RAILROAD COMMISSION OF TEXAS GAS SERVICES DIVISION GAS UTILITIES DOCKET DOCKET # 12-10226 PERMIT # PROTESTED: NO ACTIVE: YES APPLICANT # AND NAME: 6776 ATMOS ENERGY CORP., MID-TEX DIVISION REPRESENTATIVE NAME: Mr. Ryan D. Ginty PHONE: (972) 934-9227 Three Lincoln Centre, Ste. 1800 CITY CODE 5430 LBJ Freeway Dallas, , TX. 75240 0000 EXAMINER; CO EXAMINER: SUFFIX CODES:(1) JE (2) (3) SUMMARIZE: NO RELATED CASES APPLICATION STATUS: NOTICE NUMBER HEARING HOURS MOTION FOR REHEARING: MULTIPLE ORDERS APPLICATION FILED: NOTICE OF HEARING ISSUED: AMENDED NOH ISSUED: PRE-HEARING CONFERENCE: TRANSCRIPT RECEIVED: PETITION TO INTERVENE DUE: EXCEPTIONS DUE: EXCEPTIONS RECEIVED: REPLIES DUE: REPLIES RECEIVED: ORAL ARGUMENT: SUSPENSION ORDER: INTERIM ORDER SIGNED-1: INTERIM ORDER SIGNED-2: FINAL ORDER ISSUED: MFRH RECEIVED-1: MFRH RECEIVED-2: REPLIES TO MFRH DUE: REHEARING GRANTED: ORDER AFTER MFRH: APPEAL: SUBJECT TEXT REMARKS: 12/18/12 / / HEARING : HEARING CANCELLED: BRIEFS DUE: BRIEFS RECEIVED: PROPOSAL FOR DECISION DUE: PROPOSAL ISSUED: CONFERENCE : ADMIN CLOSED: CONFERENCE (INTERIM ORDER): CONFERENCE (MHR): SOI 35TH DAY: SOI SUSPENDED: SOI 150TH DAY/SUSP.: SOI PARTICIPATE REC: 185TH DAY/APPEAL: RESP. TEST. / EXH. DUE: RESP. TEST. / EXH. REC: INT. TEST. / EXH. DUE: INT. TEST. / EXH. REC: APPL. TEST / EXH. DUE: APPL. TEST. / EXH. REC: Inquiry Into the Failure of Atmos Energy Corp., Mid-Tex Division to Comply with Safety Standards (Filed By: Commission's Own Motion). / / BARRY T. SMITHERMAN, CHAIRMAN DAVID PORTER, COMMISSIONER CHRISTI CRADDICK, COMMISSIONER ^ y'^^^L OF T 54 LMDIL C. FOWLER, JR., GENERAL COUNSEL REESE B. COPELAND, DIRECTOR `'- ENFORCEMENT SECTION RAILROAD COMMISSION OF TEXAS OFFICE OF GENERAL COUNSEL TO: Carrie Ebbinghaus, GUD Safety Section FROM: Becky Tate, Legal Assistant to: Elaine Moore, Office of General Counsel - Enforcement DATE: Apri18, 2013 SUBJECT: GUD No. 10226: Enforcement Action Against Atmos Energy Corp., Mid-Tex Division for Violation of Commission Pipeline Safety Regulation Commission Enforcement action on the above-referenced docket has been finalized forthe following reason(s): Case dismissed: According to information provided by Carrie Ebbinghaus, the GUD Safety Section, would like to withdraw this docket. This docket is administratively closed. cc: Patti Richards, Vice President, Technical Services Atmos Energy Corp., Mid-Tex Division P,O. Box 223705 Dallas, TX 75222-3705 1701 NORTH CONGRESS AVENUE TDD 800-735-2989 OR TDY 512463-7284 * POST OPPICE Box 12967 * AUSTIN, TE%AS 78711-2967 AN EQUAL OPPORTUMTY EMPIAYER * PHONE: 512/463-6762 FAX: 512/463-6989 http://wmv.rrc.state.tc.us Elaine Moore From: Polly McDonald Sent: To: Cc: Subject: Thursday, April 04, 2013 8:25 AM Elaine Moore Carrie Ebbinghaus; David Flores GUD 10226 Elaine, We want to dismiss this docket. Based on informalion that Atmos submitted, it now appears that the gas involved in die fire was not released from piping operated by Atmos. Instead, it appears die gas source was more likely from customer piping downstream of die Atmos service meter to 331 West Woodin. Let me know if you need more information or have any questions. Thanks, Polly 1 BARRY T. SMITHERMAN, CHAIRMAN DAVID PORTER, COMMISSIONER CHRISTI CRADDICK, COMMISSIONER • . yCPTE O^' F t.', LINDIL C. FOWLER, JR., GENERAL COUNSEL REESE B. COPELAND, DIRECTOR ENFORCEMENT SECTIOi9 . RAILROAD COMMISSION OF TEXAS OFFICE OF GENERAL COUNSEL o w. r^°n ^ ^ °vm =' ow° March 12, 2013 rnc-jw Patti Richards, Vice President, Technical Services Atmos Energy Corp., Mid-Tex Division P.O. Box 223705 ^Dallas, TX 75222-3705 91 7199 9991 7030 8771 3473 Via First Class and CMRR # Re: N y3C . a< ^ ^ ^ ® v'^" Uj ^ S? SETTLEMENT OFFER - GUD No. 10226: Enforcement Action Against Atmos Energy Corp., Mid-Tex Division for Violations of Commission Pipeline Safety Regulations Dear Ms. Richards: