Form PHMSA F 999-95 PHMSA F 999-95 State HL Certification/Agreement Package

Gas Pipeline Safety Program Certification and Hazardous Liquid Pipeline Safety Program Certification

2010HLCertificationAgreementPackage

Gas Pipeline Safety Program Certification and Hazardous Liquid Pipeline Safety Program Certification

OMB: 2137-0584

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1200 New Jersey Avenue SE
Washington DC 20590

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

Pipeline Safety
2010 Hazardous Liquid Certification\Agreement
for

Please follow the directions listed below:
1. Review the entire document for completeness.
2. Review and have an authorized signatory sign and date the following pages:
1. Main application pages for Certification and/or Agreement, which follow this cover page
2. Second to last page, Attachment 9
3. Fasten all pages with a paper or binder clip - no staples please as this package will be scanned upon it's
arrival at PHMSA.

4. Mail the entire document, including this cover page to the following:

ATTN: Gwendolyn M. Hill
U.S. Department of Transportation
Pipeline & Hazardous Materials Safety Administration
Pipeline Safety, PHP-50
1200 New Jersey Avenue, SE Second Floor E22-321
Washington, D.C. 20590

FedSTAR Information
Electronic Submission Date:

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Pipeline and Hazardous Materials Safety Administration
1200 New Jersey Avenue, SE
Washington DC 20590

HAZARDOUS LIQUID PIPELINE SAFETY PROGRAM
CERTIFICATION FOR CALENDAR YEAR 2010

This certificate (including attachments) is submitted by the (the state agency) to the secretary of Transportation (the
Secretary) under Section 60105 of Title 49, United States Code.)
Pursuant to Section 60105(a) of this Title, the state agency hereby certifies to the secretary that:

1. Except as set forth in Attachment 1, under the Constitution and laws of it has regulatory jurisdiction over the safety
standards and practices of all intrastate pipeline transportation within as summarized on Attachment 1.
2. It has adopted, as of the date of this certification, each federal safety standard established under this Title that is
applicable to the intrastate pipeline transportation under its jurisdiction as set forth in paragraph 1, or, with respect to
each such federal safety standard established within 120 days before the date of the certification, is taking steps
pursuant to state law to adopt such standard. (The adoption by a state agency of a safety standard that is additional to
or more stringent than the applicable federal standard is compatible with the federal standards [see Section 60102(a)(1)
of this Title] does not prohibit that state agency from certifying to the actions described in this paragraph.)
3. It is enforcing each standard referred to in paragraph 2.
4. It is encouraging and promoting programs designed to prevent damage to pipeline facilities as a consequence of
demolition, excavation, tunneling, or construction activity.
5. It has authority to require each person who engages in the transportation of Hazardous Liquid or who own or operates
pipeline facilities subject to its jurisdiction as set forth in paragraph 1, to establish and maintain records, to make
reports, and to provide information, and that this authority is substantially the same as the authority provided under
Section 60117 of this Title.
6. It has authority to require each person who engages in the transportation of Hazardous Liquid who owns or operates
intrastate pipeline transportation facilities, subject to its jurisdiction as set forth in paragraph 1, to file with it for
approval a plan for inspection and maintenance substantially as described under Section 60108(a) and (b) of this Title.
7. The laws of provide for the enforcement of the safety standards referred to in paragraph 2 by injunctive and monetary
sanctions substantially the same as those provided under Sections 60120 and 60122(a)(1) and (b)-(f) of this Title.

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The state agency furthermore agrees to cooperate fully in a system of federal monitoring of the state program to assure
the program is being carried out in compliance with this certification.The terms intrastate pipeline transportation,
pipeline facilities, transportation of Hazardous Liquid, and state, are used in certification as defined in this Title. This
certification is subject to termination by the Secretary in accordance with Section 60105(f) of this Title if the Secretary
Under Section 60105(f), the Secretary, on reasonable notice and after opportunity for hearing, may reject the
certification or take such other action as deemed appropriate to achieve adequate enforcement including assertion of
federal jurisdiction. Pipeline and Hazardous Materials Safety Administration, Pipeline Safety, 1200 New Jersey Ave,
SE , Washington DC 20590.
In witness whereof, the hand and seal of the is hereby affixed on ____________.

