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By signing below, I acknowledge that I have received the following safety materials from

Ray-Carroll Fuels, LLC. I also understand that it is my responsibility to read through the

materials provided.  I recognize that all members of my family and those living in my home

understand the properties and characteristics of propane; the hazards and risks associated 

with the handling and use of propane; the appropriate methods for safely using propane; 

and what to do in the event of a propane leak. If I have any questions or need to request additional information, I will contact my Propane Supplier/Driver or the office of Ray-Carroll Fuels, LLC at 816-776-3098.

Form Received
Authorization Signature for Leak Test

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