.Documentation exists to verify the licensing or certification by other states or meter manufacturers identified above. I will provide this document to the OPS upon request. Signed:_Date:_ Print or type name:_Title:_ Subscribed and sworn before me in_County, State of_this_day of_20_. My commission expires:_Notary Public:_ REQUIRED ATTACHMENT: Signed Requirements For Calibrating, Adjusting, & Sealing LP-Gas Meters in Colorado
