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pdfNotice: This report is required by 49 CFR Part 191. Failure to report may
result in a civil penalty as provided in 49 USC 60122.
OMB No. 2137-0522 Expires: ??3/31/2025
DOT USE ONLY
Original Date
Submitted
Report Type
U.S. Department of Transportation
Pipeline and Hazardous Materials
UNDERGROUND NATURAL GAS STORAGE FACILITY
ANNUAL REPORT FOR CALENDAR YEAR 20___
Date Submitted
Safety Administration
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 20 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 https://www.phmsa.dot.gov/forms/pipeline-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: /
/
/ . /
Longitude: - /
State:
/
/
/
/
/
/ . /
/
/
/
/
/
/
/
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 ??3/1/2022
calc
Reproduction of this form is permitted
page 1 of 3
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.
OMB No. 2137-0522 Expires: ??3/31/2025
B8. Metered volume of natural gas withdrawn from the facility for calendar year (billion standard cubic
feet (BCF)), include two decimal places:
B9. Metered volume of natural gas injected into the facility for calendar year (billion standard cubic
feet (BCF)), include two decimal places:
Estimated Emissions
B10. Estimated emissions from well leaks (million standard cubic feet)
B11. Estimated emissions from venting and other intentional releases (million standard cubic feet)
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. Name of the representative well:
C4b. Maximum surface pressure (pounds per square inch gauge (psig)) at the representative well:
Reservoir or Cavern(s) Depth
C5. Approximate Maximum Depth (feet):
C6. Approximate Minimum Depth (feet):
Wells
C7. Number of Injection and/or Withdraw Wells by Year Range Placed in Storage Operation:
pre-1930
1930-1959
1960-1969
1970-2004
2005-present
Injection and/or
Withdrawal Wells
Total
calc
C8. Number of Monitoring and/or Observation Wells by Year Range Placed in Storage Operation:
pre-1930
1930-1959
1960-1969
1970-2004
Monitoring and/or
Observation Wells
2005-present
Total
calc
C9. Number of Wells drilled during the calendar year:
C10. Wells plugged and abandoned during the calendar year:
C10a. Number of wells re-plugged during the calendar year:
PHMSA Form 7100.4-1 approved ??3/1/2022
Reproduction of this form is permitted
page 2 of 3
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.
OMB No. 2137-0522 Expires: ??3/31/2025
C10b. Number of wells plugged but not abandoned during the calendar year:
C10c. Number of wells plugged and abandoned during the calendar year:
Well Safety Valves
C11. Number of Wells with automated 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:
Describe the “other type” of
Maintenance
C17. Number of Wells with new production tubing installed during the calendar year:
C18. Number of Wells with new production casing, new liner, or repairs to casing or liner 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 during the calendar year:
C22. Number of Wells with Casing Evaluation for Corrosion/metal loss during the calendar year:
C23. Number of Wells inspected using a downhole assessment method other than “Pressure Test” and
“Casing Evaluation for Corrosion/metal loss” during the calendar year*:
* describe other assessment method(s):
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 ??3/1/2022
Reproduction of this form is permitted
page 3 of 3
| File Type | application/pdf |
| File Modified | 2023-04-27 |
| File Created | 2023-04-27 |