PENNSYLVANIA
Pennsylvania Pipeline Operator Annual Registration Form
Applicant (Registrant): ___________________________________________________________________
Main Mailing Address: ___________________________________________________________________
Physical Address: _______________________________________________________________________
US DOT Operator ID Number: ___________________________
PA L&I Propane Registration Number (if applicable): ____________________________
Regulatory Contact: ____________________________________________________________________
Name Email Phone
Regulatory Contact Address: ____________________________________________________________
Assessment Contact: ____________________________________________________________________
Name Email Phone
Assessment Address: __________________________________________________________________
Federal EIN Number: _________________________
PEMA (Emergency) Contact: _____________________________________________________________
Name Email Phone
PEMA (Emergency) Contact Address: _____________________________________________________
Attorney (if applicable): _________________________________________________________________
Name Email Phone
Operational Information. (Attach additional sheets as necessary)
• For each Pennsylvania gas or hazardous liquids pipeline, provide the in-state mileage in operation as of December 31st of the prior year, by class and by county as indicated in the attached table. Indicate mileage of Class 1 pipeline serving unconventional wells.
• List on the top right corner of this form the total in-state pipeline mileage in operation as of December 31st of the prior year for all Class 2, 3, and 4 Pennsylvania gas or hazardous liquids pipelines.
• The country of manufacture for all tubular steel products installed in the prior calendar year in Pennsylvania for the exploration, gathering, or transportation of natural gas or hazardous liquids as indicated in the attached table.
Fee: $250, payable to the “Commonwealth of Pennsylvania” (or ePay if eFiled).
Fee Exemptions: [] Propane Distributor registered with PA L&I [] Borough
Verification of Application. I hereby state that the statements made in this application are true and correct to the best of my/our knowledge and belief. The undersigned understands that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 Relating to Unsworn Falsification to Authorities.
___________________________________________ _____________________________________
Print Name Title Signature Date
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- state department of
- property casualty insurers
- commonwealth of pennsylvania us
- pennsylvania public utility commission
- puc puc home page
- home department of general services
- contractor integrity provisions us
- for immediate release commonwealth of pennsylvania
- application form for approval of authority to offer
- pennsylvania
Related searches
- pennsylvania department of education employment
- university of pennsylvania finance depart
- pennsylvania education certification test
- pennsylvania bureau of workers compe
- university of pennsylvania finance program
- pennsylvania department of education certification
- pennsylvania teacher certification website
- pennsylvania department of ed
- pennsylvania teacher licensure
- pennsylvania education department
- pennsylvania department of education website
- pennsylvania licensure board