This is to inform you that the above-referenced case has been referred to the Railroad Commission's Enforcement Section to pursue compliance and an administrative penalty against Atmos Energy Corp., Mid-Tex Division ("Atmos") for violations of Pipeline Safety Regulations 8.210(a)(1) [failure to telephonically notify the Commission within two hours of discovery of any event that involves a release of gas from its pipeline] and 49 CFR §192.613(b) [if a segment of a pipeline is determined to be in unsatisfactory condition but no immediate hazard exists, the operator shall initiate a program to recondition or phase out the segment involved]. These violations stem from a September 18, 2011 structure fire that occurred in Dallas, Texas that involved a natural gas leak. Although Atmos was notified of the incident at approximately 11:30 p.m. on Sunday, September 18th, Atmos did not report it to the Commission until approximately 7:56 a.m. on Monday, September 19th. Furthermore, although the leak was discovered on a 6-inch natural gas distribution cast iron main, which Atmos found to be in unsatisfactory condition, Atmos had failed to initiate a program to recondition or phase out the segment. Should this case go to hearing, Enforcement would be required to seek an administrative penalty of not less than $20,000.00 (one violation of Pipeline Safety Regulation 8.210(a)(1) at $10,000.00 and one violation of 49 CFR §192.613(b) at $10,000.00). However, if by or before April 19, 2013, Atmos pays a $10,000.00 penalty, cures the referenced violations, and signs and returns the attached Consent Order, Enforcement would be willing to accept a fifty percent reduction of the penalty that would otherwise be requested at hearing. For your information, the penalty must be paid by check made payable to the Railroad Commission, reference the fact that it is in payment of an administrative penalty in GUD No. 10226 and be sent to the Commission, Attn: Enforcement, at the address below. Also, please sign the order on the last page only and do not date it or fill in any other blanks. 1701 NORTH CONGRESS AVENUE TDD 800-735-2989ORTDY512-063-7284 * AUSTIN, TExAS 7 8711-2 9 6 7 * POST OFriCE Box 12967 ANEQwv.OrPOftTUNrn'EntPlAYeft FAx: 512/463-6989 * PHONE: 512/463-6762 http://wmv.rzc.statc.tx.us March 12, 2013 Patti Richards GUD ] 0226 Page 2 Please be advised that if I do not receive the penalty, signed order and confirmation of compliance by no later than 5:00 p.m. on Apri119te; this offer will be deemed to have been rejected and a Complaint will be filed. In such event there will be no opportunity for further negotiations. If you have any questions, do no hesitate to contact me. Sincerely, Ivloore; Staff-Attorney Enforcement Section Office of General Counsel Railroad Commission of Texas Phone: (512) 936-2301 Enclosure RAILROAD COMMISSION OF TEXAS GAS UTILITIES DOCKET NO. 10226 ENFORCEMENT ACTION AGAINST ATMOS ENERGY CORP., MID-TEX DIVISION (COMPANY ID NO. 6776) FOR VIOLATIONS OF PIPELINE SAFETY REGULATIONS AT THE DALLAS DISTRIBUTION SYSTEM (SYSTEM ID NO. 610134), DALLAS, DALLAS COUNTY, TEXAS CONSENT ORDER 2013, the above-entitled and numbered docket came day of On this the on for consideration by the Railroad Commission of Texas ("Commission"). The Enforcement Section of the Commission, through its attorney, announce that the Enforcement Section and Atmos Energy Corp., Mid-Tex Division ("Respondent") have agreed to an informal disposition of the matters under this docket through this Consent Order ("Order"), subject to the approval of the Commission. The Commission has authority to informally dispose of this case through a consent order pursuant to TEX. GOV'T CODE ANN. § 2001.056(3). IN SETTLEMENT OF THIS DOCKET, the Enforcement Section of the Commission and Respondent do hereby agree and stipulate as follows: 1. Respondent