7100.1-1 Annual Report for Callendar Year 20__ Gas Distribution S

4SPa-19qb-W57-I4.3
NOTICE This report is required by 49 CFR Pari 191 Failure to report may
for each day the violation continues up to a maximum of $1 000 000 as prov

jult in a CIVII penalty not lo exceed $100.000 for each vlolatlon
Form Approved
d in 49 USC 60122
OMB No 2137-0522

ANNUAL REPORT FC CALENDAR YEAR 20GAS DlSTRl JTlON SYSTEM

U S Department of Transponatlon
Pipellne and Hazardous Matenals
Safety Admlnlstrat8on

INITIAL REPORT
SUPPLEMENTAL REPORT

PART A - OPERATOR INFORMATION

DOT USE ONLY

1 NAME OF OPERATOR

3 OPERATOR'S 5 DIGIT IDENTIFICATION NUMBER
l
l
l
/
l
l

2 LOCATION OF OFFICE WHERE ADDITIONAL
INFORMATION MAY BE OBTAINED

4 HEADQUARTERS NAME &ADDRESS, IF DIFFERENT

I I I I II

Number and Street

Number and Street

City and County

City and County

State and Zip Code

State and Zip Code

5 STATE IN WHICH SYSTEM OPERATES I

/ (provlde a

I

I Report miles of main a

'ART B - SYSTEM DESCRIPTION

I

!parate report for each state in which system operates)
number of sewices in system at end of year.

GFNFRAI
3 I CCL

UNPROTECTED
BARE

COATED

CATHODICALLY
PROTECTED
BARE

pb

CAST/
WROUGHT
IRON

-Ic

COATED

I

IILES OF MAIN

OTHER

DUCTIL
E
IRON
I

OTHER

TOTAL

COPPER

I

I

I

II

IO. OF
ERVICES
MILES OF MAINS IN SYSTEM AT END OF YEAR
UNKNOWN
2"ORLESS
MATERIAL

I

3 NUMBER OF SERVICES

I

1

OVER2"

OVER 4"
THRU 8"

OVER 8"
THRU 12"

OVER 12"

I

I

IERAGE SERVICE LENGTH

OVER

Reproduction of thi: orm is permitted.

TOTAL

a"

4. MILES OF MAIN AND NUMBER OF SERVICES B Y DECADE C
UNPREI 1940. _ I 1'
KNOWN
1940
1949
1'

1

INSTALLATION
119603
1969

I

MILES OF MAIN
NUMBER OF SERVICES

I

PART C - T O T A L LEAKS ELIMINATED/REPAIRED DURING YEA1
CAUSE OF LEAK

Mains

I

19701979

19801989

19901999

20002009

I

1

O N FEDERAL
I
LAND
PART D - TOTAL NUMBER OF LEAKS
I
REPAIRED OR SCHEDULED FOR REPAIR

4

Services

CORROSION
NATURAL FORCES
EXCAVATION
OTHER OUTSIDE FORCE
DAMAGE
MATERIAL OR WELDS

PART

E - PERCENT OF UNACCOUNTED FOR GAS

Unaccounted for gas as a percent of total input for the12 months
ending June 30 of the reporting year

[(Purchased gas + produced gas)
minus (customer use + company use + appropriate adjustments)]
divided by (purchased gas + produced gas) equals percent unaccounted

I

I

NUMBER OF KNOWN SYSTEM LEAKS AT
END OF YEAR SCHEDULED FOR REPAIR

PART G

- PREPARER AND AUTHORIZED SIGNATURE

Input for year ending 6/30

%.

r

(type or print) Preparer's Name and Title

Area Code and Telephone Number

Preparer's email address

Area Code and Facsimile Number

Name and Title of Person Signing

Authorized Signature

L-----%

Area Code and Telephone Number

INSTRUCTIONS FOR
A N N U A L REP

separate compan

PHMSA F 7100

FORM PHMSA F 7 100.I - I
NDAK YEAR 2003

onsolidations, they no longer are
e corporate headquarters.
, or if you need copies of Form
ation Resources Manager
ministration, Department of
phone number (202)366-

SPECIFIC INSTRUCTIONS
whole numbers.

1 figures are to be reported as
Decimals or fractions should be
e careful to use "miles" of
umber" of services is the

1 or corrected information.
tion of "report date,"
ed, or added information.

Part A

Part B

"PVC" means polyvinyl chloride plastic.

"PE" means polyethylene p Iastic.
"ABS" means acrylonitrile-butadiene-styrene plastic.

214

INST RUC'I IONS FOR COMPI
ANNUAL REPOK'1' FO

Part C
rhis section includes all reportable incident
with 5 19 I .50, repaired or eliminated during
on the "Annual Report" form.

FORM PkIMSA F 7100.1-1
NDAR YEAR 2003

s, not reported in accordance
ich is indicated by the operator

Leaks are defined as follows:
An unintentional escape of gas fro
A reportable incident is one which meets t

Leakshcidents are classified as follows:
"Corrosion" is the escape of gas re
by galvanic, bacterial, che

line or component caused

"Third Party'' is an outside force
facilities by earth movin
etc. Damage is by pers
operator.
"Outside Force" is damage res
land slides, frost, etc.
damage done by ope
A "Construction Defect" is

external force bein
excessive stress, o

A "Material Defect" is o

"Other" would be the re

Indicate all leaks eliminated during the reporting year,
7100.1, "Incident Report, Gas Distribution Systems."
Include all leaks eliminated by repair or by
Part D
Federal lands: For the purposes of
lands owned by the United States
Indian or Indian tribe, and lands
7100 1 - 1 DOC
DT 7/96

those reported on Form PHMSA
test failures.
other component.

- 1, "Federal lands" means all
lands held in trust for an
those leaks repaired,
3 I4

INSTRUCTIONS FOR COM
ANNUAL REPORT F

eliminated, or scheduled for repai
Form PFfMSA F 7 100.I .
Part E
"Unaccounted for gas" is gas lost
through appropriate adjustment.
in temperature, pressure, meter-r
purging, line breaks, etc., where
estimate; or other similar factors.

FORM PkIMSA F 71 00.1-1
NDAR YEAR 2003

ng those incidents reported on

t account for as usage or
for such factors as variations
able losses from construction,
asonable calculation or

State the amount of unaccounted
of the reporting year.

the 12 months ending June 30

[(Purchased gas + produced ga
adjustments)] divided by (pur

use + appropriate
ercent unaccounted for.

Do not report "gained" gas. If a
(Decimal or fractional percentages may be entered.)

ulations, report "0%" here.

Part F
Include any "additional informa
this report.

lassifying data included in

Part G
"Preparer" is the name of the person most knowledge: e about the information submitted in the
report or the person to be contacted for additional infc iation.
"Authorized Signature" may be the "preparerl' or an o
designated to review and sign reports of this nature.

7100 1 - 1 DOC
DT 7/96

:er or other person the operator has

414