Signature

Title

Date

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Pipeline and Hazardous Materials Safety Administration
1200 New Jersey Avenue, SE
Washington DC 20590

HAZARDOUS LIQUID PIPELINE SAFETY PROGRAM
AGREEMENT FOR CALENDAR YEAR 2010

This agreement (including attachments) is submitted by the (the state agency) to the Secretary of Transportation (the
Secretary) under Section 60106 of Title 49, United States Code.
In accordance with Section 60106(a) of this Title, the Secretary hereby authorizes the state agency to assume
responsibility for and carry out, on behalf of the Secretary, as they relate to intrastate pipeline transportation, the necessary
actions to:
1. Establishment of an adequate program for record maintenance, reporting, and inspection designed to assist compliance
with federal safety standards.
2. Establishment of procedures for approval of plans of inspection and maintenance substantially the same as those
required under Section 60108(a) and (b) of this Title.
The state agency hereby agrees to carry out the program and procedures enumerated above in accordance with any
applicable regulations issued by the Secretary and in a manner acceptable to the secretary, and to notify the Secretary of
any violation or probable violation of a federal safety standard which it discovers as a a result of its program. In addition,
the state agency agrees to submit to the Secretary, annual reports on the implementation of this agreement and to
cooperate fully in a system of federal monitoring of the state program to assure that the program is being carried out in
compliance with this agreement.
This agreement is subject to termination by the Secretary in accordance with Section 60106(d) of this Title if, after notice
and opportunity for a hearing, the Secretary finds that the state agency has failed to comply with any provision of this
agreement.
The state agency agrees to give the Secretary at least 90 days notice of its intention to terminate this agreement.
In witness whereof, the hand and seal of the is hereby affixed on ____________, and of the Secretary is hereby affixed
on ____________, effective as of the date signed by the state agency.

BY
(official signature)

SECRETARY OF TRANSPORTATION

BY
(Associate Administrator for Pipeline Safety)
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Pipeline and Hazardous Materials Safety Administration
1200 New Jersey Avenue, SE
Washington DC 20590

HAZARDOUS LIQUID PIPELINE SAFETY PROGRAM
AGREEMENT FOR CALENDAR YEAR 2010

BY
(official signature)

SECRETARY OF TRANSPORTATION

BY
(Associate Administrator for Pipeline Safety)
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CERTIFICATION/AGREEMENT ATTACHMENTS (HAZARDOUS LIQUID )
OMB Control No. 2137-0584
INSTRUCTIONS:
These attachments request information either for the entire calendar year (CY 2009: January 1 through December 31,
2009) or as of (or on) December 31, 2009. Please report actual as opposed to estimated numbers on the attachments. Be
careful to provide complete and accurate information since the PHMSA State Programs will be validating the attachments
during the state's next annual evaluation.

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.

Attachment 1: State Jurisdiction and Agent Status Over Hazardous Liquid Facilities. Requires the state to
indicate those pipeline operator types over which the state agency has jurisdiction under existing law. If the state
does not have jurisdiction over an operator type, indicate why not in the column designated No, using the one alpha
code (A or B) which best describes the reason. If the state agency has jurisdiction over an operator type, place an X
in the column designated Yes and provide information on the number of operators, the number and percent of
operators inspected, the number of inspection units, and the number and percent of inspection units inspected. If the
jurisdiction over a type of operator is under a Section 60106 Agreement, indicate X/60106 in the column designated
Yes. [If the same operator/inspection unit is visited more than once during the year, count only once under number
of operators inspected/number of inspection units inspected on Attachment I. The multiple visits would, however,
be reflected under total inspection person-days in Attachment 2.]
Attachment 2: Total State Field Inspection Activity. Requires the state to indicate by operator type the number
of inspection person-days spent during CY 2009 on inspections; standard comprehensive; design, testing, and
construction; on-site operator training; integrity management; operator qualification; investigating incidents or
accidents; damage prevention activities; and compliance follow-up. Attachment 2 should include drug and alcohol
inspections. Counting In Office Inspection Time - An inspector may choose to review pipeline company procedure
manuals or records away from the company facility in order to effectively use onsite inspection time. The amount
of time spent reviewing procedures and records may be counted as part of the inspection process. It is important
that an inspector only record time for activities that normally would be completed as part of an onsite inspection.
For example, an inspector may attribute the three hours he or she spent reviewing a pipeline operator's procedure
manual and records prior to an on site inspection towards the total inspection time. Each supervisor must carefully
review the reported time to ensure the time attributed is consistent with the activity completed and is carefully
delineated from normal office duties.
Attachment 3: Hazardous Liquid Facility Subject to State Safety Jurisdiction. States should only list the
facilities that are jurisdictional under Part 192 of which the state has safety authority over. This attachment requires
the business name and address of each person subject to the pipeline safety jurisdiction of the state agency as of
December 31, 2009. Also indicate the operator type (e.g., intrastate transmission) consistent with the listing in
Attachment I and include the number of inspection units in each operator's system.
Attachment 4: Hazardous Liquid Pipeline Incidents. Requires a list of incidents investigated by or reported to
the state agency that involved personal injury requiring hospitalization, a fatality, property damage exceeding
$50,000, and other incidents otherwise considered significant by the state agency. Please also make an effort to
clearly identify the cause of the incident using the one most appropriate alpha code footnoted in the attachment. We
summarize this information for Congress by classifying the cause into one of eight categories: (A) corrosion failure;
(B) natural force damage; (C) excavation damage; (D) other outside force damage; (E) material failure of pipe or
weld; (F) equipment failure; (G) incorrect operation; (H) other accident cause. Please provide a summary of
incident investigations.

