EIA-878 (Schedule Motor Gasoline Price Survey (Schedule B)

Petroleum Marketing Program

eia-878_f_07_18_17_SchedB

Motor Gasoline Price Survey

OMB: 1905-0174

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U.S. DEPARTMENT OF ENERGY

U.S. ENERGY INFORMATION ADMINISTRATION

Washington, DC 20585


OMB Number: 1905-0174

Expiration Date: XX/XX/XXXX

Burden: 6.5 minutes

EIA-878: MOTOR GASOLINE PRICE SURVEY

Schedule B



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. 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. See Instructions for further details on the sanctions and the provisions concerning the confidentiality of information submitted on this form.

If you have any questions, please call:

1-800-638-8812


PART 1. IDENTIFICATION DATA

1. Company Name (only if different than the label)



2. Station Name (If different than company name)

3. Station’s Physical Address

4. Station City

5. Station State

6. Station ZIP Code

7. Station Telephone Number


8. Name of Contact Person

9. Contact’s Telephone Number

10. Contact’s Email Address

11. Mailing/Contact’s Address


12. Contact’s City

13. Contact’s State

14. Contact’s ZIP Code


The information you provide on Form EIA-878 will be used for statistical purposes only. Your responses will be kept confidential and will not be disclosed in identifiable form. Per the Federal Cybersecurity Enhancement Act of 2015, Federal information systems are protected from malicious activities through cybersecurity screening of transmitted data. By law, every EIA employee, as well as every agent, is subject to a jail term, a fine, or both if he or she makes public ANY identifiable information you reported.


PART 2. ANNUAL RETAIL MOTOR GASOLINE SALES DATA

PART 3. NUMBER OF MOTOR GASOLINE PUMPS

Enter your station’s total annual sales volume for the last full calendar year

Enter the number of motor gasoline

pumps (fueling dispensers) at this station:


_____________

Grade

Ethanol Content (%)

Annual Sales Volume (in gallons)

Regular (85, 86, 87 octane)



PART 4. COMMENTS

Midgrade (88, 89, 90 octane)




Premium (91+ octane)



Other__________________

(specify octane rating)



Other__________________

(specify octane rating)




File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleThis report is mandatory under Public Law 93 275
AuthorEIA
File Modified0000-00-00
File Created2021-01-22

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