UNGSF Annual Report - REVISED

OMB No. 2137-0522 Expires: ??/??/20??
Notice: This report is required by 49 CFR Part 191. Failure to report may result in a civil penalty as provided in 49 USC 60122.
DOT USE ONLY
U.S. Department of Transportation
Pipeline and Hazardous Materials

Original Date
Submitted
Report Type

UNDERGROUND NATURAL GAS STORAGE FACILITY
ANNUAL REPORT FOR CALENDAR YEAR 20___

Safety Administration

Date Submitted

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 8 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, PHMSA, Office of Pipeline Safety (PHP-30) 1200 New Jersey Avenue, SE, Washington, D.C.
20590.
INSTRUCTIONS
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
A1. Operator’s OPS-issued Operator Identification Number (OPID): auto-populated based on PHMSA
Portal log-in
A2. Name of Operator: auto-populated based on OPID
A3. Address of Operator
A3a. Street Address: auto-populated based on OPID
A3b. City: auto-populated based on OPID
A3c. State: auto-populated based on OPID
A3d. Zip Code: auto-populated based on OPID

PART B – STORAGE FACILITY

Complete Part B once for each independent storage facility

B1. Facility Name (chosen by operator):
B2. Select only one:  INTERstate  INTRAstate
PHMSA USE ONLY Unit ID:
B3. Facility Location

Latitude: /

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Longitude: - /
State:

/
/

/
/

/
/ . /

/

/
/

/

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County:

B4. Energy Information Administration Gas Field Code:
Names of Reservoirs within this facility: populated from Parts C1
Gas Volumes
B5. Working gas capacity (billion standard cubic feet (BCF)), include two decimal places:
B6. Base (also known as Cushion or Pad) gas (billion standard cubic feet (BCF)), include two decimal
places:
B7. Total gas capacity (billion standard cubic feet (BCF)):

PHMSA Form 7100.4-1 approved ??/??/201?

calc

Reproduction of this form is permitted

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OMB No. 2137-0522 Expires: ??/??/20??
Notice: This report is required by 49 CFR Part 191. Failure to report may result in a civil penalty as provided in 49 USC 60122.

B8. Volume of natural gas withdrawn from the facility for calendar year (billion standard cubic feet
(BCF)), include two decimal places:
B9. Volume of natural gas injected into the facility for calendar year (billion standard cubic feet (BCF)),
include two decimal places:

PART C – RESERVOIRS AND WELLS Complete Part C once for each reservoir or geologic
storage formation within a facility
Facility Name: populated from Part B1
C1. Reservoir name (chosen by operator):
C2. Year reservoir placed in storage service:
C3. Type (select only one):  Salt Cavern  Hydrocarbon Reservoir  Aquifer Reservoir
 Other

Description of type:

C4. Maximum Wellhead Surface Pressure
C4a. Text identifying the indicator well:
C4b. Maximum surface pressure (pounds per square inch gauge (psig)) at the indicator well:
Reservoir or Geologic Storage Formation Depth
C5. Approximate Maximum Depth (feet):
C6. Approximate Minimum Depth (feet):
Wells
C7. Number of Injection and/or Withdraw Wells:
C8. Number of Monitoring and/or Observation Wells:
C9. Number of Wells drilled during the calendar year:
C10. Number of Wells plugged and abandoned during the calendar year:
Well Safety Valves
C11. Number of Wells with surface safety valves:
C12. Number of Wells with subsurface safety valves:
Well Gas Flow
C13. Number of Wells with gas flow only through production tubing:
C14. Number of Wells with gas flow only through production casing:
C15. Number of Wells with gas flow through both production tubing and production casing:
C16. Number of Wells with some “other type” of gas flow:
gas flow through the well:

PHMSA Form 7100.4-1 approved ??/??/201?

Describe the “other type” of

Reproduction of this form is permitted

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OMB No. 2137-0522 Expires: ??/??/20??
Notice: This report is required by 49 CFR Part 191. Failure to report may result in a civil penalty as provided in 49 USC 60122.

Maintenance
C17. Number of Wells with new production tubing installed during the calendar year:
C18. Number of Wells with new production casing, liner, or other repair during the calendar year:
C19. Number of Wells with wellhead remediation or repair during the calendar year:
C20. Number of Wells with casing, wellhead, or tubing leaks during the calendar year:
C21. Number of Wells with Pressure Test Mechanical Integrity Tests (MIT) during the calendar year:
C22. Number of Wells with Logged for Corrosion/wall loss MIT during the calendar year:
C23. Number of Wells with MIT other than “Pressure Test” and “Logged for Corrosion/wall loss” during
the calendar year*:
* describe other MIT:

PART D – CONTACT INFORMATION
D1. Name of person submitting report:
D2. Title of person in D1:
D3. Work e-mail address of person in D1: auto-populated based on Portal login
D4. Work phone number of person in D1: ____

__

D5. Name of person to contact with questions about this report:
D6. Title of person in D5:
D7. Email address of person in D5: ____

__

D8. Phone number of person in D5: ____

__

PHMSA Form 7100.4-1 approved ??/??/201?

Reproduction of this form is permitted

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