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Attachment 5: State Compliance Actions. This requires a summary of state pipeline inspection and compliance
actions. [In the Number of Compliance Actions Taken column, keep in mind one compliance action can cover
multiple probable violations.]
Attachment 6: State Record Maintenance and Reporting. Requires a list of records and reports maintained and
required by the state agency.

Attachment 7: State Employees Directly Involved in the Hazardous Liquid Pipeline Safety Program. This
attachment requires a list by name and title of each employee directly involved in the Hazardous Liquid pipeline
safety program. Be sure to include the percentage of time each employee has been involved in the Hazardous
Liquid pipeline safety program during 2009. If an employee has not been in the Hazardous Liquid pipeline safety
program the full year of 2009, please note the number of months working on the program. Indicate a Qualification
Category for each of the state's inspectors (see Attachment 7a). The categories are shown in descending order of
education and experience. Please enter the number of the highest description applicable to each inspector. For each
inspector and supervisor, indicate the month and year he/she successfully completed the training courses at the
Pipeline Safety Office of Training and Qualifications in Oklahoma City, OK. Finally, provide in summary form the
number of all staff (supervisors, inspectors/investigator, damage prevention/technical and clerical/administrative)
working on the Hazardous Liquid pipeline safety program and the person-years devoted to Hazardous Liquid
pipeline safety. Person-years should be reported in hundreds (e.g., 3.25).
Attachment 8: State Compliance with Federal Requirements. This requires the state to indicate whether it is in
compliance with applicable federal requirements. If a particular requirement is not applicable to the state (e.g.,
offshore inspections), indicate NA in the column designated Y/N/NA If a regulation has been adopted, indicate the
date adopted (e.g., 05/01/04) in the appropriate column. If the regulation is applicable but has not been adopted,
indicate N in the Y/N/NA column and explain why not in the appropriate column (e.g., requires legislative action).
[If the state has not adopted the maximum please indicate civil penalty levels in effect in the state as of December
31, 2009. Note that at the end of Attachment 8 we are requesting each state to indicate the frequency its legislature
meets in general session. This information will be taken into account when determining if applicable federal
regulations have been adopted within 24 months of the effective date or two general sessions of the state legislature.

Attachment 9: Certification Regarding Drug-Free Workplace Requirements. This requires each state to certify
that it will maintain a drug-free workplace as a precondition to receiving a federal grant. The certification requires
signature by an authorized official.
Attachment 10: Performance and Damage Prevention Questions. This attachment requires a narrative of each
states goals and accomplishments. In addition it requires a narrative on each states progress toward meeting the
nine elements of an effective damage prevention program as described in the PIPES Act of 2006.

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DEFINITIONS

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.

