PHMSA form 7100.2-1

Notice: This report is required by 49 CFR Part 191. Failure to report can result in a civil penalty not to exceed $1,000 for each violation Form Approved
for each day that such violation persists except that the maximum civil penalty shall not exceed $200,000 as provided in 49 USC 1678. OMB No. 2137-0522

U.S. Department of Transportation Pipeline and Hazardous Materials Safety Administration

ANNUAL REPORT FOR CALENDAR YEAR 20___ GAS TRANSMISSION & GATHERING SYSTEMS

INITIAL REPORT  SUPPLEMENTAL REPORT 

INSTRUCTIONS

Important: Please read the separate instructions for completing this form before you begin. They clarify the information requested and provide specific examples. If you do not have a copy of the instructions, you can obtain one from the Office of Pipeline Safety Web Page at http://ops.dot.gov.

PART A - OPERATOR INFORMATION

DOT USE ONLY

1. NAME AND COMPANY OR ESTABLISHMENT

4. OPERATOR'S 5 DIGIT IDENTIFICATION NUMBER / / / / / /

2. LOCATION OF OFFICE WHERE ADDITIONAL INFORMATION MAY BE OBTAINED

5. HEADQUARTERS NAME & ADDRESS, IF DIFFERENT

Number & Street

Number & Street

City & County

City & County

State & Zip Code

State & Zip Code

3. STATE IN WHICH SYSTEM OPERATES: / / / (provide a separate report for each state in which system operates)

PART B - SYSTEM DESCRIPTION

Report miles of pipeline in system at end of year.

1. GENERAL - MILES OF PIPELINE IN THE SYSTEM AT END OF YEAR THAT ARE JURISDICTIONAL TO OPS

STEEL

CATHODICALLY PROTECTED

UNPROTECTED

CAST IRON WROUGHT IRON PIPE

PLASTIC PIPE

OTHER PIPE

TOTAL

BARE

COATED

BARE

COATED

TRANSMISSION

ONSHORE

OFFSHORE

GATHERING

ONSHORE

OFFSHORE

SYSTEM TOTALS

2. MILES OF PIPE BY NOMINAL SIZE

UNKNOWN

4” OR LESS

OVER 4” THRU 10”

OVER 10” THRU 20”

OVER 20” THRU 28”

OVER 28”

TOTAL

TRANSMISSION

ONSHORE

OFFSHORE

GATHERING

ONSHORE

OFFSHORE

SYSTEM TOTALS

3. MILES OF PIPE BY DECADE OF INSTALLATION

UNKNOWN

PRE-1940

1940-1949

1950-1959

1960-1969

1970-1979

1980-1989

1990-1999

2000-2009

TOTAL

TRANSMISSION

ONSHORE

OFFSHORE

GATHERING

ONSHORE

OFFSHORE

SYSTEM TOTALS

4. MILES OF PIPE BY CLASS LOCATION

CLASS 1

CLASS 2

CLASS 3

CLASS 4

TOTAL

TRANSMISSION

ONSHORE

OFFSHORE

N/A

N/A

N/A

GATHERING

ONSHORE

OFFSHORE

N/A

N/A

N/A

SYSTEM TOTALS

Form PHMSA F 7100.2-1 (12/05) Continue on Next Page

Reproduction of this form is permitted.

PART C – TOTAL LEAKS ELIMINATED/REPAIRED DURING YEAR					PART D - TOTAL NUMBER OF LEAKS ON FEDERAL LAND OR OCS REPAIRED OR SCHEDULED FOR REPAIR
CAUSE OF LEAK	TRANSMISSION		GATHERING
	ONSHORE	OFFSHORE	ONSHORE	OFFSHORE	1. TRANSMISSION
CORROSION					ONSHORE
NATURAL FORCES					OFFSHORE
EXCAVATION					OUTER CONTINENTAL SHELF
OTHER OUTSIDE FORCE DAMAGE					2. GATHERING
MATERIAL AND WELDS					ONSHORE
EQUIPMENT AND OPERATIONS					OFFSHORE
OTHER					OUTER CONTINENTAL SHELF
PART E - NUMBER OF KNOWN SYSTEM LEAKS AT END OF YEAR SCHEDULED FOR REPAIR
1. TRANSMISSION
2. GATHERING
PART F - PREPARER AND AUTHORIZED SIGNATURE
(type or print) Preparer's Name and Title							Area Code and Telephone Number
Preparer's E-mail Address							Area Code and Facsimile Number
Name and Title of Person Signing (type or print) Name and Title Authorized Signature (type or print) Name and Title						Date		Area Code and Telephone Number

Form PHMSA F 7100.2-1 (12/05)