is a "gas utility" as that term is defined in Section 121.001 of the Texas Utilities Code. 2. Respondent is an "operator" as that term is defined in Title 16, Section 8.5(20) of the Texas Administrative Code. 3. Respondent is a "person" as that term is defined in Title 16, Section 8.5(21) of the Texas Administrative Code. 4. Respondent is a "gas company" as that term is defined in Title 16, Section 8.5(11) of the Texas Administrative Code. 5. The Enforcement Section and Respondent hereby agree that the alleged violations set forth in Gas Utilities Docket No. 10226, regarding Safety Evaluation No. 2011-3489, are hereby settled and compromised under the terms of this Order. 6. Respondent makes no admission of any alleged pipeline safety violation, but wishes to address the Commission's concerns under the terms of this Order. 7. The Commission wishes to further the goal of safe operations of gas pipeline facilities within the State of Texas. 8. Respondent has elected not to avail itself of the opportunity for public hearing. Consent Order, GUD No. 10226, Page 2 9. The Commission has jurisdiction to assess an administrative penalty against Respondent pursuant to Sections 121.206 and 121.207 of the Texas Utilities Code. 10. The violations alleged in Gas Utilities Docket No. 10226 have been placed in compliance by Respondent with the requirements of Pipeline SafetyRegulations 8.210(a)(1) and 49 CFR §192.613(b). 11. An administrative penalty in the amount of TEN THOUSAND DOLLARS ($10,000.00) shall be recovered by the Commission for the violations asserted against Respondent. 12. Respondent has placed into the possession of the Commission funds in the amount of TEN THOUSAND DOLLARS ( $10,000.00) as payment of administrative penalties assessed in Gas Utilities Docket No. 10226 pursuant to TEX. UTIL. CODE ANN. §§ 121.206 and 121.207. 13. The person signing hereunder for Respondent has authority to represent Respondent in this matter. Jurisdiction of this docket having been established and an agreement of the parties having been reached, it is, therefore, ORDERED by the Railroad Commission of Texas that Atmos Energy Corp., Mid-Tex Division is assessed an administrative penalty in the amount of TEN THOUSAND DOLLARS ( $10,000.00), and that Gas Utilities Docket No. 10226 is informally disposed of and closed by this Consent Order. Done this 2013. day of RAILROAD COMMISSION OF TEXAS (Order approved and signatures affixed by Master , 2013.) Agreed Order dated APPROVED AS TO FORM AND SUBSTANCE Atmos Energy Corp., Mid-Tex Division By: Patti Richards, Vice President, Technical Services Page 1 of 1 Ship Request File Copy Only. Texas Procurement And Support Service Tracking 9171999991703087713473 To: From: Name: Department: Phone: Remark1: Becky Tate 455 RRC/OGC-Enforcement section 463-4889 Ship To 1:: Ship To 2: Address: Patti Richards, V.P. Technical Services Atmos Energy Corp., Mid-Tex Division P. O. Box 223705 EEM: GUD10226 Remark2: Dallas, TX 75222 Remark3: Country: Reference: us S pec ial I nstructio ns: Requested Date: 3/12/2013 8:27:33 AM To print this form: 1) Click the Print button. (Print two copies, one to attach to your package and one to keep for your records.) 2) Place the form in a waybill pouch or attach it to your shipment so that the barcode portion of the page can be read and scanned. Print Form (1 of 1) http://pbtx.gl.com/dems/(S(f3 lqy 1 jwh l j rwavrofwyarj f))/ShipRequestFinal.aspx?demsid=Z9000005107... 