PHMSA F-7100.3-1 LNG Annual Report

Incident and Annual Reports for Gas Pipeline Operators

LNGannualReportwInstructions

Incident and Annual Reports for Gas Pipeline Operators

OMB: 2137-0522

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 2137-0522 can be found here:

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Notice: This report is required by 49 CFR Part 191. Failure to report may result in a civil penalty not to exceed $100,000 for each violation
for each day the violation continues up to a maximum of $1,000,000 as provided in 49 USC 60122.

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

ANNUAL REPORT FOR CALENDAR YEAR 20___
LIQUEFIED NATURAL GAS (LNG) FACILITIES

Form Approved
OMB No. 2137-0522
Expires: xx/xx/xxxx
INITIAL REPORT

SUPPLEMENTAL REPORT




A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to
comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays
a current valid OMB Control Number. The OMB Control Number for this information collection is 2137-0522. Public reporting for this collection
of information is estimated to be approximately 12hours per response, including the time for reviewing instructions, gathering the data needed,
and completing and reviewing the collection of information. All responses to this collection of information are mandatory. Send comments
regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information
Collection Clearance Officer, PHMSA, Office of Pipeline Safety (PHP-30) 1200 New Jersey Avenue, SE, Washington, D.C. 20590.
Important: Please read the separate instructions for completeing this form before you begin.
PART A - OPERATOR INFORMATION

DOT USE ONLY

1. OPERATOR’S 5 DIGIT IDENTIFICATION NUMBER (OPID)

2. NAME OF COMPANY OR ESTABLISHMENT:

/
IF SUBSIDIARY, NAME OF PARENT:
__________________________________________________

3. INDIVIDUAL WHERE ADDITIONAL INFORMATION MAY BE
OBTAINED:

4. HEADQUARTERS ADDRESS:

Name

Company Name

Title

Street Address

__________________________________________________
Email Address

State: /

/ Zip Code: /

/__/__/__/-/__/__/__/-/__/__/__/__/

Telephone Number

/ - /

5. DOES THIS REPORT REPRESENT A CHANGE FROM LAST YEAR’S FINAL REPORTED INFORMATION FOR PART B, OR INCLUDE
LEAKS OR REPORTABLE INCIDENTS IN PART C OR SAFETY-RELATED CONDITIONS OR EVENTS IN PART D? (Select all that apply. If
there are changes to PART B, or if there are numbers to report in PARTS C or D, complete those sections. Also, if there are changes to PART B
from the previous year’s report, select the relevant checkbox(es) for the YES questions below.)
 This report is FOR CALENDAR YEAR 2010 reporting or is a FIRST-TIME REPORT and, therefore, the remaining
choices in this Question 5 do not apply. Complete all remaining PARTS of this form as applicable.
 NO, there are NO CHANGES from last year’s final reported information for PART B. Do NOT complete PART B, but
complete PARTS C and/or D when applicable.
 YES, this report represents a CHANGE FROM LAST YEAR’S FINAL REPORTED INFORMATION for PART B
due to corrected information; however, the assets and operations are the same as those which were covered under
last year’s report. Submit a Supplement for last year’s report, and then complete PART B and, when applicable, PARTS
C and/or D.
 YES, this report represents a CHANGE FROM LAST YEAR’S FINAL REPORTED INFORMATION for PART B
because of the following change(s) in assets and/or operations from those which were covered under last year’s
report. Complete PART B and, when applicable, PARTS C and/or D. (Select all reasons for these changes from the
following list)








Merger of companies and/or operations
Acquisition of LNG facility
Divestiture of LNG facility
New construction or new installation of LNG facilities
Modifications to existing LNG facilities
Change in OPID
Other  Describe: _______________________________________________

 NO, there are NO LEAKS OR REPORTABLE INCIDENTS RESULTING IN A RELEASE to report in PART C. Do
NOT complete PART C, but complete PARTS B and/or D when applicable.
 NO, there are NO SAFETY-RELATED CONDITIONS OR EVENTS to report in PART D. Do NOT complete PART
D, but complete PARTS B and/or C when applicable.

Form PHMSA F 7100.3-1

Pg. 1 of 3
Reproduction of this form is permitted.

