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pdfNotice: This report is required by 49 CFR Parts 191 and 195. Failure to report may result in a civil penalty as
provided in 49 USC 60122.
U.S. Department of Transportation
Pipeline and Hazardous Materials
Safety Administration
Form Approved TBD by OMB
OMB No. 2137-0627
Expiration Date:TBD by OMB
DOT USE ONLY
NATIONAL REGISTRY NOTIFICATION
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 2137-0627. Public reporting for this collection
of information is estimated to be approximately 60 minutes 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.
STEP 1 – ENTER BASIC NOTIFICATION INFORMATION
1.
Operator’s PHMSA-issued Operator Identification Number (OPID): /
2.
Current name of Operator assigned to this OPID: _______________________________
3.
Operator Headquarters address: _____________________________________
4.
Date of this notification: /
5.
Name of Operator contact for this notification:
City: _____________________
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Month
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State: /
Day
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Zip Code: /
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Year
Last ___________________________ First ____________________ MI _
6.
Phone number and email address of Operator contact for this notification.
7.
Select the type of pipelines and/or facilities involved in this notification: (select all that apply)
LNG Plant or Facility
Gas Distribution
Gas Transmission
Gas Gathering
Hazardous Liquid
Underground Natural Gas Storage (UNGS) Facility
STEP 2 – SELECT TYPE OF NOTIFICATION
TYPE A –OPERATOR NAME CHANGE
1.
Indicate the Operator Name for this OPID as you want it to appear in PHMSA records: _______________________________
2.
Reason for this change: _________________________________________________________________________________
3.
Indicate the effective date for this change: /
/
Month
/
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Day
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/
Ceasing Operatorship
Year
TYPE B – CHANGE IN ENTITY OPERATING
Is this Notification for (select only one):
Assuming Operatorship
1a. If assuming operatorship, list OPID Number of previous Operator: /
/
/
/
/
/
/
/
/ or
/ or
Not assigned
Previous Operator name: ___________________________
1b. If ceasing operatorship, list OPID Number of new Operator: /
/
Not assigned
New Operator name: ___________________________
I would like to deactivate my OPID Number
2. Reason for this change: __________________________________________________________________________________
3. Indicate the effective date for this change: /
Form PHMSA F 1000.2
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Month
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Day
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Year
Reproduction of this form is permitted.
Pg. 1 of 9
Notice: This report is required by 49 CFR Parts 191 and 195. Failure to report may result in a civil penalty as
provided in 49 USC 60122.
Form Approved TBD by OMB
OMB No. 2137-0627
Expiration Date:TBD by OMB
TYPE C – SHARED SAFETY PROGRAM CHANGE
Important Instruction to Operator: When a common PHMSA-required pipeline safety program exists which covers assets having
multiple OPID numbers, the Operators assigned those OPIDs are required to inform PHMSA as to which one of the various OPIDs is
“primary” for the purposes of PHMSA inspections and National Registry Reporting (e.g., which OPID should be contacted and referred
to when PHMSA or a state exercising jurisdiction intends to inspect that safety program), and must do so for each PHMSA-required
pipeline safety program listed below.
1.
List the new Operator-designated “primary” OPID for each common PHMSA-required pipeline safety program associated
with this notification. The previous “primary” OPID will be populated from PHMSA data. Those programs not selected below
will be considered to not have changed: (select all that apply)
For ALL facilities
1a.
Anti-Drug Plan and Alcohol Misuse Plan (199.101, 199.202)
New: /
/
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/
Previous: /
Indicate the effective date for this change(s): /
/
Month
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Day
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Year
/
1b. Procedure Manual for Operations, Maintenance, and Emergencies (192.605, 192.615, 195.402,
193.2017, 192.12)
New: /
/
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Previous: /
Indicate the effective date for this change(s): /
/
Month
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Day
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Year
/
For Gas Distribution, Gas Gathering, Gas Transmission, or Hazardous Liquid Pipeline Facilities
1c.
