Form EIA-64A Annual Report of the Origin of Natural Gas Liquids Produ

Form Approved XXXXXX XXXX

OMB No. 1905-0057

Expiration Date: xx/xx/xxxx

Expiration Date: XX/XX/XXXX

Burden: 6 hours

Version No. xxxx.xx

A

NNUAL REPORT OF THE ORIGIN OF NATURAL GAS LIQUIDS PRODUCTION
FORM EIA-64A

REPORT YEAR 2012

T

his report is mandatory under 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 sections F and G on page 2 in the 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.

RESPONDENT INFORMATION

1.0 Does this report reflect active natural gas processing at the facility for the entire year? Yes No

Months covered by this report: through

2.0 Submission Status: Original Amended

2012 Explain in 7.0 Comments below.

EIA ID NUMBER:

Submit completed form by April 19, 2013 via:

3.1 Plant Name:

Ext:

3.2 Geographic Location:

3.3 Operating Co. Name:

3.4 Room / Suite Number:

Street / PO Box:

City:

Use Area of Origin Codes on page 6

State:

-

3.5 Operating Co. Contact Name:

Phone No.:

Fax No.:

Email Address:

-

-

- -

Zip Code:

Secure File Transfer: https://signon.eia.gov/upload/noticeoog.jsp

Email: OOG.SURVEYS@eia.gov
Fax: 202-586-1076

Mail: Oil & Gas Surveys

U. S. Department of Energy, EIA Ben Franklin Station

PO Box 279

Washington DC 20044-0279

Questions? Call the EIA-64A Coordinator

1-800-879-1470

between 9:00 a.m. and 4:30 p.m. Eastern Time

ORIGIN OF NATURAL GAS RECEIVED AND NATURAL GAS LIQUIDS PRODUCED

Line	Area of Origin Code	Natural Gas Received Millions of Cubic Feet (MMCF)	Natural Gas Liquids Production Thousands of Barrels (MBls)
	(A)	(B)	(C)
4.1
4.2
4.3
4.4
4.5
4.6
4.7
4.8	TOTAL
5.0	Gas Shrinkage Resulting from Natural Gas Liquids Extracted (MMCF)
6.0	Natural Gas Used as Fuel in Processing (MMCF)
7.0	Comments: Identify any unusual aspects of your operations during the report month. (To start a new line, use alt + enter.)