Form Approved
OMB No. 2137-0522
Expires: xx/xx/xxxx

PART B - FACILITY DESCRIPTION, TYPE, AND FUNCTION

Name, ID, and Status, should be EXACTLY THE SAME as NPMS fields LNG_NM, LNG_ID, and STATUS_CD.
Location must match the location submitted to NPMS. The LNG Facility ID (LNG_ID in NPMS) is a unique ID for a
specific facility and is assigned by the Operator.
Use the following key to complete the Descriptive table(s) below:
Status Codes
I In Service
B Abandoned
R Retired

LNG Source
T Truck
R Railroad
M Ship/Barge
L Liquefaction

Type of LNG Facility
BL Base Load
PS Peak Shaving
SA Satellite
MT Mobile/Temporary
OT Other  Describe

Function of LNG Facility
MI Marine Terminal - Import
ME Marine Terminal - Export
MB Marine Terminal - Both
SL Storage w/ Liquefaction
SN Storage w/o Liquefaction
SB Storage w/ Both
SU Stranded Utility
VF Vehicular Fuel
NR Nitrogen Rejection Unit
OT Other  Describe
LNG Plant / Facility
#1

LNG Plant / Facility
#2

Add Plants /
Facilities as needed

Name of LNG Plant / Facility
NPMS LNG ID
Plant / Facility Location
State
Latitude
Longitude
Plant / Facility Status
Date Put In Service
Process
Liquefaction Rate (MMCF/D)
Number of Vaporizers
Total Capacity (MMCF/D)
LNG Source
Interstate or Intrastate
LNG Storage
Number of LNG Tanks
Total Capacity (Bbls)
Type of LNG Plant / Facility
Function of LNG Plant / Facility
Inspection UNIT ID
(DOT INTERNAL USE ONLY)

Form PHMSA F 7100.3-1

Pg. 2 of 3
Reproduction of this form is permitted.

Form Approved
OMB No. 2137-0522
Expires: xx/xx/xxxx

For each LNG Facility listed above (that is, for each column completed above), complete PARTs C and D.
PARTs C and D
The data reported in these PARTs C and D apply to LNG PLANT / FACILITY NUMBER /__/__/
PART C – LEAKS AND REPORTABLE
INCIDENTS IN PAST YEAR

Totals

Total number where
Insulation Degradation was
a factor

Natural Force Damage,
Excavation Damage,
Eqiupment Failure and all
other causes
not otherwise listed

Other Outside
Force Damage

Original
Manufacturingrelated

LOCATION

Construction-,
Installation-, or
Fabricationrelated

Corrosion

In-plant Piping or Weld ONLY
(For these types of failures
involving Equipment,
see the Instructions)

Incorrect Operation

Record the number of leaks and reportable incidents resulting in a release detected and
repaired, by location and cause. (NOTE: Careful review of the instructions is required.)

Plant Piping and Equipment

Calc

Storage Tank

Calc

Other Location

Calc
Totals

Calc

PART D – OTHER CONDITIONS AND EVENTS

Calc

Record the number of Safety-Related Conditions and Events.

Number of
Safety-Related
Conditions Reported

TYPE

Calc

Number of Events

Totals

Rollover

Calc

Security Breach

Calc

ESD Actuations not reported as
Incidents
- Activated by false signal
- Activated by maintenance or other
non- emergency event
Insulation Degradation

Calc

Other Types

Calc
Totals

Calc
Calc

Calc

PART E - PREPARER SIGNATURE
/__/__/__/-/__/__/__/-/__/__/__/__/
Telephone Number

Preparer's Name(type or print)

/__/__/__/-/__/__/__/-/__/__/__/__/
Preparer's Title

Facsimile Number

Preparer's E-mail Address

Form PHMSA F 7100.3-1

Pg. 3 of 3
Reproduction of this form is permitted.

INSTRUCTIONS FOR FORM PHMSA F-7100.3-1 (Rev. xx-2010)
ANNUAL REPORT FOR CALENDAR YEAR 20__
LIQUEFIED NATURAL GAS (LNG) FACILITIES
GENERAL INSTRUCTIONS
All section references are to Title 49 of the Code of Federal Regulations (49 CFR). The Liquefied
Natural Gas (LNG) Facilities Annual Report has been revised as of calendar year 2010 affecting
submissions for 2010 and beyond. Please read through the Annual Report and instructions carefully
before beginning to complete the Report. Where common data elements exist between this Report and
an operator’s NPMS submission, the data submitted by the operator on their Annual Report should be
the same as the data submitted through NPMS when possible. (Additionally, and in order to align an
operator’s NPMS submission with their Annual Report data, PHMSA suggests that operators send
their NPMS submission to PHMSA by March 15, representing LNG Facility assets as of December 31
of the previous year.)
Annual Reports must be submitted by March 15 for the preceding calendar year. In order to
improve the accuracy of reported data, operators are requested to review prior years’ reports in order to
validate that their reported numbers are accurate, or to identify and correct inconsistencies or errors
that are either found or that may exist in any previously reported data. Operators should file
Supplemental Reports as necessary, including those supplementing prior years’ Reports.
Each LNG Facility operator is required to file an Annual Report. The terms “component,” “liquefied
natural gas or LNG,” “LNG Facility,” “LNG Plant,” and “operator”, are defined in § 193.2007.
If you need copies of the Form PHMSA F-7100.3-1 and/or instructions, they can be found on the
Pipeline Safety Community main page, http://phmsa.dot.gov/pipeline, by clicking Data and Statistics
and then selecting the Forms hyperlink. If you have questions about this Report or these instructions,
please call the PHMSA Information Resources Manager at (202) 366-8075.

