Form PHMSA f 999-95 PHMSA f 999-95 Hazardous Liquid Base Grant Progress Report (Certificati

1200 New Jersey Avenue SE
Washington DC 20590

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

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 2137-0584. Public
reporting for this collection of information is estimated to be approximately 58.5 hours 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, Pipeline and Hazardous Materials Safety Administration
(PHMSA), PHP-30, 1200 New Jersey Ave SE, Washington, D.C. 20590. OMB Control Number: 2137-0584, Expiration Date: 7/31/2014

Pipeline Safety
20__ Hazardous Liquid Base Grant Progress Report
for

Please follow the directions listed below:
1. Review the entire document for completeness.
2. Review and have an authorized signatory sign and date page 2:
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:

PHMSA F 999-95
DUNS:
20__ Hazardous Liquid Base Grant Progress Report

, Page: 1

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

OFFICE OF PIPELINE SAFETY
20__ Hazardous Liquid Base Grant Progress Report

Office:

Authorized Signature

Printed Name

Title

Date

PHMSA F 999-95
DUNS:
20__ Hazardous Liquid Base Grant Progress Report

, Page: 2

PROGRESS REPORT ATTACHMENTS (HAZARDOUS LIQUID )
PHMSA Form No. PHMSA F 999-95
INSTRUCTIONS:
These attachments request information either for the entire calendar year (CY20__: January 1 through December 31,
20__) or as of (or on) December 31, 20__. 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.

.

.

.
.

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 1. 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 20__ 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, 20__. Also indicate the operator type (e.g., intrastate transmission) consistent with the listing in
Attachment 1 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.

PHMSA F 999-95
DUNS:
20__ Hazardous Liquid Base Grant Progress Report

, Page: 3

.
.
.

.

.

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 20__. If an employee has not been in the Hazardous Liquid pipeline safety
program the full year of 20__, 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, 20__. 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 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.

PHMSA F 999-95
DUNS:
20__ Hazardous Liquid Base Grant Progress Report

, Page: 4

DEFINITIONS

.
.
.
.

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.

PHMSA F 999-95
DUNS:
20__ Hazardous Liquid Base Grant Progress Report

, Page: 5

Attachment 1 - Stats on Operators
STATE JURISDICTION AND AGENT STATUS OVER HAZARDOUS LIQUID FACILITIES AS
OF DECEMBER 31, 20__

Operator Type

State Agency Jurisdiction/
Agent Status
No1

No. of
Operators

Yes

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

1

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)

F - No, State is currently not an interstate agent.
X/60105P = Yes, I have Section 60105 (Certification) over some of the operator type (meaning: I have 60105
authority over some, but not all of this operator type and do not have a 60106 agreement with PHMSA to inspect
them). These operators are identified in the notes below.
X/IA - Yes I have Interstate Agent jurisdiction over this type of operator
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:

PHMSA F 999-95
DUNS:
20__ Hazardous Liquid Base Grant Progress Report

, Page: 6

Attachment 2 - State Inspection Activity
TOTAL STATE FIELD INSPECTION ACTIVITY AS
OF DECEMBER 31, 20__

Operator Type

Design,
Standard
Testing and
Comprehensive
Construction

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

0
0
0
0
0
0

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

0
0
0
0
0
0

0
0
0
0
0
0

0
0
0
0
0
0

Total

0
0
0
0
0
0

Total

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

PHMSA F 999-95
DUNS:
20__ Hazardous Liquid Base Grant Progress Report

, Page: 7

Attachment 3 - List of Operators
HAZARDOUS LIQUID FACILITIES SUBJECT TO STATE SAFETY JURISDICTION AS OF DECEMBER 31, 20__

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

Operator
Petroleum Products
(Operator type & Inspection Units)
Business Name
Operator ID
Address

PHMSA F 999-95
DUNS:
20__ Hazardous Liquid Base Grant Progress Report

Intrastate
Trunklines

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

Interstate

Anhydrous
Ammonia

Carbon Dioxide

, Page: 8

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

Inspection Unit totals by type

Total Operators
Attachment 3 Notes

PHMSA F 999-95
DUNS:
20__ Hazardous Liquid Base Grant Progress Report

, Page: 9

Attachment 4 - Incidents/Accidents
SIGNIFICANT4 HAZARDOUS LIQUID INCIDENTS/ACCIDENTS JANUARY 1, THROUGH DECEMBER 31,
20__
Date of
Incident

Location City/County/etc.

Injuries Fatalities Property
#
#
Damage3
$

Cause
Code1

Name of Operator:
Cause Reported by Operator (Describe)2

1

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.