Damage Prevention Program (192.614, 195.442)
New: /
/
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/
Previous: /
Indicate the effective date for this change(s): /
1d.
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Previous: /
Indicate the effective date for this change(s): /
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Day
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Year
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Month
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Day
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Year
Control Room Management Procedures (192.631, 195.446)
New: /
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Previous: /
Indicate the effective date for this change(s): /
1f.
Month
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Public Awareness/Education Program (192.616, 195.440)
New: /
1e.
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Month
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Day
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Year
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Operator Qualification Program (192.805, 195.505)
New: /
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Previous: /
Indicate the effective date for this change(s): /
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Month
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Day
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Year
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For Gas Distribution, Gas Transmission, Hazardous Liquid Pipeline Facilities, or UNGS Facilities
1g.
Integrity Management Program (192.907, 192.1005, 195.452, 192.12)
New: /
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Previous: /
Indicate the effective date for this change(s): /
/
Month
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Day
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Year
/
For Hazardous Liquid Pipeline Facilities…
1h.
Response Plan for Onshore Oil Pipelines (or Alternative State Plan) (194.101)
New: /
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Previous: /
Indicate the effective date for this change(s): /
Form PHMSA F 1000.2
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Month
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Reproduction of this form is permitted.
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Day
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Year
/
Pg. 2 of 9
Notice: This report is required by 49 CFR Parts 191 and 195. Failure to report may result in a civil penalty as
provided in 49 USC 60122.
Form Approved TBD by OMB
OMB No. 2137-0627
Expiration Date:TBD by OMB
TYPE D –CHANGE IN OWNERSHIP FOR GAS OR LIQUID
1.
Is this Notification for:
An Acquisition
A Divestiture
2.
If an acquisition, list OPID Number of previous Operator, if one has been assigned: /
/
/
/
/ /
Not assigned
Previous Operator name: ___________________________
3.
If a divestiture, list OPID Number of new Operator, if one has been assigned:
/
/
/
/
/ /
Not assigned
New Operator name: ___________________________
I would like to deactivate my OPID Number
4.
Indicate the effective date for this acquisition or divestiture: /
/
/
Month
/
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/
Day
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/
Year
TYPE F – CONSTRUCTION OR REHABILITATION OF GAS OR LIQUID FACILITIES
1.
Anticipated start date of field work activities:
/
2.
Anticipated date of operational start-up:
/
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Month
Month
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Day
Day
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Year
Year
Select the single option below that describes the preponderance of the work. Describe the work more fully in Step 4.
Construction of new pipeline or facilities
Replacement of exisiting pipeline or facilities
Rehabilitation of existing pipeline or facilities
Reversal of flow
Conversion of service
Change in commodity
UNGS facility well work
TYPE I – CHANGE IN OWNERSHIP FOR LNG
1.
Is this Notification for:
An Acquisition
A Divestiture
2.
If an acquisition, list OPID Number of previous Operator, if one has been assigned: /
/
/
/
/ /
Not assigned
/
/
/
/ /
Not assigned
Previous Operator name: ___________________________
3.
If a divestiture, list OPID Number of new Operator, if one has been assigned:
/
New Operator name: ___________________________
I would like to deactivate my OPID Number
4.
Indicate the effective date for this acquisition and/or divestiture: /
5.
Plant/Facility 1
Interstate
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Month
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Day
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Year
/
Intrastate
5a. Name: _______________________________________
5b. If Onshore, give location as: State: /
/
/
5c. If Offshore in State waters, give location as: State: /
County: ______________________
/
/
5d. If Offshore OCS, give location as:
6.
OCS Atlantic
OCS Gulf of Mexico
OCS Pacific
OCS Alaska
Plant/Facility 2
Interstate
Intrastate
Form PHMSA F 1000.2
Reproduction of this form is permitted.
Pg. 3 of 9
Notice: This report is required by 49 CFR Parts 191 and 195. Failure to report may result in a civil penalty as
provided in 49 USC 60122.