Rev xx-20xx

Page 1 of 8

INSTRUCTIONS FOR FORM PHMSA F-7100.3-1 (Rev. xx-2010)
ANNUAL REPORT FOR CALENDAR YEAR 20__
LIQUEFIED NATURAL GAS (LNG) FACILITIES
REPORTING METHOD
Annual Reports must be submitted online unless an alternate method is approved (see Alternative
Reporting Methods below). Use the following procedure:
1. Navigate
to
the
Pipeline
Safety
Community
main
page,
http://www.phmsa.dot.gov/pipeline, click the ONLINE DATA ENTRY link listed.
2. Click on the LNG Facilities Annual Report link.
3. Enter Operator Identification Number (OPID) and PIN. [If an operator does not have
an OPID or a PIN, the ONLINE DATA ENTRY page includes directions on how to
obtain one.]
4. Click Add to begin data entry for a new calendar year’s Report. [For Supplemental
Reports, click on the Report ID and select Modify to make corrections or add new
information.]
5. To save intermediate work without formally submitting it to PHMSA, click Save.
6. Click Submit when you have completed the Report (for either an Initial Report or a
Supplemental Report) and are ready to initiate formal submission of your Report to
PHMSA.
7. A confirmation page will appear for you to print and save for your records.
Alternative Reporting Methods
Operators for whom electronic reporting imposes an undue burden and hardship may submit a written
request for an alternative reporting method. Operators must follow the requirements in §191.7(c) to
request an alternative reporting method and must comply with any conditions imposed as part of
PHMSA’s approval of an alternate reporting method.

SPECIFIC INSTRUCTIONS
Make an entry in each block for which data is available. Estimate data only if necessary. Avoid
entering any data as UNKNOWN or 0 (zero) except where zero is appropriate to indicate that there
were no instances or amounts of the attribute being reported.
Enter the Calendar Year for which the Report is being filed, bearing in mind that reporting
requirements are for the preceding calendar year (i.e., for the March 15, 2011 deadline, the Report
should provide information for assets as they existed at the end of the 2010 calendar year ).
Check Initial Report if this is the original filing for the calendar year. Check Supplemental Report
if this is a follow-up to a previously filed Report to amend or correct information for that calendar
year. On Supplemental Reports, enter all information requested in Parts A and E, and only the new or
revised information for the other Parts of the Report.

Rev xx-20xx

Page 2 of 8

INSTRUCTIONS FOR FORM PHMSA F-7100.3-1 (Rev. xx-2010)
ANNUAL REPORT FOR CALENDAR YEAR 20__
LIQUEFIED NATURAL GAS (LNG) FACILITIES
PART A – OPERATOR INFORMATION
Complete all 5 sections of Part A before continuing to Part B.
1. Operator’s 5-digit Identification Number (OPID)
All operators that meet the definition of an “operator” under § 193.2007 must have a PHMSAassigned Operator Identification Number (also known as an OPID). If the person completing the
Report does not know the OPID for the facility(ies) being reported, this information may be
requested from the PHMSA Information Resources Manager at (202) 366-8075. (See instructions
on the ONLINE DATA ENTRY page as described above.)
2. Name of Company or Establishment
This is the company name used when registering for an OPID and PIN in the Online Data Entry
System. When completing the Report online, the Name of Operator is automatically filled in based
on the OPID entered in Part A, Question 1. If the name that appears does not coincide with the
OPID, contact the PHMSA Information Resources Manager.
If the company corresponding to the OPID is a subsidiary, enter the name of the parent company.
3. Individual Where Additional Information May Be Obtained
Enter the name, title, email address and telephone number of the individual who should be
contacted if additional information regarding this Report submission is needed.
4. Headquarters Address
Enter the address and phone number of the operator’s corporate headquarters.
5. Does this Report represent a change from last year’s final reported information for Part B,
or include leaks or reportable incidents in Part C, or Safety-Related Conditions or Events in
Part D?
Check “This Report is for calendar year 2010 reporting or is a first-time Report…” only for the
reporting of calendar year 2010 data, including any supplements to that information, or if this is a
first-time Report. Because this revision of the Annual Report will be used for the first time to
report data for calendar year 2010, some of the “Parts” of this Report referred to in this question
are new and, therefore, no comparable data will have been reported for the prior year. For calendar
year 2010 only, respond to this question by selecting the box “This Report is for calendar year
2010 reporting or is a first-time Report…”, and then complete all remaining Parts of the Report as
applicable. Similarly, if no Annual Report has been previously filed for this operator, OPID, or
facility(ies), or for other reasons, select the box “This Report is for calendar year 2010 reporting or
is a first-time Report…”, and then complete all remaining Parts of the Report as applicable.
Rev xx-20xx

