Eia 176 Form PDF Details

Eia 176 form is a mandatory form that is required to be filed whenever there is a new oil or gas well drilled in the United States. The purpose of this form is to provide information about the well to the public, including its location and what type of resources are located in the area. Filing this form helps ensure that everyone has access to important information about wells, and allows for better tracking of drilling activity.

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Form NameEia 176 Form
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OMB No. 1905-0175

Expiration Date: 12/31/2011

Version No.: 2009.01

Burden: 12.0 hours

ANNUAL REPORT OF NATURAL AND SUPPLEMENTAL GAS SUPPLY & DISPOSITION

FORM EIA-176

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. For the sanctions and the provisions concerning the confidentiality of information submitted on this form, see instructions. 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.

PART 1. RESPONDENT IDENTIFICATION DATA

 

 

 

 

 

 

PART 2.

SUBMISSION INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A completed form must be filed by March 1

REPORT PERIOD:

Year:

2

0

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Form may be submitted using one of the following methods:

EIA ID NUMBER:

1

 

 

 

 

 

 

 

 

 

 

 

 

 

If this is a resubmission, enter an "X" in the box:

 

 

 

 

 

 

Mail to: EIA-176

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If any Respondent Identification Data has changed since the last report,

 

U. S. Department of Energy

 

Oil & Gas Survey

enter an "X" in the box:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ben Franklin Station

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Company Name:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

P.O. Box 279

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Washington, DC 20044-0279

Operations in (State):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OOG.SURVEYS@eia.gov

Contact Name:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Email:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phone No.:

 

 

-

 

 

 

-

 

 

 

 

Ext:

 

 

Fax:

(202) 586-1076

 

 

 

 

 

 

 

 

 

 

Fax No.:

 

 

-

 

 

 

-

 

 

 

 

 

 

 

 

 

 

Secure File Transfer:

Address 1:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

https://signon.eia.doe.gov/upload/noticeoog.jsp

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address 2:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City:

 

 

State:

 

 

 

Zip:

 

 

-

 

 

Questions?

Call: (877) 800-5261

Email address:

List the affiliates or subsidiaries for which data are included in this State:

PART 3. TYPE OF OPERATIONS (check all that apply)

a.

Distribution company - investor owned

h.

 

Storage operator

b.

Distribution company - municipally owned

I.

 

Synthetic natural gas (SNG) plant operator

c.

Distribution company - privately owned

j.

 

Producer

d.

Distribution company - cooperative

k.

 

Gatherer

e.

Distribution company - other ownership

l.

 

Liquefied natural gas (LNG) operator

f.

Interstate pipeline (FERC regulated)

m.

 

Other (specify)

g.Intrastate pipeline

Does your company's vehicle fleet include vehicles powered by alternative fuels?

Yes

 

 

No

 

 

If yes, how many vehicles in your company's fleet are powered by alternative fuels?

 

 

 

 

 

 

 

 

 

 

 

 

Comments: (To separate one comment from another, press ALT+ENTER)

Page 1

OMB No. 1905-0175

Expiration Date: 12/31/2011

Version No.: 2009.01

ANNUAL REPORT OF NATURAL AND SUPPLEMENTAL GAS SUPPLY & DISPOSITION

FORM EIA-176

REPORT PERIOD:

 

Year:

2

0

 

 

 

 

 

 

COMPANY NAME:

Resubmission

 

 

EIA ID NUMBER:

1

7

6

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PART 4. NATURAL AND SUPPLEMENTAL GAS SUPPLY FOR THE REPORT STATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VOLUME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Mcf @ 14.73

NOTES*

 

 

 

 

 

 

 

 

ITEM DESCRIPTION

 

 

psia and 60o F)

E

F

1.0If you are a producer, report production within the report State of:

1.1Natural gas** (if reporting natural gas production, lease use data should also be reported on

 

line 15.0) ……………… …………………………………………………………………………………

1.2

Synthetic natural gas (SNG) …………………………………………………………………………….

2.0 If you are a storage operator, report operations within the report State of:

 

 

2.1

Underground storage withdrawals

……………………………………………………………………..

2.2

Liquefied natural gas (LNG) storage withdrawals (peaking facilities only)

………………………..

2.3

Above ground storage withdrawals

………………………………………………………………….

3.0 If you are an interstate pipeline company or other company receiving physical custody at State

 

lines or U.S. borders, report receipts

……………………………………………………………………..

From Company

1

1

In neighboring State or Country

1

1

From Company

1

1

In neighboring State or Country

1

1

From Company

1

1

In neighboring State or Country

1

1

From Company

1

1

In neighboring State or Country

1

1

4.0

If you are a distributor, report receipts at city gates within the report State …

……………………………

 

5.0

Report any other receipts of natural gas within the report State (excluding Federal Offshore)

..

 

………

6.0

Supplemental gaseous fuels supplies (Specify type)

 

 

 

 

 

 

 

 

1

 

 

1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

 

 

1

 

 

 

 

 

Total supply within report State (sum of all items in lines 1.0 through 6.0) …..

 

 

 

 

 

 

 

7.0

………………………..

PART 5. LIQUEFIED NATURAL GAS (LNG) STORAGE INVENTORY

 

 

 

 

 

 

 

 

8.0

If you operate a LNG facility, report LNG inventory as of December 31 of the report year

…………….

 

 

 

*Check E if data reported are an estimate; check F if you are providing a footnote in Part 7 for this data item. **If reporting Natural Gas Production (1.1), data should also be reported on lease use (15.0).

