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

This form may be submitted to the EIA by mail, fax, e-mail, or secure file transfer. Should you choose to submit your data via e-mail, we must advise you that e-mail is an insecure means of transmission because the data are not encrypted, and there is some possibility that your data could be compromised. You can also send your Excel files to EIA using a secure method of transmission: HTTPS. This is an industry standard method to send information over the web using secure, encrypted processes. (It is the same method that commercial companies communicate with customers when transacting business on the web.) To use this service, we recommend the use of Microsoft Internet Explorer 8.0 or later or Mozilla Firefox 5.0 or later. Send your surveys using this secure method at: https://signon.eia.doe.gov/upload/noticeoog.jsp

OMB No. 1905-0175

Expiration Date: xx/xx/xxxx

Version No.: xxxx.xx

MONTHLY REPORT OF NATURAL GAS PURCHASES AND DELIVERIES TO CONSUMERS

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

PART 2. SUBMISSION INFORMATION

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

REPORT PERIOD:

Month:

Year:

2

0

EIA ID NUMBER:

8

5

7

Form may be submitted using one of the following methods:

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

If any Respondent Identification Data has changed since the last report,

Mail to:

ATTN: EIA-857

enter an "X" in the box:

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

Company Name:

Contact Name:

Phone No.:

Ext:

Email:

[email protected]

Fax No.:

Fax:

(202) 586-1076

Address 1:

Secure File Transfer:

Address 2:

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

City:

State:

Zip:

-

Email address:

Questions?

Call:

(877) 800-5261

PART 3. NATURAL GAS PURCHASES AND DELIVERIES TO CONSUMERS BASED ON CALENDAR MONTH RECORDS

Volume

Cost

(Mcf @ 14.73 psia-60oF)

(Including taxes)

Purchased gas received in distribution service area (Citygate). Include volumes withdrawn from storage for delivery in report month and exclude volumes purchased and stored for delivery in the future. Report all costs including commodity, transportation, and storage costs. See instructions for full explanation.

1.0

Total operational sendout to consumers of gas owned and not owned

………

2.0

Gas used in operations, including space heat, pipeline distribution or

2.1

storage compressor use, and line loss……………………………………

PART 4. NATURAL GAS DELIVERIES TO CONSUMERS BASED ON FINANCIAL RECORDS

Deliveries of natural gas that you do own to consumers within the

Number of Customers

Volume

Revenue

report State

(Mcf @ 14.73 psia-60oF)

(Including taxes)

Residential

………………………………………………………….

3.0

Commercial (excluding company use and vehicle fuel)

…………..

4.0

Vehicle Fuel

………………………………………………………

4.1

Industrial

………………………………………………………….

5.0

Electric Power

………………………………………………………

6.0

Other (not included in above categories)

7.0

(Specify Type)

Deliveries of natural gas that you do not own to consumers within the

Number of Customers

Volume

Revenue

report State

(Mcf @ 14.73 psia-60oF)

(Including taxes)

Residential

………………………………………………………….

8.0

Commercial (excluding vehicle fuel)

…………………………………………………………………

9.0

Vehicle Fuel

………………………………………………………..

9.1

Industrial

………………………………………………………….

10.0

Electric Power

………………………………………………………

11.0

Other (not included in above categories)

12.0

(Specify type)

Total of all deliveries (Lines 3.0 through 12.0)

………………………………………………

13.0

0

Does any information provided in lines 1-13 include prior period adjustments?

14.0

Yes

No

If so, please detail the amount of the adjustment and applicable line(s) in

comment area below.

Heat content of gas delivered to consumers (Btu/cubic ft.):

15.0

Comments: Identify any unusual aspects of your reporting month's activity. (To separate one comment from another, press ALT + ENTER.)