PHMSA F7100.3-1 Annual Report for Liquefied Natural Gas Facilities

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

Form Approved ??3/1/2022
OMB No. 2137-0522
Expires: ??3/31/2025

DOT USE ONLY
U.S. Department of Transportation

ANNUAL REPORT FOR CALENDAR YEAR 20___

Pipeline and Hazardous Materials

LIQUEFIED NATURAL GAS (LNG) FACILITIES

Safety Administration

Initial Date
Submitted
Report Submission
Type
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 ??12 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.
Important: Please read the separate instructions for completeing 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
https://www.phmsa.dot.gov/forms/pipeline-forms.
PART A - OPERATOR INFORMATION

DOT USE ONLY

1. OPERATOR’S 5 DIGIT IDENTIFICATION NUMBER (OPID)

2. NAME OF COMPANY OR ESTABLISHMENT:

/

/

/

/

/

/
IF SUBSIDIARY, NAME OF PARENT:
__________________________________________________

3. INDIVIDUAL WHERE ADDITIONAL INFORMATION MAY BE
OBTAINED:
Name

4. HEADQUARTERS ADDRESS:
Street Address

State: /

Title

__________________________________________________

Email Address

/

/ Zip Code: /

/

/

/

/

/ - /

/

/

/

/

/__/__/__/-/__/__/__/-/__/__/__/__/
Telephone Number

/__/__/__/-/__/__/__/-/__/__/__/__/
Telephone Number

5. RESERVED

Form PHMSA F 7100.3-1 (rev ??10-2014)

Reproduction of this form is permitted.

Pg. 1 of 5

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

Form Approved ??3/1/2022
OMB No. 2137-0522
Expires: ??3/31/2025

PART B - PLANT DESCRIPTION, TYPE, AND FUNCTION

Name, ID, and Status, should be EXACTLY THE SAME as NPMS fields LNG_NM, LNG_ID, and STATUS_CD.
Location must match the location submitted to NPMS. The LNG Facility ID (LNG_ID in NPMS) is a unique ID for a
specific facility and is assigned by the Operator.
Use the following key to complete the Descriptive table(s) below:
Status Codes
I In Service
B Abandoned
R Retired

LNG Source
T Truck
R Railroad
M Ship/Barge
L Liquefaction

Type of LNG Plant
BL Base Load
PS Peak Shaving
SA Satellite
MT Mobile/Temporary
OT Other  Describe

Function of LNG Plant
MI Marine Terminal - Import
ME Marine Terminal - Export
MB Marine Terminal – Both
SL Storage w/ Liquefaction
SN Storage w/o Liquefaction
SB Storage w/ Both
SU Stranded Utility
VF Vehicular Fuel
NR Nitrogen Rejection Unit
OT Other  Describe
LNG Plant
#1

LNG Plant
#2

Add Plants as
needed

Name of LNG Plant
NPMS LNG ID
Location of Plant
For a fixed LNG Plant, provide the
State (e.g., TX); for a
Mobile/Temporary facility, provide
the Zip Code where it is
typically stored.
Plant Status
Date Put In Service
Process
Maximum Liquefaction Rate
(MMCF/D)
Number of Vaporizers
Maximum Vaporization
Capacity (MMCF/D)
LNG Source
Interstate or Intrastate
LNG Storage
Number of LNG Tanks
Total Capacity (Bbls)
Type of LNG Plant
Function of LNG Plant
Inspection UNIT ID
(DOT INTERNAL USE ONLY)
Form PHMSA F 7100.3-1 (rev ??10-2014)

Reproduction of this form is permitted.

Pg. 2 of 5

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

Form Approved ??3/1/2022
OMB No. 2137-0522
Expires: ??3/31/2025

For each LNG Plant listed above (that is, for each column completed above), complete PARTs C and D.
PARTs C and D
The data reported in these PARTs C and D apply to LNG PLANT NUMBER /__/__/ (from PART B)
PART C1 – LEAKS DISCOVERED IN
PAST YEAR

Record the number of leaks resulting in a release discoveredetected and repaired,
by location and cause. (NOTE: Careful review of the instructions is required.)

Cause

Leaks
Plant Piping and
Equipment

Locationeaks
Storage Tank

Other Location

Totals

External Corrosion

Calc

Internal Corrosion

Calc

Natural Force Damage

Calc

Excavation Damage

Calc

Other Outside Force Damage

Calc

Construction-,
Installation-, or
Fabrication-related

Calc

Original
Manufacturingrelated

Calc

Low Temperature
Embrittlement

Calc

Equipment Failure

Calc

Incorrect Operation

Calc

Other Causes

Calc

In-plant Piping
or Weld ONLY
(For these
types of
failures
involving
Equipment,
see the
Instructions)

Totals

Form PHMSA F 7100.3-1 (rev ??10-2014)

Calc

Calc

Reproduction of this form is permitted.

Calc

Calc

Pg. 3 of 5

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

PART C2 – LEAKS REPAIRED IN
PAST YEAR

Form Approved ??3/1/2022
OMB No. 2137-0522
Expires: ??3/31/2025

Record the number of leaks resulting in a release repaired
by location and cause. (NOTE: Careful review of the instructions is required.)

Cause

Plant Piping and
Equipment

Location
Storage Tank

Other Location

Totals

External Corrosion

Calc

Internal Corrosion

Calc

Natural Force Damage

Calc

Excavation Damage

Calc

Other Outside Force Damage

Calc

Construction-,
Installation-, or
Fabrication-related

Calc

Original
Manufacturingrelated

Calc

Low Temperature
Embrittlement

Calc

Equipment Failure

Calc

Incorrect Operation

Calc

Other Causes

Calc

In-plant Piping
or Weld ONLY
(For these
types of
failures
involving
Equipment,
see the
Instructions)

Totals

Form PHMSA F 7100.3-1 (rev ??10-2014)

Calc

Calc

Reproduction of this form is permitted.

Calc

Calc

Pg. 4 of 5

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

Form Approved ??3/1/2022
OMB No. 2137-0522
Expires: ??3/31/2025

Record the number of Events.
(NOTE: Careful review of the instructions is required.)

PART D – OTHER EVENTS

TYPE

Number of Events

Rollover
Security Breach
ESD Actuations not reported as
Incidents
- Activated by false signal
- Activated by maintenance or other
non- emergency event
Insulation Degradation
Other Types
Totals

Calc

PART E - ESTIMATED EMISSIONS DURING CALENDAR YEAR (MMCF)
Emissions Source
Emissions
Leaks from Plant Piping and Equipment
Leaks from Storage Tanks
Other Leaks
Blowdowns, Venting and Purging

PART E F - PREPARER SIGNATURE
/__/__/__/-/__/__/__/-/__/__/__/__/
Telephone Number

Preparer's Name

/__/__/__/-/__/__/__/-/__/__/__/__/

Preparer's Title

Facsimile Number

Preparer's E-mail Address

Form PHMSA F 7100.3-1 (rev ??10-2014)

Reproduction of this form is permitted.

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