Form Approved TBD by OMB
OMB No. 2137-0627
Expiration Date:TBD by OMB
6a. Name: _______________________________________
(Repeat same questions as for Plant/Facility 1, and then add other Plants/Facilities as needed)
1.
TYPE J – CONSTRUCTION FOR LNG
Plant/Facility 1
Interstate
Intrastate
1a. Name: _______________________________________
1b. If Onshore, give location as: State: /
/
/
County: ______________________
1c. If Offshore in State waters, give location as: State: /
/
/
1d. If Offshore OCS, give location as:
OCS Atlantic
OCS Gulf of Mexico
OCS Pacific
OCS Alaska
1e. Anticipated start date of field work activities:
1f. Anticipated date of operational start-up:
/
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Month
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Month
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Day
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Day
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Year
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Year
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1g. Select the single option below that describes the preponderance of the work. Describe the work more fully in Step 4.
Construction of new facilities
Replacement of exisiting facilities
Rehabilitation of existing facilities
2.
Plant/Facility 2
Interstate
Intrastate
2a. Name: _______________________________________
(Repeat same questions as for Plant/Facility 1, and then add other Plants/Facilities as needed)
STEP 3 – ENTER SUPPLEMENTAL INFORMATION FOR
PIPELINES AND PIPELINE FACILITIES
1.
For TYPE B, D, or F, complete STEP 3.
The pipelines and/or facilities included in this notification are associated with the following types of facilities and transport the
following types of commodities: (select all that apply)
Gas Distribution
Line Pipe
Natural Gas
Propane Gas
Landfill Gas
Synthetic Gas
Hydrogen Gas
Other Gas Name: ___________________________________________
Facilities
Gas Transmission
Line Pipe
Natural Gas
Propane Gas
Synthetic Gas
Form PHMSA F 1000.2
Reproduction of this form is permitted.
Pg. 4 of 9
Notice: This report is required by 49 CFR Parts 191 and 195. Failure to report may result in a civil penalty as
provided in 49 USC 60122.
Form Approved TBD by OMB
OMB No. 2137-0627
Expiration Date:TBD by OMB
Hydrogen Gas
Landfill Gas
Other Gas Name: ___________________________________________
Gas Transmission Facilities
Gas Gathering
Line Pipe
Facilities
Hazardous Liquid
Transmission Line Pipe
Crude Oil
Refined and/or Petroleum Product (non-HVL)
HVL or Anhydrous Ammonia
Anhydrous Ammonia
LPG (Liquefied Petroleum Gas) / NGL (Natural Gas Liquid)
Other HVL Name: ___________________________________________
CO2 (Carbon Dioxide)
Biofuel / Alternative Fuel (including ethanol blends, but excluding Fuel Grade Ethanol)
Fuel Grade Ethanol (also referred to as Neat Ethanol)
Regulated Hazardous Liquid Gathering
Facilities
Reporting-Regulated Gathering
Gravity Line
Underground Natural Gas Storage (UNGS) Facility
2.
Will any single pipeline or pipeline facility included in this notification be subject to BOTH 49 CFR Part 192 AND 49 CFR Part
195 due to the planned transportation of commodities which are subject to both Parts?
No Yes
Form PHMSA F 1000.2
Reproduction of this form is permitted.
Pg. 5 of 9
Notice: This report is required by 49 CFR Parts 191 and 195. Failure to report may result in a civil penalty as
provided in 49 USC 60122.
Form Approved TBD by OMB
OMB No. 2137-0627
Expiration Date:TBD by OMB
The series of questions under this STEP 3, Question 3 should be completed for each of the following facility types as selected in
STEP 3, Question 1: Gas Distribution, Gas Gathering, Gas Transmission and Hazardous Liquid.
3.