Inspection Unit. An inspection unit is all or part of an operator's pipeline facilities that are under the control of an
administrative unit that provides sufficient communication and controls to ensure uniform design, construction,
operation, and maintenance procedures for the facilities. (See Glossary of Terms in Guidelines for States Participating
in the Pipeline Safety Program for application of the inspection unit concept to transmission and hazardous liquid
pipeline systems, distribution systems, liquefied natural gas systems, municipality, master meter system, regulated
gathering pipeline systems, and propane-air systems/petroleum gas systems.)
Inspection Person-Day. An inspection person-day is all or part of a day spent by a state agency representative
including travel in an on site examination or evaluation of an operator or his system to determine if the operator is in
compliance with federal or state pipeline safety regulations, in an on site investigation of a pipeline incident, or in jobsite training of an operator. Time expended on such activities should be reported as one inspection person-day for each
day devoted to safety issues, regardless of the number of operators visited during that day.
Probable Violation. A probable violation is a non-compliance with any section or, where a section is divided into
subsections (a), (b), (c), etc., any subsection of federal or state pipeline regulations. Each numbered section should be
counted separately. Multiple non-compliances of a numbered section discovered on the same inspection should be
counted as one probable violation with multiple pieces of evidence.
Compliance Action. A compliance action is an action or series of sequential actions taken to enforce federal or state
pipeline regulations. One compliance action can cover multiple probable violations. A compliance action may take the
form of a letter warning of future penalties for continued violation, an administratively imposed monetary sanction or
order directing compliance with the regulations, an order directing corrective action under hazardous conditions, a
show-cause order, a criminal sanction, a court injunction, or a similar formal action.

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Attachment 1 - Stats on Operators
STATE JURISDICTION AND AGENT STATUS OVER HAZARDOUS LIQUID FACILITIES AS
OF DECEMBER 31, 2009

Operator Type

State Agency Jurisdiction/
Agent Status
No1

Yes

No. of
Operators

Operators
Inspected
#

No. of
Inspection
Units

Units Inspected
#

Petroleum Products
Intrastate trunklines
Regulated gathering lines
Offshore facilities (state waters)
Interstate

Anhydrous Ammonia
Carbon Dioxide
Total

0
0
0
0
0
0

Codes: A - None in state and does not have jurisdiction;
B - State does not have jurisdictional authority (Provide current status or action being taken to obtain authority
in notes section below)

Distribution "Other" - ie Co-ops, Public Utility Districts, etc.
States should explain any special circumstances
General Instructions - All above facilities should only include facilities as defined by federal pipeline regulations and
should not include extended jurisdiction by state regulation.
Attachment 1 Notes:

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SA
Operator Type

Petroleum Products
Intrastate trunklines
Regulated Gathering lines
Offshore facilities (state waters)
Interstate
Anhydrous Ammonia
Carbon Dioxide

Total

Attachment 2 - State Inspection Activity

Design,
Standard
Testing and
Comprehensive
Construction

Drug and Alcohol
Total Count of Drug and Alcohol Inspections
Attachment 2 Notes

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TOTAL STATE FIELD INSPECTION ACTIVITY AS
OF DECEMBER 31, 2009

0
0
0
0
0
0

On-Site
Operator
Training
0
0
0
0
0
0

Investigating Damage
Integrity
Operator
Compliance
Incidents or Prevention
Management Qualification
Follow-up
Accidents
Activities
0
0
0
0
0
0

0
0
0
0
0
0

Total

0
0
0
0
0
0

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Attachment 3 - List of Operators

HAZARDOUS LIQUID FACILITIES SUBJECT TO STATE SAFETY JURISDICTION AS OF DECEMBER 31, 2009

Operator

Business Name
Operator ID
Address

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Anhydrous
Ammonia
Carbon Dioxide
(Operator type & (Operator type &
Inspection Units) Inspection Units)

Petroleum Products
(Operator type & Inspection Units)

Intrastate
Trunklines

Off-shore
Gathering Lines Facilities (State
in non-rural areas
Waters)

Interstate

Anhydrous
Ammonia

Carbon Dioxide

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SA
Inspection Unit totals by type

Total Operators

Attachment 3 Notes

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Anhydrous
Ammonia
Carbon Dioxide
(Operator type & (Operator type &
Inspection Units) Inspection Units)

Petroleum Products
(Operator type & Inspection Units)

Intrastate
Trunklines

Off-shore
Gathering Lines Facilities (State
Waters)
in non-rural areas

Interstate

Anhydrous
Ammonia

Carbon Dioxide

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Attachment 4 - Incidents/Accidents

SIGNIFICANT4 HAZARDOUS LIQUID INCIDENTS/ACCIDENTS JANUARY 1, THROUGH DECEMBER 31,
2009
Date of
Incident

Location City/County/etc.

Injuries Fatalities Property
#
#
Damage3
$

Cause
Code1

Name of Operator:

Cause Reported by Operator (Describe)2

Cause Codes: A - Corrosion failure; B - Natural Force Damage; C - Excavation Damage; D - Other Outside Force
Damage; E - Pipe, Weld or Joint Failure; F - Equipment Failure; G - Incorrect Operation; H - Other Incident Cause
2

Please attach a summary or report of the state agency's investigation of each of the above incidents.
Interstate agents should use the 191.3 Incident definition for listing incidents investigated on interstate facilities.