3/12/2013 Railroad Commissio* Safety Division Docket Referral 12/10/12 10:22 AM Docket Number: Inspection Package ID: Page 1 of I 105024 Company: (6776)ATMOS ENERGY CORP., MID-TEX DIVISION Region Referral Date: Attorney: Status and Status Date: ❑ Referred to Legal: ❑ Agreed Order: ❑ Legal Negotiating; ❑ PFD° ❑ Complaint Filed: ❑ Dismissal: ❑ Hearing: Comments: It is requested that a $10,000 fine be assessed for each violation, Total Enhanced Penalty: $ 20,000.00 Penalty Amount Collected: Form PS-53 ^ Railroad Commissioo Safety Division Docket Referral: Violation List 12/10/12 10:22 AM Docket Number: Page 1 of 2 Inspection Package ID: 105024 Company: (6776)ATMOS ENERGY CORP., MID-TEX DIVISION Violation Code: 16C-210-001 The Pipeline Safety Section of the Railroad Commission was not telephonically notified of reportable accidents/incidents within two (2) hours following their discovery, Requirement: Title 16, 8.210 (a)(1) Violation Notes Evaluation ID Violation State 20113489 Uncorrected Previous Evaluation ID Location 300 W. Woodin Blvd. Dallas, Texas Note The incident was reported to the operator on Sunday, September 18, 2011 at 11:29pm, It was reported to the Pipeline Safety Section of the Railroad Commission on Monday, September 19, 2011 at 7:56 am. The operator failed to telephonically notify the Commission of the reportable incident within the required two (2) hours following its discovery. Penalties Evaluation ID 20113489 First Day of Non-compliance Days Out Of Compliance Penslty Amount Enhanced Penalty Amount $ 10,000.00 Enhancement Reason Straight Penalty Not Per Day Rated Violation Code: 192-613-003 The listed pipeline segment(s) was found in unsatisfactory condition, but there was no program to recondition or phase out the segment(s). Requirement: 49 CFR 192.613(b) Violation Notes Evaluation ID Violation State 20113489 Uncorrected Previous Evaluation ID Location Note 300 W. Woodin Blvd. Dallas, Texas Atmos Energy has cast-iron segments in some of their distribution systems. Although Atmos leak surveys its distribution systems as required by 49CFR192, there was no cast-iron replacement program in place to determine when these segments will be removed. Penalties Evaluation ID First Day of Non-compliance Days Out Of Compliance Penalty Amount Form PS-53 Enhanced Penalty Amount Enhancement Reason 12/10/12 10:22 AM 0 Railroad Commissios Safety Division Docket Referral: Violation List Docket Number: Page 2 of 2 Inspection Package ID: Company: (6776)ATMOS ENERGY CORP., MID-TEX DIVISION 105024 Penalties Evaluation ID 20113489 First Day of Non-compliance Days Out Of Compliance Penalty Amount Form PS-53 Enhanced Penaltv Amount $ 10,000.00 Enhancement Reason Straight Penalty Not Per Day Rated Barty T. Smitherman, Chairman David Porter, Commissioner Buddy Garcia, Commissioner Mary Ross McDonald Director RAILROAD COMMISSION OF TEXAS Pipeline Safety Division November 20, 2012 455-20 Ms. Patti Richards, V. P. Technical Services ATMOS ENERGY CORP., MID-TEX DIVISION P. O. Box 223705 Dallas, TX 75222-3705 Re: Pipeline Safety Evaluation Inspection Package Number: 105024 ATMOS ENERGY/DALLAS (All correspondence must include the Inspection Package Number) Dear Ms. Patti Richards: Recently, an incident, complaint, or other condition required our staff to conduct an investigation of pipeline facilities operated by your company. The facilities and the subject of the investigation are identified in the attached Safety Evaluation Summary. Investigations are conducted in accordance with pipeline safety requirements of the Texas Utilities Code, Section 121.201 for natural and other gas pipeline facilities and TEX. NAT. RES. CODE, Sections 117.001 and 117.011 (Vernon Supp, 2002) for hazardous liquid pipeline facilities. During the investigation, selected physical conditions, written procedures, and records were reviewed. At the time of this investigation, alleged violations of the minimum safety regulations were found and are detailed in this correspondence. Violations of the Pipeline Safety rules are subject to administrative penalties. The legal enforcement staff will contact you regarding any enforcement action that may apply as a result of the repeat violation(s) noted during the evaluation. The investigation