Page 2

OMB No. 1905-0175

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Expiration Date: 12/31/2011

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Version No.: 2009.01

 

ANNUAL REPORT OF NATURAL AND SUPPLEMENTAL GAS SUPPLY & DISPOSITION

 

 

 

 

 

 

 

 

 

 

 

 

 

FORM EIA-176

 

 

 

 

 

 

REPORT PERIOD:

Year:

2

0

 

 

 

 

 

 

COMPANY NAME:

 

Resubmission

 

 

EIA ID NUMBER:

1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PART 6. NATURAL AND SUPPLEMENTAL GAS DISPOSITION FOR THE REPORT STATE

 

 

 

 

 

 

9.0 Heat content of gas delivered to consumers

(Btu/cf)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NUMBER OF

 

VOLUME

REVENUE

 

 

 

 

ITEM DESCRIPTION

 

 

 

 

 

 

 

(including taxes)

NOTES*

 

 

 

 

 

 

 

 

(Mcf @ 14.73

 

 

 

 

 

 

 

 

CUSTOMERS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

psia and 60o F)

(whole dollars)

E

F

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10.0Deliveries of natural gas that you do own to end-use consumers within the report State (for assistance in determining proper

categorization of customers, see page 3 of instructions)

10.1Residential ………………………………………………………….

10.2Commercial ………………………………………………………….

10.3Industrial ………………………………………………………….

10.4Electric power ………………………………………………………

10.5Vehicle fuel ………………………………………………………….

10.6Other (not included in above categories)

(Specify type)

11.0 Deliveries of natural gas that you do not own to end-use consumers within the report State (for assistance in determining proper

categorization of customers, see page 3 of instructions)

11.1Residential ………………………………………………………….

11.2Commercial ………………………………………………………….

11.3Industrial …………………………………………………………….

11.4Electric power ……………………………………………………..

11.5Vehicle fuel …………………………………………………………

11.6Other (not included in above categories)

(Specify type)

*Check E if data reported are an estimate; check F if you are providing a footnote in Part 7 for this data item.

Page 3

OMB No. 1905-0175

Expiration Date: 12/31/2011

Version No.: 2009.01

ANNUAL REPORT OF NATURAL AND SUPPLEMENTAL GAS SUPPLY & DISPOSITION

FORM EIA-176

REPORT PERIOD:

 

Year:

2

0

 

 

 

 

 

 

COMPANY NAME:

 

 

Resubmission

 

EIA ID NUMBER:

1

7

6

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PART 6. NATURAL AND SUPPLEMENTAL GAS DISPOSITION FOR THE REPORT STATE (continued)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VOLUME

 

 

 

 

 

 

 

 

 

 

ITEM DESCRIPTION

 

 

 

 

(Mcf @ 14.73

NOTES*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

psia and 60o F)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E F

12.0 Natural gas consumed in your operations:

 

 

 

 

 

 

 

 

 

 

12.1

Pipeline or storage compressor use

 

…………………………………………………………………

 

 

12.2

New pipeline fill …………………………………………………………………………………………..

 

 

12.3

Pipeline distribution use ………………………………………………………………………………..

 

12.4

Other

 

……………………….. (Specify type):

 

1

……………………….

 

 

 

 

 

13.0 If you are a storage operator, report operations within the State:

 

 

 

 

 

 

13.1

Underground storage injections (including new fields) ………………………………………………

 

 

13.2

Liquefied natural gas (LNG) storage injections (peaking facilities only)

 

……………………….

 

 

13.3

Above ground storage injections

…………………………………………………………………….

 

14.0If you are an interstate pipeline company or other company moving gas across or to State lines or U.S. borders, report volumes transported. (See instructions if additional lines are needed.)

To Company

 

 

 

In neighboring State or Country

1

1

To Company

 

 

 

In neighboring State or Country

 

 

 

 

 

1

1

To Company

 

 

 

In neighboring State or Country

 

 

 

 

 

1

1

 

 

 

 

 

 

 

To Company

 

1

In neighboring State or Country

 

 

 

 

 

15.0 Lease use (reported by producers only)

…………………………………………………………………….

16.0Returned to oil and/or gas reservoirs, used for repressuring, reinjection (reported by producers only)

17.0Losses from leaks, damage, accidents, migration and/or blow down within the report State: …………

18.0 Other disposition within the report State (not included above):

 

18.1

To distribution companies …………………………………………………………………………….

18.2

To other pipelines in the report State

…………………………………………………………………

18.3

To storage operators in the report State

……………………………………………………………..

18.4

To other …………………… (specify type)

 

……………………

 

 

 

 

 

 

 

 

 

 

……………………

 

 

 

 

19.0Total disposition (sum of all items 10.1 through 18.4)

20.0 Difference between gas supply (+) and disposition (-) (Part 4 line 7.0 minus Part 6 line 19.0) (this value may be a negative number)

*Check E if data reported are an estimate; check F if you are providing a footnote in Part 7 for this data item.

Page 4

OMB No. 1905-0175

Expiration Date: 12/31/2011

Version No.: 2009.01

ANNUAL REPORT OF NATURAL AND SUPPLEMENTAL GAS SUPPLY & DISPOSITION

 

 

 

 

 

 

 

 

 

 

 

FORM EIA-176

 

 

 

REPORT PERIOD:

Year:

2

0

 

 

 

 

 

 

COMPANY NAME:

Resubmission

EIA ID NUMBER:

1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PART 7. FOOTNOTES

 

 

 

 

 

 

 

 

Part

Item

 

 

 

 

 

 

 

 

 

 

 

 

 

No.

No.

 

 

 

 

 

 

 

 

 

Footnote

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Page 5

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