EIA-857 Monthly Report of Natural Gas Purchases and Deliveries t

OMB No. XXXX-XXXX
Ex piration Date: 12/31/20XX
Version No.: 20XX.X
MONTHLY REPORT OF NATURAL GAS PURCHASES AND DELIVERIES TO CONSUMERS
Burden: 3.5 hours
FORM EIA-857
This report is mandatory under the Federal Energy Administration Act of 1974 (Public Law 93-275). Failure to comply may result in criminal fines, civil penalties and
other sanctions as provided by law. For the sanctions and the provisions concerning the confidentiality of information submitted on this form, see instructions. Title 18
USC 1001 makes it a criminal offense for any person knowingly and willingly to make to any Agency or Department of the United States any false, fictitious,
or fraudulent statements as to any matter within its jurisdiction.

PART 1. RESPONDENT IDENTIFICATION DATA
REPORT PERIOD: Month:
EIA ID NUMBER:

Year:

PART 2. SUBMISSION INFORMATION
Completed form(s) must be filed no later than 30 calendar days following
the end of the report period.

2 0

8 5 7

If this is a resubmission, enter an "X" in the box:

Form may be submitted using one of the following methods:
m

If any Respondent Identification Data has changed since the

Mail:

ATTN: EIA-857
U. S. Department of Energy
Oil & Gas Survey
Ben Franklin Station
P.O. Box 279
Washington, DC 20044-0279

T

last report, enter an "X" in the box:
Company Name:
Contact Name:

-

Address 1:

Email address:

Ext:

Email:

[email protected]

Fax:

(202) 586-1076

Secure File Transfer:

Address 2:
City:

-

AF

Phone No.:
Fax No.:

https://idc.eia.doe.gov/upload/noticeoog.jsp

State:

Zip:

-

Questions?

Call: (877) 800-5261

PART 3. NATURAL GAS PURCHASES AND DELIVERIES TO CONSUMERS
Item Description
Purchased Gas Received in Distribution Service Area (City Gate)..

D

R

Deliveries of natural gas that you do own to end-use consumers
within the report State:
Residential .…………………………………………………………......
Commercial ……………………………………………………………..
Industrial …………………………………………………………………
Electric Power …………………………………………………………..
Other (not included in above categories) __________________ ..

Volume

Cost

(Mcf @14.73 psia-60oF)

(Including taxes)

1

Number of
Customers

Volume

Revenue

(Mcf @14.73 psia-60oF)

(Including taxes)

Number of
Customers

Volume

Revenue

(Mcf @14.73 psia-60oF)

(Including taxes)

2
3
4
5
6

(Specify Type)

Deliveries of natural gas that you do not own to end-use consumers
within the report State:
Residential .…………………………………………………………....... 7
Commercial ……………………………………………………………... 8
Industrial …………………………………………………………………. 9
Electric Power ………………………………………………………….... 10
Other (not included in above categories) ___________________ .. 11
(Specify Type)

Heat content of gas delivered to consumers (Btu/cubic ft.):
Comments: Identify any unusual aspects of your reporting month's activity. (To separate one comment from another, press ALT + ENTER.)