results reflect the general status and condition of the entire system. It is your responsibility to take action, not only to correct the specific deficiencies listed in the attachment, but also to recognize and correct any other conditions which do not meet the minimum safety standards. If you have any questions or need assistance, do not hesitate to contact Jody Kerl in the Fort 1701 NORTH CONGRESS AVENUE • POST OFFICE BOX 12967' AUSTIN, TEXAS 78711-2967' PHONE (512) 463-7058 FAX (512) 463-7319 TDD (800) 735-2989 OR TOY (512) 463-7284 AN EQUAL OPPORTUNITY EMPLOYER November 20, 201* Page 2 • Worth Regional Office at (817) 882-8966. Sincerely, Mary oss McDonald Director Enclosure:. Safety Evaluation Summary Alleged Violation List 1701 NORTH CONGRESS AVENUE • POST OFFICE BOX 12967 • AUSTIN, TEXAS 78711-2967 `PHONE (512) 463-7058 FAX (512) 463-7319 TDD (800) 735-2989 OR TDY (512) 463-7284 AN EQUAL OPPORTUNITY EMPLOYER 11/20/12 2:56 PM Railroad Commission of As Safety Division Safety Evaluation Summary Page 1 of 1 Inspection Package: 105024 Activity/Classication: Specialized/Accident Operator: Unit: 6776 ATMOS ENERGY CORP., MID-TEX DIVISION Ms. Patti Richards V. P. Technical Services P. O. Box 223705 Dallas, TX 75222-3705 3374 ATMOS ENERGY/DALLAS Inspection Package Performed Start Date: 10/31/2011 End Date: 11/30/2011 Alleged Violations Eval No 20113489 System ID and Name System Type 610134 DALLAS Inspector(s) Jody Kerl Distribution Repeat Uncorrected Corrected Total 0 2 Regional Office Fort Worth Phone Number (817) 882-8966 San Sein Fort Worth (817) 882-8966 Terry Sullivan Fort Worth (817) 882-8966 0 2 Action A plan of correction is due by December 20, 2012 Important Note: The pipeline system(s) listed above are identified by a number and name and represent the physical pipe, valves and other components operated by your company. Additionally, there may be a pipeline system listed that is named System of Company ID Number where number is the identification number of your company. This system is used to represent your company and does not represent any physical pipeline system. For internai purposes it allows the Commission to more properly record inspection work performed at the company level. Where deficiencies are found in programs, plans, procedures, and records at the company level and are not with a specific physical system, alleged violations will be cited against the System of Company ID Number. • . • Railroad Commission of Mas Safety Division 11/20/12 2:56 PM Page 1 of 1 Alleged Violation List All correspondence must include the Inspection Package and Evaluation Number Inspection Package: 105024 Activity/Classication: Specialized/Accident System Name: DALLAS Evaluation Number: 20113489 Item Number: 1 Action Needed; Violation requires a plan of correction by December 20, 2012, Description: The Pipeline Safety Section of the Railroad Commission was not telephonically notified of reportable accidents/incidents within two (2) hours following their discovery. Requirement: Title 16, 8.210 (a)(1) Notes: Description: Other: Reportable Incident Location: 300 W. Woodin Blvd. Dallas, Texas Comment: The incident was reported to the operator on Sunday, September 18, 2011 at 11:29pm. It was reported to the Pipeline Safety Section of the Railroad Commission on Monday, September 19, 2011 at 7:56 am. The operator failed to telephonically notify the Commission of the reportable incident within the required two (2) hours following its discovery. Item Number: 2 Action Needed: Violation requires a plan of correction by December 20, 2012. Description: The listed pipeline segment(s) was found in unsatisfactory condition, but there was no program to recondition or phase out the segment(s). Requirement: 49 CFR 192.613(b) Notes: Description: Other: Procedure Location: 300 W, Woodin Blvd, Dallas, Texas Comment: Atmos Energy