Have you ever wondered what it takes to be a hazmat driver? In order to transport hazardous materials, drivers need to have the proper certification. The Form Phmsa F 7100 1 1 is an application for hazmat drivers seeking certification. This form must be filled out and submitted to theFederal Motor Carrier Safety Administration (FMCSA). In order to help applicants understand this process, we will provide a brief overview of the Form Phmsa F 7100 1 1. Keep reading below for more information on theForm Phmsa F 7100 1 1!
Question | Answer |
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Form Name | Form Phmsa F 7100 1 1 |
Form Length | 3 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 45 sec |
Other names | Gas Distr Annual Form PHMSA F 7100.1 1 (01 2011) phmsa form 71001 |
NOTICE: This report is required by 49 CFR Part 191. Failure to report may result in a civil penalty not to exceed $100,000 for |
OMB No. |
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each violation for each day the violation continues up to a maximum of $1,000,000 as provided in 49 USC 60122. |
Expiration Date 01/31/2014 |
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U.S. Department of Transportation
Pipeline and Hazardous Materials
Safety Administration
ANNUAL REPORT FOR CALENDAR YEAR 20___ |
INITIAL REPORT |
GAS DISTRIBUTION SYSTEM |
SUPPLEMENTAL REPORT |
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
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PART A - OPERATOR INFORMATION |
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DOT USE ONLY |
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1. |
NAME OF OPERATOR |
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3. OPERATOR'S 5 DIGIT IDENTIFICATION NUMBER |
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2. |
LOCATION OF OFFICE WHERE ADDITIONAL |
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4. HEADQUARTERS NAME & ADDRESS, IF DIFFERENT |
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INFORMATION MAY BE OBTAINED |
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Number and Street |
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Number and Street |
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City and County |
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City and County |
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State and Zip Code |
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State and Zip Code |
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5. |
STATE IN WHICH SYSTEM OPERATES:/ / |
/ (provide a separate report for each state in which system operates) |
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PART B - SYSTEM DESCRIPTION |
Report miles of main and number of services in system at end of year. |
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1. |
GENERAL |
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STEEL
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UNPROTECTED |
CATHODICALLY |
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PROTECTED |
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BARE |
COATED |
BARE |
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MILES OF MAIN
PLASTIC
CAST/
WROUGHT
IRON
DUCTILE
IRON
COPPER
OTHER
SYSTEM TOTAL
NO. OF SERVICES
2. MILES OF MAINS IN SYSTEM AT END OF YEAR
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UNKNOWN |
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2" OR LESS |
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OVER 2" |
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OVER 4" |
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OVER 8" |
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OVER 12" |
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SYSTEM |
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THRU 4" |
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THRU 8" |
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THRU 12” |
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TOTALS |
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STEEL |
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DUCTILE IRON |
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COPPER |
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CAST/WROUGHT |
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IRON |
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PLASTIC |
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1. PVC |
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2. PE |
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3. ABS |
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4. OTHER |
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PLASTIC |
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SYSTEM TOTALS |
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3. NUMBER OF SERVICES IN SYSTEM AT END OF YEAR
AVERAGE SERVICE LENGTH |
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FEET |
Form PHMSA F |
Reproduction of this form is permitted. |
Page 1 of 3 |
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MATERIAL |
UNKNOWN |
1" OR LESS |
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OVER 1" |
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OVER 2" |
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OVER 4" |
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OVER 8" |
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TOTAL |
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THRU 2" |
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THRU 4" |
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THRU 8” |
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STEEL |
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DUCTILE IRON |
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COPPER |
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CAST/WROUGHT |
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IRON |
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PLASTIC |
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1. PVC |
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2. PE |
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3. ABS |
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4. OTHER |
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PLASTIC |
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OTHER |
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SYSTEM |
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TOTALS |
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4. MILES OF MAIN AND NUMBER OF SERVICES BY DECADE OF INSTALLATION
UN-
KNOWN
MILES OF MAIN
NUMBER OF
SERVICES
PRE- 1940
1940-
1949
1950- 1960-
1959 1969
1970-
1979
1980- 1990-
1989 1999
2000-
2009
2010-
2019
TOTAL
PART C - TOTAL LEAKS AND HAZARDOUS LEAKS ELIMINATED/REPAIRED DURING YEAR
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Mains |
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Services |
CAUSE OF LEAK |
Total |
Hazardous |
Total |
Hazardous |
CORROSION
NATURAL FORCES
EXCAVATION DAMAGE
OTHER OUTSIDE FORCE DAMAGE
MATERIAL OR WELDS
EQUIPMENT
INCORRECT OPERATIONS
OTHER
NUMBER OF KNOWN SYSTEM LEAKS AT END OF YEAR SCHEDULED FOR REPAIR
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PART D – EXCAVATION DAMAGE |
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PART E – EXCESS FLOW VALVE (EFV) DATA |
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Number of Excavation Damages |
__________________ |
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Total Number Of EFVs on |
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Installed During Year _________ |
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Number of Excavation Tickets |
__________________ |
Estimated Number of EFVs In System At End Of Year _________
Form PHMSA F |
Reproduction of this form is permitted. |
Page 2 of 3 |
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PART F - TOTAL NUMBER OF LEAKS ON FEDERAL LAND |
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PART G - PERCENT OF UNACCOUNTED FOR GAS |
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REPAIRED OR SCHEDULED FOR REPAIR |
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Unaccounted for gas as a percent of total input for the12 months |
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ending June 30 of the reporting year. |
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[(Purchased gas + produced gas) minus (customer use + |
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company use + appropriate adjustments)] divided by (purchased |
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gas + produced gas) equals percent unaccounted for. |
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Input for year ending 6/30________________________ %. |
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PART H - ADDITIONAL INFORMATION
PART I - PREPARER AND AUTHORIZED SIGNATURE
(Type or print) Preparer’s Name and Title
Preparer’s email address
Name and Title of Person Signing
Authorized Signature
Area Code and Telephone Number
Area Code and Facsimile Number
Area Code and Telephone Number
Form PHMSA F |
Reproduction of this form is permitted. |
Page 3 of 3 |