Significant: Investigated by or reported to the state agency, involving personal injury requiring hospitalization,
fatality, property damage exceeding $50,000 and other incidents otherwise considered significant which involved
jurisdictional facilities.

Attachment 4 Notes

2010 Hazardous Liquid Certification

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Attachment 5 - Stats on Compliance Actions

Probable Violation Categories

Intrastate

Interstate

Number carried over from prvious CY (including carryover and long
term)
Number found during CY

STATE COMPLIANCE ACTIONS -- CALENDAR YEAR (CY) 2009

Number submitted for DOT action (60106 Agreement agent only)
Number corrected during CY (including carryover from previous year)
Number to be corrected at end of CY (including carryover and long
term)

Number of Compliance Actions Taken 1
(see definition)

Civil Penalties
Number assessed during CY
Dollars assessed during CY

Number collected during CY
Dollars collected during CY
1

Do not double count for a related series of actions.

Attachment 5 Notes

2010 Hazardous Liquid Certification

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Attachment 6 - List of Records Kept

HAZARDOUS LIQUID STATE RECORD MAINTENANCE AND REPORTING
DURING CY 2009

Attachment 6 Notes

2010 Hazardous Liquid Certification

MP
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Attachment 7 - Staffing and TQ Training

STATE EMPLOYEES DIRECTLY INVOLVED IN THE HAZARDOUS LIQUID PIPELINE
SAFETY PROGRAM DURING CY 2009

Name/Title

% #
Qual. MM/YYYY Successfully Completed TQ Course
Time Months
Cat. PL3254 PL3256 PL3257 PL2258 PL2284 PL2288 PL3291 PL3292 PL3293 PL3294 PL3OQ PL00305

Name/Title

% #
Qual. MM/YYYY Successfully Completed TQ Course
Time Months
Cat. PL1250 PL3251 PL3252 PL4253 PL1255 PL3275 PL3295 PL3296 PL1297 PL3306

Name/Title

Summary

% #
Qual. MM/YYYY Successfully Completed TQ Course
Time Months
Cat. PL3600

Employee Type
No. of Staff
Supervisor
Inspector
Damage Prevention/Technical
Clerical/Administrative
Total

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Person-Years

PL31C PL00311

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SA
Attachment 7 Notes

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Attachment 8 - Compliance with Federal Regulations

STATE COMPLIANCE WITH FEDERAL REQUIREMENTS AS OF DECEMBER 31, 2009

No.
1

Effective
Date

Impact

Maximum Penalties Substantially Same as DOT ($100,000/$1,000,000);
Indicate actual amount in note.

Note1

191.23 and 191.25 Safety-Related Conditions(through current amendment
191-14)
Part 192 Amendments

01-90

Pre 2002

[All applicable amendments prior to and including 2002]

4/23/2004

Definition of high consequnce areas for gas transmission lines

9/4/2003

Procedures for Producer-operated outer continental shelf natural
pipelines that cross directly into state waters

10/15/2003

various changes to gas pipeline safety standards from NAPSR
recommendations

5/6/2005

Modification to the definition of a Transmission Line

5/26/2004

Pipeline integrity management for transmission lines in HCAs

9/14/2004

Pressure limiting and regulating stations

7/28/2004

Passage of internal inspection devices on new and retrofitted
transmission pipelines

9/9/2004

Performance of periodic underwater inspections

6/20/2005

API RP 1162 Public awareness campaign

100

7/15/2005

PSIA Statuory changes to Operator Qualification Program

101

11/25/2005 Adoption of Nace Standard as a direct assesment standard

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Adoption
AdoptionStatus
Date

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SA
102

4/14/2006

Definition of a Gathering Line

103

7/10/2006

Incorporate by Reference various Standards

103a

2/1/2007

Update Incorporated by Reference and Corrrection

72 FR 20055

4/23/2007

Design and Construction Standards to Reduce Internal Corrosion in
Gas Transmission Pipelines

104

5/23/2007

Integrity Management Program Modifications and Clarifications

105

12/13/2007

Applicability of Public Awareness Regulations to Certain Gas
Distribution Operators

106

3/28/2008

Administrative Procedures, Updates and Technical Amendments (73
FR 16562)

107

10/17/2008

Standards for Increasing the Maximum Allowable Operating Pressure
for Gas Transmission Pipelines (73 FR 62147)