Page 3 of 8

INSTRUCTIONS FOR FORM PHMSA F-7100.3-1 (Rev. xx-2010)
ANNUAL REPORT FOR CALENDAR YEAR 20__
LIQUEFIED NATURAL GAS (LNG) FACILITIES
For calendar year submissions beyond 2010, an option has been created to allow the operator to
provide data for relevant Parts when certain portions of the information have not changed.
Check the “No” box related to Part B if there are no changes in the information reported in Part B
of this form from the information reported for the prior year in Part B for the LNG Facility(ies) that
is(are) the subject of this Report. If this box is checked, Part B need not be completed.
When there are changes in the information reported for the current reporting year compared against
the prior calendar year, these changes can occur for one of the two following reasons:
1) New information or new calculations may have changed the understanding of
facility data, leading to differences in some data elements reported on the Annual
Report in the previous year’s Report, even though the physical assets themselves
have not changed, or
2) The facility(ies) may have changed – either physically or operationally.
Check one or both of the two “Yes” boxes if reported facility information has
changed. If the change is due to a change in the facility(ies) and/or operations
(number 2 above), check the appropriate box or boxes to indicate the nature of the
change(s). If “Other” is selected, provide a brief description of the change. If
either one of or both “Yes” boxes are checked, complete Part B.
•
•

Merger, Acquisition, or Divestiture involves a change in ownership or
operating responsibility that would likely result in changes in the reported
information.
New construction or new installation that would likely result in changes in
reported information.

•

Modifications that would likely result in changes in reported information.

•

Change in an operator’s OPID number – or changes in the facilities
covered by a particular OPID number - may result in changes throughout
the Annual Report.

Check the “No” box related to Part C if there have been no leaks or reportable incidents from the
facility during the reporting year that would be reported in Part C. Do not complete Part C.
Check the “No” box related to Part D if there have been no Safety-Related Conditions or other
Events during the reporting year that would be reported in Part D. Do not complete Part D.

Rev xx-20xx

Page 4 of 8

INSTRUCTIONS FOR FORM PHMSA F-7100.3-1 (Rev. xx-2010)
ANNUAL REPORT FOR CALENDAR YEAR 20__
LIQUEFIED NATURAL GAS (LNG) FACILITIES
PART B – FACILITY DESCRIPTION, TYPE, AND FUNCTION
Report in Part B the elements identified related to the description, type, and function of the
Plants/Facilities covered by this Annual Report, and as they existed at the end of the reporting year.
The Name, ID, and Status of the Plant/Facility, should be EXACTLY THE SAME as NPMS fields
LNG_NM, LNG_ID, and STATUS_CD, and the location must match the location submitted to NPMS.
It should be noted that the LNG Facility ID (LNG_ID in NPMS) is a unique ID for a specific facility
and is assigned by the Operator. The following descriptions apply to the Type of LNG Facility entries:
Base Load: A facility that operates continuously at a constant rate to provide gas supply throughout
the year.
Peak Shaving: LNG peak shaving facilities are used for storing surplus natural gas for use during peak
demand periods such as winter and summer.
Satellite: Satellite peak shaving plants do not include process equipment to convert natural gas to
LNG. Instead, trucks deliver LNG for storage on site. Satellite peak shaving plants typically inject
natural gas into distribution pipeline systems.
Mobile/Temporary: These facilities are used to provide a temporary supply during scheduled
activities such as maintenance or construction or supply emergencies that may arise. For these
facilities, identify whether the facility is associated with an interstate or intrastate pipeline.
Other: Describe the Plant/Facility type in the space provided.

