Form PS-8000A - The Railroad Commission of Texas
Form PS-8000A - The Railroad Commission of Texas
Form PS-8000A - The Railroad Commission of Texas
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RAILROAD COMMISSION OF TEXAS<br />
SAFETY DIVISION – PERMIT SECTION<br />
Information is requested for all transmission/trunkline and gathering pipelines transporting hazardous liquids and CO2 or gas which is flammable, toxic or<br />
corrosive under the specified T-4 Permit Number. Please complete a separate questionnaire for each T-4 permit application on file. If additional information is<br />
necessary to complete this form, telephone the Pipeline Safety Section in Austin at (512) 463-7058. SIGNATURE REQUIRED ON BACK<br />
I. GENERAL INFORMATION<br />
NAME OF OPERATOR T-4 Permit No. _______________<br />
MAILING ADDRESS Total miles____________<br />
CITY, STATE, ZIP+4<br />
TELEPHONE NUMBER ( ) FAX ( )<br />
NAME OF COMPLIANCE REPRESENTATIVE<br />
MAILING ADDRESS CHECK IF SAME AS ABOVE<br />
CITY, STATE, ZIP+4<br />
TELEPHONE NUMBER ( ) FAX ( )<br />
II. SYSTEM INFORMATION <strong>The</strong> referenced T-4 permit may be several pipelines or pipeline systems, or a single listing permit with one pipeline or pipeline system.<br />
Are the pipelines covered under this permit Interstate Intrastate<br />
SYSTEM or SECTION FLUID<br />
TYPE<br />
PIPELINE<br />
CHECK ALL<br />
CLASS<br />
NAME, LINE # or BEING (Check as applicable) SPECIFICATIONS<br />
AS APPLICABLE LOCATION: COUNTIES<br />
IDENTIFICATION TRANSPORTED<br />
1, 2, 3 or 4<br />
Trunkline/<br />
Transmission<br />
Gathering<br />
Production/Flow<br />
Trunkline/<br />
Transmission<br />
Gathering<br />
Production/Flow<br />
Trunkline/<br />
Transmission<br />
Gathering<br />
Production/Flow<br />
Miles ____________<br />
O.D. ____________<br />
Wall<br />
Thickness ____________<br />
Pipe<br />
Grade ____________<br />
MAOP ____________<br />
Miles ____________<br />
O.D. ____________<br />
Wall<br />
Thickness ____________<br />
Pipe<br />
Grade ____________<br />
MAOP ____________<br />
Miles ____________<br />
O.D. ____________<br />
Wall<br />
Thickness ____________<br />
Pipe<br />
Grade ____________<br />
MAOP ____________<br />
*Rural<br />
Non-Rural<br />
Bay Area<br />
Offshore<br />
Navigable Waterway<br />
Environmentally<br />
Sensitive<br />
*Rural<br />
Non-Rural<br />
Bay Area<br />
Offshore<br />
Navigable Waterway<br />
Environmentally<br />
Sensitive<br />
*Rural<br />
Non-Rural<br />
Bay Area<br />
Offshore<br />
Navigable Waterway<br />
Environmentally<br />
Sensitive<br />
Trunkline/<br />
Transmission<br />
Miles<br />
O.D.<br />
____________<br />
____________<br />
*Rural<br />
Non-Rural<br />
Gathering<br />
Wall<br />
Thickness ____________<br />
Bay Area<br />
Offshore<br />
Pipe<br />
Navigable Waterway<br />
Grade ____________ Environmentally<br />
Production/Flow MAOP ____________<br />
Sensitive<br />
* Rural means outside the limits <strong>of</strong> any incorporated or unincorporated city, town, village, or any other designated residential or<br />
commercial area such as a subdivision, a business or shopping center, or community development.<br />