For Gas Distribution, the pipelines and/or facilities covered by this notification are:
3a. Approximate number of regulated miles of Mains: calc
miles
3b. List all of the States in which these Mains are physically located:
State 1: /___/___/
Miles:
/___/___/___/___/___/___/___/___/___/
State 2: /___/___/
Miles:
/___/___/___/___/___/___/___/___/___/
(Add States as needed)
3c. Facilities:
State 1: /___/___/
Description: ___________________________________________
State 2: /___/___/
Description: ___________________________________________
(Add States as needed)
3.
For Gas Gathering, the pipelines and/or facilities covered by this notification are:
Interstate
Intrastate
Onshore
3a. Approximate number of regulated pipeline miles: calc miles
--------------------------------------------------------------------------------------------------------------------------------------For Construction of new pipeline (including replacement of existing pipeline) ONLY, include Question
3b.
3b. Are portions of this pipeline to be installed in common parallel corridors, rights-of-way, or trenches with
other utilities? (select all that apply)
No
Yes, parallel to other pipelines subject to 49 CFR 192 or 195
Yes, parallel to other electric facilities such as Transmission/Distribution lines and/or Wind Farm power lines
Yes, parallel to other underground Utilities such as water or sewer (sanitary/storm)
Yes, parallel to other underground Utilities such as cable TV or other communications lines
Yes, parallel to other facilities Describe: ________________________________
--------------------------------------------------------------------------------------------------------------------------------------3c. List all of the States and Counties in which the Onshore pipelines and/or facilities are physically located :
Pipelines:
State 1: /___/___/
Miles:
/___/___/___/___/___/___/___/___/___/
Counties: ___________________________________________
State 2: /___/___/
Miles:
/___/___/___/___/___/___/___/___/___/
Counties: ___________________________________________
(Add States as needed)
Facilities
State 1: /___/___/
Description: ___________________________________________
Counties: ___________________________________________
State 2: /___/___/
Description: ___________________________________________
Counties: ___________________________________________
(Add States as needed)
Offshore
3f. Approximate number of regulated pipeline miles: calc
Form PHMSA F 1000.2
miles
Reproduction of this form is permitted.
Pg. 6 of 9
Notice: This report is required by 49 CFR Parts 191 and 195. Failure to report may result in a civil penalty as
provided in 49 USC 60122.
Form Approved TBD by OMB
OMB No. 2137-0627
Expiration Date:TBD by OMB
3g. Select all of the OCS (Outer Continental Shelf) Areas in which the Offshore pipelines and/or facilities are
physically located:
OCS Atlantic
OCS Gulf of Mexico
OCS Pacific
OCS Alaska
Miles:
Miles:
Miles:
Miles:
/___/___/___/___/___/___/___/___/___/
/___/___/___/___/___/___/___/___/___/
/___/___/___/___/___/___/___/___/___/
/___/___/___/___/___/___/___/___/___/
3h. List all of the State waters in which these pipelines and/or facilities are physically located
Pipelines:
State 1: /___/___/ Miles:
/___/___/___/___/___/___/___/___/___/
Counties: ___________________________________________
State 2: /___/___/ Miles:
/___/___/___/___/___/___/___/___/___/
Counties: ___________________________________________
(Add States as needed)
Facilities
State 1: /___/___/
Description: ___________________________________________
Counties: ___________________________________________
State 2: /___/___/
Description: ___________________________________________
Counties: ___________________________________________
(Add States as needed)
3.
For Gas Transmission or Hazardous Liquid, the pipelines and/or facilities covered by this notification are: (Select Interstate
and/or Intrastate, and complete the remaining Questions for each set of Interstate assets and/or Intrastate assets and for each
selection of Gas Transmission and/or Hazardous Liquid facilities, depending on which facility type was selected in STEP 3,
Question 1.
NOTE: This series of questions should be completed separately for each of the following facility types selected: Gas Transmission
and Hazardous Liquid. In other words, if the Notification covers Gas Transmission as well as Hazardous Liquid facilities, then this
series of questions will need to be completed two separate times – once for each of these two facility types.
