Form EIA-857, "Monthly Report of Natural Gas Purchases and Deliveries to Consumers"

OMB No. 1905-0175
Expiration Date: 12/31/2011
Version No.: 2009.01
MONTHLY REPORT OF NATURAL GAS PURCHASES AND DELIVERIES TO CONSUMERS Burden: 3.5 hours
FORM EIA-857
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 2. SUBMISSION INFORMATION

PART 1. RESPONDENT IDENTIFICATION DATA
REPORT PERIOD:

Month:

EIA ID NUMBER:

8 5 7

Year:

Completed form(s) must be filed no later than 30 calendar days following the end
of the report period.

2 0

If this is a resubmission, enter an "X" in the box:
If any Respondent Identification Data has changed since the last report,

Form may be submitted using one of the following methods:

ATTN: EIA-857
U. S. Department of Energy
Oil & Gas Survey
Ben Franklin Station
P.O. Box 279
Washington, DC 20044-0279

Mail to:

enter an "X" in the box:
Company Name:
Contact Name:
Email:

OOG.SURVEYS@eia.doe.gov

Fax No.:

Fax:

(202) 586-1076

Address 1:

Secure File Transfer:

Ext:

Phone No.:

Address 2:
City:

https://idc.eia.doe.gov/upload/noticeoog.jsp
State:

-

Zip:

Questions?

Email address:

Call: (877) 800-5261

PART 3. NATURAL GAS PURCHASES AND DELIVERIES TO CONSUMERS

Purchased Gas Received in Distribution Service Area (City Gate)

……….

Cost
(Including taxes)

Number of
Customers

Volume
(Mcf @ 14.73 psia-60oF)

Revenue
(Including taxes)

Number of
Customers

Volume
o
(Mcf @ 14.73 psia-60 F)

Revenue
(Including taxes)

1

Deliveries of natural gas that you do own to end-use consumers within the
report State:
Residential ………………………………………………………….
Commercial …………………………………………………………
…………………………………………………………
Industrial
Electric Power ………………………………………………………
Other (not included in above categories)

Volume
(Mcf @ 14.73 psia-60oF)

2
3
4
5
6

(Specify Type)

Deliveries of natural gas that you do not own to end-use consumers within
the report State:
Residential ………………………………………………………….
Commercial …………………………………………………………
…………………………………………………………
Industrial
Electric Power ………………………………………………………
Other (not included in above categories)

7
8
9
10
11

(Specify Type)

Heat content of gas delivered to consumers (Btu/cubic ft.):
Comments: Identify any unusual aspects of your reporting month's activity. (To separate one comment from another, press ALT + ENTER.)