3

Interstate agents should use the 191.3 Incident definition for listing incidents investigated on interstate facilities.

4

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

PHMSA F 999-95
DUNS:
20__ Hazardous Liquid Base Grant Progress Report

, Page: 10

Attachment 5 - Stats on Compliance Actions

STATE COMPLIANCE ACTIONS -- CALENDAR YEAR (CY) 20__
Probable Violation Categories

Intrastate

Interstate

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

PHMSA F 999-95
DUNS:
20__ Hazardous Liquid Base Grant Progress Report

, Page: 11

Attachment 6 - List of Records Kept
HAZARDOUS LIQUID STATE RECORD MAINTENANCE AND REPORTING
DURING CY 20__

Attachment 6 Notes

PHMSA F 999-95
DUNS:
20__ Hazardous Liquid Base Grant Progress Report

, Page: 12

Attachment 7 - Staffing and TQ Training
STATE EMPLOYEES DIRECTLY INVOLVED IN THE HAZARDOUS LIQUID PIPELINE
SAFETY PROGRAM DURING CY 20__
Name/Title

%
Time

#
Qual.
Months Cat.

Summary
Employee Type
No. of Staff
Supervisor
Inspectors/Investigators
Damage Prevention/Technical
Clerical/Administrative
Total

Last Name

First Name

Person-Years

Course

Completion
Date

Attachment 7 Notes

PHMSA F 999-95
DUNS:
20__ Hazardous Liquid Base Grant Progress Report

, Page: 13

Attachment 8 - Compliance with Federal Regulations
STATE COMPLIANCE WITH FEDERAL REQUIREMENTS AS OF DECEMBER 31, 20__

No.

Effective
Date

1

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

Impact

Adoption
AdoptionStatus
Date

Note1
191.23 and 191.25 Safety-Related Conditions(through current amendment
191-14)
Part 192 Amendments

2
3
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

1

Note
91

Note1
92
Note1
93
Note1
94
Note1
95
1

Note
96

Note1
PHMSA F 999-95
DUNS:
20__ Hazardous Liquid Base Grant Progress Report

, Page: 14

97

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

7/15/2005

PSIA Statuory changes to Operator Qualification Program

11/25/2005

Adoption of Nace Standard as a direct assesment standard

4/14/2006

Definition of a Gathering Line

7/10/2006

Incorporate by Reference various Standards

2/1/2007

Update Incorporated by Reference and Corrrection

4/23/2007

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

5/23/2007

Integrity Management Program Modifications and Clarifications

12/13/2007

Applicability of Public Awareness Regulations to Certain Gas
Distribution Operators

Note1
98
1

Note
99

1

Note
100

Note1
101
1

Note
102

1

Note
103

Note1
103a
1

Note

72 FR 20055
Note1
104
1

Note
105

Note1

PHMSA F 999-95
DUNS:
20__ Hazardous Liquid Base Grant Progress Report

, Page: 15

106

3/28/2008

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

10/17/2008

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

12/24/2008

PA-11 Design Pressures (73 FR 79005)

Note1
107
Note1
108
Note1
4

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)

1

Note
18

Note1
19
1

Note
20

Note1
5

Part 199 - Drug Testing

6

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

1

Note
20

1

Note
21

Note1

PHMSA F 999-95
DUNS:
20__ Hazardous Liquid Base Grant Progress Report

, Page: 16

22

7/14/2004

New address for reporting

3/8/2005

Administration name change

3/28/2008

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

Note1
23
1

Note
24

Note1
7

State Adoption of Part 198 State One-Call Damage Prevention Program

a.

Mandatory coverage of areas having pipeline facilities
1

Note
b.

Qualification for operation of one-call system

Note1
c.

Mandatory excavator notification of one-call center
1

Note
d.

State determination whether calls to center are toll free
1

Note
e.

Mandatory intrastate pipeline operator participation

Note1
f.

Mandatory operator response to notification
1

Note
g.

Mandatory notification of excavators/public
1

Note
h.

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

Note1

PHMSA F 999-95
DUNS:
20__ Hazardous Liquid Base Grant Progress Report

, Page: 17

1

If Adoption Status is No, Please provide an explanation
State Attendance at 20__ NAPSR Regional Meeting:
Frequency of General Legislative Session:

Attachment 8 Notes

PHMSA F 999-95
DUNS:
20__ Hazardous Liquid Base Grant Progress Report

, Page: 18

Attachment 10 - Performance and Damage Prevention Questions

CALENDAR YEAR (CY) 20__

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

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

PHMSA F 999-95
DUNS:
20__ Hazardous Liquid Base Grant Progress Report

, Page: 19