has cast-iron segments in some of their distribution systems. Although Atmos leak surveys its distribution systems as required by 49CFR192, there was no cast-iron replacement program in place to determine when these segments will be removed. • Railroad Commission of Tell Pipeline Safety Evaluation System Field Package Routing Sheet Inspection Package ID: 105024 Activity / Classification: Specialized / Accident Company: 6776 ATMOS ENERGY CORP., MID-TEX DIVISION Unit: 3374 ATMOS ENERGY/DALLAS INSPECTOR Lead Inspector: Jody Kerl Inspector(s); San Sein, Terry Sullivan Region(s): Fort Worth-6 Date Mailed to Supervisor: Database Change Form Included? ❑ Yes ❑ No Requires Invoice for 16 TAC 8.201 Fee ❑ Yes ❑ No ' SUPERVISOR Supervisor; Jody Kerl Date Reviewed: Date Mailed to Austim Legal Enforcement Requested: ❑ Yes ❑ No Director's Approval: HEADQUARTERS Database Change Complete:. Data Entry Complete: Letter Sent: Filed: Specialized Approval: Received: Notes: Distribution • Railroad Commission of Texs Pipeline Evaluation System Field Package ID: 105024, Specialized /Accident Company/Unit/System Data COMPANY INFORMATION Company 6776 ATMOS ENERGY CORP., MID-TEX Representative Mr. Jeffery Knight Title V. P. Technical Services Phone 214-206-2807 24 Hour Phone 866-322-8667 FAX 214-206-2126 E-Mail jeffery.knight@atmosenergy.com Please make any changes to address information in the shaded areas Type Address Line 1 Mailing Address P. O. Box 223705 Address Line 2 City, State Dallas, TX Zip Code 75222-3705 ddress Changes UNIT INFORMATION Unit 3374 ATMOS ENERGY/DALLAS Representative Mr. Terry Triern itle Survey & Corr. Supv. Phone 469-261-7461 24 Hour Phone 800-817-8090 FAX E-Mail Please make any changes to address information in the shaded areas Type Address Line 1 Mailing Address 2601 Logan Street Address Line 2 City; State Dallas, TX Zip Code 75215 ddress Changes Physical Address ddress Changes SYSTEMS SELECTED FOR EVALUATION System ID 610134 DALLAS S y stem Name S y stem Code Distribution Evaluation ID 20113489 • Railroad Commission of Tet Pipeline Evaluation System Field Package ID: 105024, Specialized / Accident Distribution Evaluation Data 12/10/2012 10:22 EVALUATION INFORMATION Page 1 of 2 C Evaluation ID 20113489 Company (6776) ATMOS ENERGY CORP., MID-TEX DIVISION Unit (3374) ATMOS ENERGY/DALLAS Begin Date 10/31/2011 End Date 11/30/2011 Miles Evaluated 3026.500 Integrity Code Risk Based Contact I Michael Green Contact I Title Operations Supervisor Contact 2 Contact 2 Title Contacted at 2601 Logan Street, Dallas SYSTEM INFORMATION CHANGES System ID 610134 System Name DALLAS Status Active Jurisdiction Jurisdictional Intra-Interstate Intrastate System Code (D) Distribution Gathering Type Install Year 1920 T4 Number 99999 Total Miles 3026.500 Region Fort Worth MILES BY COUNTY County Miles by County DALLAS 3026.50 Changes PREVIOUS EVALUATIONS Evaluation Activity / Classification 20121248 Standard / Comprehensive System ID Begin Date End Date 610134 05/07/2012 05/22/2012 Lead Inspector Terry Sullivan • Railroad Commission of Text Pipeline Evaluation System Field Package ID: 105024, Specialized / Accident Distribution Evaluation Data 12/10/2012 10:22 Page 2 of 2 PREVIOUS VIOLATIONS Evaluation Violation Code State Status Status Date 20121248 192-479-006 Corrected Complete 05/14/2012 20121248 192-463-001 Uncorrected Pending 05/22/2012 0 Railroad Commission of Te• Pipeline Evaluation System Field Package ID: 105024, Specialized / Accident Alleged Violations 12/10/2012 10:22 System: 610134 DALLAS Evaluation ID: 20113489 Item. No Violation Code ❑ Violation Type (Check One) Prev Eval No (Repeats Only) Page 1 of No vi Notes (Check One) 1 ❑ Uncorrected ❑ Corrected ❑ Repeat ❑ Y es ❑ No 2 ❑ Uncorrected ❑ Corrected ❑ Re p eat ❑ Y es ❑ No 3 ❑ Uncorrected ❑ Corrected ❑ Re p eat ❑ Y es ❑ No 4 ❑ Uncorrected ❑ Corrected ❑ Repeat ❑ Yes ❑ No 5 ❑ Uncorrected ❑ Corrected ❑ Re eat ❑ Yes ❑ No 6 ❑ Uncorrected ❑ Corrected ❑ Repeat ❑ Yes ❑ No ❑ Uncorrected ❑ Corrected ❑ Re eat ❑ Yes 7 8 ❑ Uncorrected ❑ Corrected ❑ Repeat ❑ Yes ❑ No 9 ❑ Uncorrected ❑ Corrected ❑ Re eat ❑ Yes ❑ No 10 ❑ Uncorrected ❑ Corrected ❑ Repeat ❑ Yes ❑ No 11 ❑ Uncorrected ❑ Corrected ❑ Repeat ❑ Yes ❑ No 12 ❑ Uncorrected ❑ Corrected ❑ Re eat ❑ Yes ❑ No 13 ❑ Uncorrected O Corrected Repeat ❑ Yes ❑ No ❑ No 10 Railroad Commission of Texas Pipeline Evaluation System Field Package ID: 105024, Specialized / Accident System Events/Comments 12/10/2012 10:22 System: 610134 DALLAS Evaluation ID: 20113489 Page 1 of 1 SYSTEM EVENTS Date System ID at Event 05/19/2010 610134 Total Miles Changed ID # 20101256, May 18, 2010 Milagage updated due to previous evaluation milage rounding. New milage is 3,026.5 miles From: 3062.5 To: 3026.5 05/08/2012 610134 Total Miles Changed 5/8/12 TES Added .828 Miles to this system due to pipe added to the Atmos distribution system. Total = 3,027,328 Miles From: 3026.5 To., 3027.33 Action Event Note SYSTEM COMMENTS Employee Date Comment System Conversion 02/06/2009 PER KATHRYN GUZMAN DB CHANGES 11/19/01, SYSTEM NAME CHANGED System Conversion 02/06/2009 FROM'DALLAS - QUAD I' TO 'DALLAS' AND THE FOLLOWING SYSTEMS System Conversion 02/06/2009 MERGED INTO THE DALLAS SYSTEM: DALLAS - QUAD II, III AND IV System Conversion 02106/2009 & UNIT NAME CHANGED FROM DALLAS NORTH TO DALLAS UNIT - SEC, System Conversion 02/06/2009 NORTH DALLAS(612024) COMBINED W/THE DALLAS DIST,. SYSTEM PER System Conversion 02/06/2009 KWG 04-0957 3/29/04 SEC, System Conversion 02/06/2009 OPERATOR CHANGE FROM TXU GAS DISTRIBUTION (5702) TO TXU GAS System Conversion 02/06/2009 COMPANY (6468) PER MLM 12/15/03 SEC. System Conversion 02/06/2009 OPERATOR CHANGE FROM TXU GS COMPANY (6468) TO ATMOS ENERGY System Conversion 02/06/2009 CORP., MID-TEX DIVISION (6776) PER MLM 4/7/05 SEC. System Conversion 02/06/2009 MILEAGE ADJUSTED FROM 2755.9 TO 2770.7 PER ARG EVALUATION System Conversion 02/06/2009 07-0719 5/25/07 SEC. System Conversion 02/06/2009 MILEAGE ADJUSTED FROM 2770.7 TO 3062.5 MILES PER BDB GROUP System Conversion 02/06/2009 EVALUATION 08-0667 5/28/08 SEC. • Railroad Commission of Texas Pipeline Evaluation System Field Package ID: 105024, Specialized / Accident Distribution System Data 12/10/2012 10:22 System: 610134 Evaluation ID: 20113489 Page 1 of 5 DALLAS SYSTEM DETAIL CURRENT INFORMATION Purchased Meters 9 Customers CHANGES 242565 Odorizers Provided By Self Odorizers ❑ Supplier ❑ Self ❑ No Change ❑ Bypass ❑ Wick ❑ Farm Taps 0 Drip ❑ Injection ❑ No Change 0 Odorizer Types Injection Odorant Scentinal E City Gate Stations 7 Patrol Points 84 Safety Related Condition #(s) N Farm Taps 0 Service Average Length (Ft) 30.600 Regulator Stations 125 Master Meter Regulator Stations 30 Low Pressure? Yes Cathodic Protection Zones 4100 Short Cathodic Pressure Sections ❑ Yes ❑ No 0 Casings 46 Shorted Casings 46 Unrepaired Grade 2 Leaks 13 Unrepaired Grade 3 Leaks 1172 Unrepaired Leaks As Of 04/25/2011 OVERPRESSURE PROTECTION TYPES Pressure Device Provided By Clianges. Monitor Relief MAXIMUM ALLOWABLE OPERATING PRESSURE MAOP 55 Location Changes IP @ pipeline 12 I Low pressure @ pipeline I I 200 I High Pressure @ pipeline I I 12/10/2012 10:22 System: 610134 Evaluation ID: 20113489 • Railroad Commission of Tex Pipeline Evaluation System Field Package ID: 105024, Specialized / Accident Distribution System Data DALLAS Page 2 of 5 0 Railroad Commission of Texas 12/10/2012 10:22 Page 3 of 5 Pipeline Evaluation System Field Package ID: 105024, Specialized I Accident Distribution System Data System: 610134 Evaluation ID: 20113489 DALLAS SUPPLIERS System ID 632316 System Name Company ID D (MESQUITE TO IRVING) 6777 Company Name ATMOS PIPELINE - TEXAS REPAIRED LEAKS Leak Data Date: Leak Cause Corrosion 12/31/2010 