<strong>The</strong> <strong>Railroad</strong> <strong>Commission</strong> does not discriminate on the basis <strong>of</strong> race, color, national origin, sex, religion, age, or disability in employment or the provision <strong>of</strong> services.<br />
TDD/TDY (512) 463-7284 <strong>PS</strong>-<strong>8000A</strong> REVISED 01/09
SYSTEM or SECTION<br />
NAME, LINE # or<br />
IDENTIFICATION<br />
FLUID<br />
BEING<br />
TRANSPORTED<br />
TYPE<br />
(Check as applicable)<br />
Trunkline/<br />
Transmission<br />
Gathering<br />
Production/Flow<br />
Trunkline/<br />
Transmission<br />
Gathering<br />
Production/Flow<br />
Trunkline/<br />
Transmission<br />
Gathering<br />
Production/Flow<br />
Trunkline/<br />
Transmission<br />
Gathering<br />
Production/Flow<br />
Trunkline/<br />
Transmission<br />
Gathering<br />
Production/Flow<br />
Trunkline/<br />
Transmission<br />
Gathering<br />
Production/Flow<br />
Do any <strong>of</strong> these pipelines transport H2S? □ No<br />
PIPELINE<br />
SPECIFICATIONS<br />
Miles ___________<br />
O.D. ___________<br />
Wall<br />
Thickness ___________<br />
Pipe<br />
Grade ___________<br />
MAOP ___________<br />
Miles ___________<br />
O.D. ___________<br />
Wall<br />
Thickness ___________<br />
Pipe<br />
Grade ___________<br />
MAOP ___________<br />
Miles ___________<br />
O.D. ___________<br />
Wall<br />
Thickness ___________<br />
Pipe<br />
Grade ___________<br />
MAOP ___________<br />
Miles ___________<br />
O.D. ___________<br />
Wall<br />
Thickness ___________<br />
Pipe<br />
Grade ___________<br />
MAOP ___________<br />
Miles ___________<br />
O.D. ___________<br />
Wall<br />
Thickness ___________<br />
Pipe<br />
Grade ___________<br />
MAOP ___________<br />
Miles ___________<br />
O.D. ___________<br />
Wall<br />
Thickness ___________<br />
Pipe<br />
Grade ___________<br />
MAOP ___________<br />
CHECK ALL<br />
AS APPLICABLE<br />
*Rural<br />
Non-Rural<br />
Bay Area<br />
Offshore<br />
Navigable Waterway<br />
Environmentally<br />
Sensitive<br />
*Rural<br />
Non-Rural<br />
Bay Area<br />
Offshore<br />
Navigable Waterway<br />
Environmentally<br />
Sensitive<br />
*Rural<br />
Non-Rural<br />
Bay Area<br />
Offshore<br />
Navigable Waterway<br />
Environmentally<br />
Sensitive<br />
*Rural<br />
Non-Rural<br />
Bay Area<br />
Offshore<br />
Navigable Waterway<br />
Environmentally<br />
Sensitive<br />
*Rural<br />
Non-Rural<br />
Bay Area<br />
Offshore<br />
Navigable Waterway<br />
Environmentally<br />
Sensitive<br />
*Rural<br />
Non-Rural<br />
Bay Area<br />
Offshore<br />
Navigable Waterway<br />
Environmentally<br />
Sensitive<br />
CLASS<br />
LOCATION:<br />
1, 2, 3 or 4<br />
□ Yes Identify____________________________Concentration________ppm<br />
COUNTIES<br />
IF ADDITIONAL SPACE IS NEEDED, REPRODUCE THIS PAGE.<br />
Send completed report to: RAILROAD COMMISSION OF TEXAS, SAFETY DIVISION, PERMIT SECTION, P.O. BOX 12967, AUSTIN, TEXAS 78711-2967.<br />
___________________________________________________________<br />
NAME AND TITLE OF REPORTING OFFICIAL __________________________________________________________________<br />
SIGNATURE OF REPORTING OFFICIAL<br />
___________________________________________________________<br />
E-MAIL ADDRESS<br />
<strong>PS</strong>-<strong>8000A</strong> REVISED 01/09
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