Interstate
Intrastate
Onshore
3a. Approximate number of regulated pipeline miles: calc miles
--------------------------------------------------------------------------------------------------------------------------------------For Construction of new pipeline (including replacement of existing pipeline) ONLY, include
Question 3b.
3b. Are portions of this pipeline to be installed in common parallel corridors, rights-of-way, or
trenches with other utilities? (select all that apply)
No
Yes, parallel to other pipelines subject to 49 CFR 192 or 195
Yes, parallel to other electric facilities such as Transmission/Distribution lines and/or
Wind Farm power lines
Yes, parallel to other underground Utilities such as water or sewer (sanitary/storm)
Yes, parallel to other underground Utilities such as cable TV or other communications
lines
Yes, parallel to other facilities Describe:
____________________________________
--------------------------------------------------------------------------------------------------------------------------------------3c. List all of the States and Counties in which the Onshore pipelines and/or facilities are physically
located :
Pipelines
State 1: /___/___/
Miles:
/___/___/___/___/___/___/___/___/___/
Counties: ___________________________________________
Form PHMSA F 1000.2
Reproduction of this form is permitted.
Pg. 7 of 9
Notice: This report is required by 49 CFR Parts 191 and 195. Failure to report may result in a civil penalty as
provided in 49 USC 60122.
Form Approved TBD by OMB
OMB No. 2137-0627
Expiration Date:TBD by OMB
State 2: /___/___/
Miles:
/___/___/___/___/___/___/___/___/___/
Counties: ___________________________________________
(Add States as needed)
Facilities
State 1: /___/___/
Description: ___________________________________________
Counties: ___________________________________________
State 2: /___/___/
Description: ___________________________________________
Counties: ___________________________________________
(Add States as needed)
Offshore
3f. Approximate number of regulated pipeline miles: calc miles
3g. Select all of the OCS (Outer Continental Shelf) Areas in which the Offshore pipelines and/or
facilities are physically located:
OCS Atlantic
OCS Gulf of Mexico
OCS Pacific
OCS Alaska
Miles:
Miles:
Miles:
Miles:
/___/___/___/___/___/___/___/___/___/
/___/___/___/___/___/___/___/___/___/
/___/___/___/___/___/___/___/___/___/
/___/___/___/___/___/___/___/___/___/
3h. List all of the State waters in which these pipelines and/or facilities are physically located:
Pipelines
State 1: /___/___/
Miles:
/___/___/___/___/___/___/___/___/___/
Counties: ___________________________________________
State 2: /___/___/
Miles:
/___/___/___/___/___/___/___/___/___/
Counties: ___________________________________________
(Add States as needed)
Facilities
State 1: /___/___/
Description: ___________________________________________
Counties: ___________________________________________
State 2: /___/___/
Description: ___________________________________________
Counties: ___________________________________________
(Add States as needed)
3.
For Underground Natural Gas Storage (UNGS), the facilities covered by this notification are:
Interstate
Intrastate
3a. List the Facility Name, State and County in which each facility is physically located:
Facility Name: ___________________
State: /___/___/
County: ________________
(Add Facilities as needed)
Form PHMSA F 1000.2
Reproduction of this form is permitted.
Pg. 8 of 9
Notice: This report is required by 49 CFR Parts 191 and 195. Failure to report may result in a civil penalty as
provided in 49 USC 60122.
Form Approved TBD by OMB
OMB No. 2137-0627
Expiration Date:TBD by OMB
Step 4 Provide a brief and general description of the pipelines and/or facilities covered by this notification:
In addition to the information provided below, Operators are encouraged to provide a general overview map (or maps) depicting the approximate
geographic location of the pipelines and/or facilities covered by this notification.
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
Form PHMSA F 1000.2
Reproduction of this form is permitted.
Pg. 9 of 9
| File Type | application/pdf |
| File Title | NOTICE: This report is required by 49 CFR Part 195 |
| Author | Debbie |
| File Modified | 2019-10-01 |
| File Created | 2019-10-01 |