PART C – RELEASES IN PAST YEAR
Report in Part C leaks as well as incidents reportable under § 191.3 which resulted in a release of
LNG, liquefied petroleum gas, refrigerant gas, or other gas. Leaks are unintentional escapes of LNG,
liquefied petroleum gas, refrigerant gas, or other gas from the facility that are not reportable as
Incidents under § 191.3. Report in Part C the total number of leaks and reportable incidents involving
a release of LNG, liquefied petroleum gas, refrigerant gas, or other gas that were repaired during the
reporting year, by location and cause. Report these releases originating in plant piping/equipment,
storage tanks, or other locations separately as indicated on the form. Also, include the total number of
such releases where insulation degradation was a factor. Include all releases repaired or eliminated
including by replaced pipe or other component during the calendar year. Do not include test failures.
Enter zero (0) in any cell for which no releases occurred. Do not leave any cells blank.
CORROSION: includes releases caused by galvanic, atmospheric, stray current, microbiological, or
other corrosive action. These are not limited to a hole in pipe. If the bonnet or packing gland on a
valve or flange on piping deteriorates or becomes loose resulting in a release due to corrosion and
failure of bolts, it is classified as Corrosion. For incidents reported on PHMSA’s LNG Facility
Rev xx-20xx

Page 5 of 8

INSTRUCTIONS FOR FORM PHMSA F-7100.3-1 (Rev. xx-2010)
ANNUAL REPORT FOR CALENDAR YEAR 20__
LIQUEFIED NATURAL GAS (LNG) FACILITIES
Incident Reporting form, this includes both the “External Corrosion” and “Internal Corrosion” subcauses under F1 – Corrosion Failure.
CONSTRUCTION-, INSTALLATION-, OR FABRICATION-RELATED:
includes releases
caused by a dent, gouge, excessive stress, or some other defect or anomaly introduced during the
process of constructing, installing, or fabricating in-plant piping (or welds which are an integral part of
in-plant piping), including welding or other activities performed at the facility. For incidents reported
on PHMSA’s LNG Facility Incident Reporting form, this includes the “Construction-, Installation-, or
Fabrication-related” sub-cause under F5 – Material Failure of Pipe or Weld.
ORIGINAL MANUFACTURING-RELATED: includes releases caused by a defect or anomaly
introduced during the process of manufacturing the pipe used in in-plant piping, including seam
defects and defects in the pipe body. For incidents reported on PHMSA’s LNG Facility Incident
Reporting form, this includes the “Original Manufacturing Defect-related” sub-cause under F5 –
Material Failure of Pipe or Weld.
OTHER OUTSIDE FORCE DAMAGE: includes releases resulting from non-excavation-related
outside forces, such as nearby industrial, man-made, or other fire or explosion; damage by vehicles or
other equipment; failures due to mechanical damage; and, intentional damage including vandalism and
terrorism. For incidents reported on PHMSA’s LNG Facility Incident Reporting form, this includes all
of the sub-causes under F4 – Other Outside Force Damage.
INCORRECT OPERATION: includes releases resulting from operating, maintenance, repair, or
other errors by facility personnel, including, but not limited to improper valve selection or operation,
inadvertent overpressurization, or improper selection or installation of equipment. For incidents
reported on PHMSA’s LNG Facility Incident Reporting form, this includes all of the sub-causes under
F7 – Incorrect Operation.
ALL OTHER CAUSES NOT OTHERWISE LISTED: includes the following:
•

Natural Force Damage:
includes releases resulting from earth movement,
earthquakes, landslides, subsidence, lightning, heavy rains/floods, washouts, flotation,
mudslide, scouring, temperature, frost heave, frozen components, high winds, or similar
natural causes. For incidents reported on PHMSA’s LNG Facility Incident Reporting
form, this includes all of the sub-causes under F2 – Natural Force Damage

•

Excavation Damage: includes releases resulting directly from excavation damage by
operator's personnel (oftentimes referred to as “first party” excavation damage) or by
the operator’s contractor (oftentimes referred to as “second party” excavation damage)
or by people or contractors not associated with the operator (oftentimes referred to as
“third party” excavation damage). Also, includes leaks and reportable incidents that are
determined to have resulted from previous damage due to excavation activity. For
incidents reported on PHMSA’s LNG Facility Incident Reporting form, this includes all
the sub-causes under F3 – Excavation Damage;

Rev xx-20xx

Page 6 of 8

INSTRUCTIONS FOR FORM PHMSA F-7100.3-1 (Rev. xx-2010)
ANNUAL REPORT FOR CALENDAR YEAR 20__
LIQUEFIED NATURAL GAS (LNG) FACILITIES
•

Low Temperature Embrittlement of in-plant piping (due to a process fluid) means
failure of in-plant piping or weld due to the effect of handling cryogenic fluids.