108

12/24/2008 PA-11 Design Pressures (73 FR 79005)

Part 193 Amendments (applicable only where state has jurisdiction over LNG)

01-17

Pre 2002

[All applicable amendments prior to and including 2002]

4/9/2004

Updated LNG standards by section

7/10/2006

Incorporate by Reference various Standards

3/28/2008

Administrative Procedures, Updates and Technical Amendments (73
FR 16562)
Part 199 - Drug Testing

Part 199 Amendments

01-19

Pre 2002

[All applicable amendments prior to and including 2002]

3/12/2003

Definition of Administrator

12/31/2003 Instructions for Single Use Form for MIS

7/14/2004

New address for reporting

3/8/2005

Administration name change

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SA
7

Administrative Procedures, Updates and Technical Amendments (73
FR 16562)
State Adoption of Part 198 State One-Call Damage Prevention Program

Mandatory coverage of areas having pipeline facilities

Qualification for operation of one-call system

Mandatory excavator notification of one-call center

State determination whether calls to center are toll free

Mandatory intrastate pipeline operator participation

Mandatory operator response to notification

Mandatory notification of excavators/public

Civil penalties/injunctive relief substantially same as DOT ($25000/
$500000)

If Adoption Status is No, Please provide an explanation
State Attendance at 2009 NAPSR Regional Meeting:
Frequency of General Legislative Session:

Attachment 8 Notes

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3/28/2008

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Attachment 9 - Drug Free Workplace
CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS

SA
INSTRUCTIONS FOR CERTIFICATION

1. By signing and/or submitting this application or grant agreement, the grantee is providing the certification set out below.
2. The certification set out below is a material representation of fact upon which reliance was placed when the agency determined to
award the grant. If it is later determined that the grantee knowingly rendered a false certification or otherwise violates the
requirements of the Drug-Free Workplace Act, the agency, in addition to any other remedies available to the Federal Government,
may take action authorized under the Drug-Free Workplace Act.

CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS
A. The grantee certifies that it will provide a drug-free workplace by:
(a) Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled
substance is prohibited in the grantees workplace and specifying the actions that will be taken against employees for violation of such
prohibition;
(b) Establishing a drug-free awareness program to inform employees about—
(1)The danger of drug abuse in the workplace;
(2)The grantees policy of maintaining a drug-free workplace;
(3)Any available drug counseling, rehabilitation, and employee assistance programs; and
(4)The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace.
(c) Making it a requirement that each employee to be engaged in the performance of the grant be given a copy of the statement required by
paragraph (a);
(d) Notifying the employee in the statement required by paragraph (a) that, as a condition of employment under the grant, the employee
will—
(1)Abide by the terms of the statement; and
(2)Notify the employer of any criminal drug statute conviction for a violation occurring in the workplace no later than five days after
such conviction;
(e) Notifying the agency within ten days after receiving notice under subparagraph (d) (2) from an employee or otherwise receiving actual
notice of such conviction;
(f) Taking one of the following actions within 30 days of receiving notice under subparagraph (d) (2) with respect to any employee who is
so convicted—
(1) Taking appropriate personnel action against such an employee up to and including termination; or
(2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such
purposes by a Federal, State, or local health, law enforcement, or other appropriate agency;
(g) Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs (a), (b), (c), (d), (e),
and (f).
B. The grantee shall insert in the space provided below the site(s) for the performance of work done in connection with the specific grant.

Place of Performance (street address, city, county, state, zip code).

TITLE

DATE
Attachment 9 Notes

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SIGNATURE

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Attachment 10 - Performance and Damage Prevention Questions

Planned Performance: What are your Planned Annual and Long-term goals for your Pipeline Safety Program?

CALENDAR YEAR (CY) 2009

Past Performance: What did the Pipeline Safety Program accomplish during the subject year (to this document) to contribute
toward the program's annual and long-term goals?

1. Has the state or agency reviewed the Damage Prevention Assistance Program (DPAP) document in the last twelve months?

2. Has the state or agency developed or is in the process of developing a plan to address the nine elements contained in the PIPES
Act of 2006 for an effective State Damage Prevention Program?

If yes to question 2, where does the state or agency stand on implementation of the nine elements contained in the PIPES Act of
2006? Please provide a description of how the state or agency has or will meet each element. If not, please provide a brief passage
explaining the reasons why the state or agency has not.

Attachment 10 Notes

2010 Hazardous Liquid Certification

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File Type	application/pdf
File Modified	2010-09-17
File Created	2010-09-17