Form PHMSA F7100 1-1 PHMSA F7100 1-1 Gas Distribution Annual Report

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 OMB No.
each violation for each day the violation continues up to a maximum of $1,000,000 as provided in 49 USC 60122.
Expiration Date

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

ANNUAL REPORT FOR CALENDAR YEAR 20___
GAS DISTRIBUTION SYSTEM

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. Public reporting for
this collection of information is estimated to be approximately 16 hours per submission, 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 completing this form before you begin. They clarify the information requested and provide specific
examples. If you do not have a copy of the instructions, you can obtain one from the PHMSA Pipeline Safety Community Web Page
at http://www.phmsa.dot.gov/pipeline/library/forms.
PART A - OPERATOR INFORMATION

DOT USE ONLY

1. NAME OF OPERATOR

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

2. LOCATION OF OFFICE WHERE ADDITIONAL
INFORMATION MAY BE OBTAINED

4. HEADQUARTERS NAME & ADDRESS, IF DIFFERENT

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:/

/

/ (provide a separate report for each state in which system operates)

6. THIS REPORT PERTAINS TO THE FOLLOWING COMMODITY GROUP (Select Commodity Group based on the predominant gas carried and
complete the report for that Commodity Group. File a separate report for each Commodity Group included in this OPID.)








Natural Gas
Synthetic Gas
Hydrogen Gas
Propane Gas
Landfill Gas
Other Gas  Name of Other Gas:

7. THIS REPORT PERTAINS TO THE FOLLOWING TYPE OF OPERATOR (Select Type of Operator based on the structure of the company included
in this OPID for which this report is being submitted.):

 Investor Owned
 Municipally Owned
 Privately Owned
 Cooperative
 Other Ownership specify:

Form PHMSA F 7100.1-1 (rev xy/2014)

Reproduction of this form is permitted.

Page 1 of 4

PART B - SYSTEM DESCRIPTION
1. GENERAL

Report miles of main and number of services in system at end of year.

STEEL
CATHODICALLY
UNPROTECTED
PROTECTED
BARE
COATED
BARE
COATED

PLASTIC

CAST/
WROUGHT
IRON

DUCTILE
IRON

COPPER

OTHER

MILES OF MAIN

Calc

Calc

Calc

Calc

Calc

NO. OF SERVICES

Calc

Calc

Calc

Calc

Calc

Reconditioned
Cast Iron

Calc

SYSTEM
TOTAL

Calc

Calc

Calc

2. MILES OF MAINS IN SYSTEM AT END OF YEAR
MATERIAL

UNKNOWN

OVER 2"
THRU 4"

2" OR LESS

OVER 4"
THRU 8"

OVER 8"
THRU 12”

SYSTEM
TOTALS

OVER 12"

STEEL

Calc

DUCTILE IRON

Calc

COPPER

Calc

CAST/WROUGHT
IRON
PLASTIC
1. PVC

Calc
Calc

2. PE

Calc

3. ABS

Calc

4. OTHER
PLASTIC

Calc

OTHER

Calc

Reconditioned
Cast Iron

Calc

SYSTEM TOTALS

Calc

Calc

Calc

Calc

Calc

Calc

Calc

Describe Other Material:
3. NUMBER OF SERVICES IN SYSTEM AT END OF YEAR
MATERIAL

UNKNOWN

1" OR LESS

OVER 1"
THRU 2"

AVERAGE SERVICE LENGTH
OVER 2"
THRU 4"

OVER 4"
THRU 8”

OVER 8"

TOTAL

STEEL

Calc

DUCTILE IRON

Calc

COPPER

Calc

CAST/WROUGHT
IRON
PLASTIC
1. PVC

Calc
Calc

2. PE

Calc

3. ABS

Calc

4. OTHER
PLASTIC

Calc

OTHER

Calc

Reconditioned
Cast Iron
SYSTEM
Calc
TOTALS
Describe Other Material:

Form PHMSA F 7100.1-1 (rev xy/2014)

Calc
Calc

Calc

Calc

Reproduction of this form is permitted.

Calc

Calc

Calc

Page 2 of 4

FEET

4. MILES OF MAIN AND NUMBER OF SERVICES BY DECADE OF INSTALLATION
UNPRE1940195019601970KNOWN
1940
1949
1959
1969
1979
MILES OF MAIN

19801989

19901999

20002009

20102019

TOTAL
Calc

NUMBER OF
SERVICES

Calc

PART C - TOTAL LEAKS AND HAZARDOUS LEAKS ELIMINATED/REPAIRED DURING YEAR

Mains
CAUSE OF LEAK

Total

Services
Hazardous

Total

Hazardous

CORROSION FAILURE
NATURAL FORCE DAMAGE
EXCAVATION DAMAGE
OTHER OUTSIDE FORCE DAMAGE
PIPE, WELD, OR JOINT FAILURE
EQUIPMENT FAILURE
INCORRECT OPERATION
OTHER CAUSE

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

PART D – EXCAVATION DAMAGE

PART E – EXCESS FLOW VALVE (EFV) DATA

1. Total Number of Excavation Damages by Apparent Root Cause Calc __

Total Number Of EFVs on Single-family Residential Services
Installed During Year _________

a. One-Call Notification Practices Not Sufficient: _______
b. Locating Practices Not Sufficient: _______

Estimated Number of EFVs In the System At End Of Year
_________

c. Excavation Practices Not Sufficient: _______
d. Other: _______

2. Number of Excavation Tickets

__________________

PART F - TOTAL NUMBER OF LEAKS ON FEDERAL LAND
REPAIRED OR SCHEDULED FOR REPAIR

PART G - 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 for.
Input for year ending 6/30________________________ %.

Form PHMSA F 7100.1-1 (rev xy/2014)

Reproduction of this form is permitted.

Page 3 of 4

PART H - ADDITIONAL INFORMATION

PART I - PREPARER

Preparer’s Name and Title

Preparer’s email address

Name and Title of Person Signing

Form PHMSA F 7100.1-1 (rev xy/2014)

Area Code and Telephone Number

Area Code and Facsimile Number

Area Code and Telephone Number

Reproduction of this form is permitted.

Page 4 of 4