•

Equipment: includes releases resulting from: malfunction of control/relief equipment
including valves, regulators, or other instrumentation; failures of pumps or compressors,
or pump- or compressor-related equipment; failures of various types of connectors,
connections, and appurtenances; failures of the body of equipment, vessel plate, or other
material (including those caused by construction-, installation-, or fabrication-related
and original manufacturing-related defects or anomalies and low temperature
embrittlement); and, all other equipment-related failures. For incidents reported on
PHMSA’s LNG Facility Incident Reporting form, this includes all of the sub-causes
under F6 – Equipment Failure.

•

Other: includes releases resulting from any other cause, including those of an
unknown or unknowable nature. For incidents reported on PHMSA’s LNG Facility
Incident Reporting form, this includes both of the two sub-causes under F8 – Other
Incident Cause.

INSULATION DEGRADATION: refers to reduced effectiveness of insulation (e.g., loss of
vacuum) that was a contributing factor to or that causes a release from primary containment, usually
due to thermal damage.

PART D – OTHER CONDITIONS AND EVENTS
Report the number of events that were determined to be significant to safety that occurred at the
facility(ies) during the reporting year, such as movement of tanks and/or tank foundations and
impairment of the structural integrity or safety of tanks, piping, or other LNG facility equipment or
components. Report separately the number of events that were reported as Safety-Related Conditions
(§ 191.23) and events not reported as Safety-Related Conditions. Section 191.23(b)(4) specifies that a
Safety-Related Condition Report need not be filed if corrective action is completed before the deadline
for filing a Report. Such events should be included in the “Number of Events” column in Part D.
Conditions or events that resulted in a release of LNG, liquefied petroleum gas, refrigerant gas, or
other gas from the facility should be reported in Part C. Enter zero (0) in any cell for which no events
occurred. Do not leave any cells blank.
Rollover refers to an event in which significant stratification has occurred within a tank and, as a
result, significant quantities of liquefied gas suddenly relocate due to differences in density. Rollovers
have resulted in damage to storage facilities and are safety significant events for LNG carriers and their
unloading operations at import terminals.
Security Breach refers to an actual breach of security. Actuation of security alarms due to
circumstances other than an actual breach need not be reported.

Rev xx-20xx

Page 7 of 8

INSTRUCTIONS FOR FORM PHMSA F-7100.3-1 (Rev. xx-2010)
ANNUAL REPORT FOR CALENDAR YEAR 20__
LIQUEFIED NATURAL GAS (LNG) FACILITIES
Emergency Shutdown Device (ESD) Actuations that result from actual emergencies must be
reported as Incidents (§§ 191.3 and 191.15). These events need not be reported again here. Report in
this Part ESD Actuations that resulted from causes other than an actual emergency. Report ESD
Actuations that resulted from a false signal separately from those resulting from maintenance or other
non-emergency event at the facility.
Insulation Degradation refers to reduced effectiveness of insulation (e.g., loss of vacuum) requiring
corrective action. Do not include instances of insulation degradation that contributed to or resulted in a
leak or reportable incident. These should be reported in Part C.
Other Types should include major meteorological or geophysical disturbances or other events that the
operator considers to have been significant to safety including, but not necessarily limited to, SafetyRelated Conditions and safety significant events not otherwise included in other rows of Part D and
that were reported during the reporting year or that would have been reported had corrective action not
been completed before the reporting deadline. Do not report again any events that have been included
in other rows of Part D.

PART E – PREPARER SIGNATURE

The Preparer is the person who compiled the information and prepared the responses to the Report.
Enter the Preparer’s name and title, and e-mail address if the Preparer has one, and the phone and fax
numbers used by the Preparer.

Rev xx-20xx

Page 8 of 8

File Type	application/pdf
File Title	ANNUAL REPORT
Subject	LNG Facility Annual Report
File Modified	2010-10-06
File Created	2010-10-06