Main Leaks 141 Service Leaks 228 62 281 1 3 9 24 65 170 Natural Forces Excavation Other Outside Force Damage Material or Welds Equipment Operations Other MILES.OF MAIN BY SIZE *Reminder: Ranges listed are for historical information. New data collected should be detailed by individual pipe size and type. Pipe Type Pipe Size Miles of 3. inch equivalent Miles 4615.50 Steel Unprotected Bare 2" or Less 4.419 Steel Unprotected Bare Over 2" Thru 4" 4.561 Steel Unprotected Bare Over 4" Thru 8" 3.443 Steel Unprotected Bare Over 8" Thru 12" 0.009 Steel Protected Coated 2" or Less 418,160 Steel Protected Coated Over 2" Thru 4" 818.900 Steel Protected Coated Over 4" Thru 8" 334.120 Steel Protected Coated Over 8" Thru 12" 62,156 Steel Protected Coated Over 12" 119.300 Cast/Wrought Iron Over 2" Thru 4" 313.267 Cast/Wrought Iron Over 4" Thru 8" 224.629 Cast/Wrought Iron Over 8" Thru 12" 4.306 Cast/Wrought Iron Over 12" 0.263 PE 2" or Less 349.701 12/10/2012 10:22 System: 610134 Evaluation ID: 20113489 Railroad Commission of Teo Pipeline Evaluation System Field Package ID: 105024, Specialized / Accident Distribution System Data Page 4 of 5 DALLAS MILES OF MAIN BY SIZE *Reminder: Ranges listed are for historical information. New data collected should be detailed by individual pipe size and tvpe. Pipe Type Pipe Size Miles of 3 inch equivalent Miles 4615.50 PE Over 2" Thru 4" 266.622 PE Over 4" Thru 8" 102.184 PE Over 8" Thru 12" 0.290 PE Over 12" 0.176 NUMBER OF SERVICES BY SIZE *Reminder: Ranges listed are for historical information. New data collected should be detailed by individual Pipe Type Pipe Size Services Steel Protected Coated 1" or Less 11115 Steel Protected Coated Over 1" Thru 2" 86119 Steel Protected Coated Over 2" Thru 4" 432 Steel Protected Coated Over 4" Thru 8" 75 PE 1" or Less 48842 I I PE Over 1" Thru 2" 9472 I PE Over 2" Thru 4" 252 PE Over 4" Thru 8" 15 12/10/2012 10:22 System: 610134 Evaluation ID: 20113489 0 Railroad Commission of Tet Pipeline Evaluation System Field Package ID: 105024, Specialized / Accident Distribution System Data Page 5 of 5 • DALLAS LOST AND UNACCOUNTABLE GAS Reporting Month June 2010 Evaluation Comment: No Evaluation Comment MCF Purchased 129537343.000 MCF Lost 125782077,000 0 Railroad Commission of Tex'dR Pipeline Evaluation System Field Package ID: 105024, Specialized / Accident Alleged Violations 12/10/2012 10:22 System: 610134 Evaluation ID: 20113489 Page 1 of 1 DALLAS VIOLATIONS Item Number: I Description: The Pipeline Safety Section of the Railroad Commission was not telephonically notified of reportable accidents/incidents within two (2) hours following their discovery, Requirement: Title 16, 8.210 (a)(1) Notes: , Descriptiont Other: Reportable Incident Location: 300 W. Woodin Blvd. Dallas, Texas Comment: The incident was reported to the operator on Sunday, September 18, 2011 at 11:29pm.. It was reported to the Pipeline Safety Section of the Railroad Commission on Monday, September 19, 2011 at 7:56 am. The operator failed to telephonically notify the Commission of the reportable incident within the required two (2) hours following its discovery. Item Number: 2 Description: The listed pipeline segment(s) was found in unsatisfactory condition, but there was no program to recondition or phase out the segment(s). Requirement: 49 CFR 192.613(b) Notes: Description: Other: Procedure Location: 300 W. Woodin Blvd. Dallas, Texas Comment: Atmos Energy has cast-iron segments in some of their distribution systems. Although Atmos leak surveys its distribution systems as required by 49CFR192, there was no cast-iron replacement program in place to determine when these segments will be removed. 10 Pipeline System: Pipeline Failure Investigati3h Report Dallas _ Operator: Operator ID: 6776 Location: Unit Number: 3374 331 W. Woodin Blvd., Dallas, TX Material Released: Investigation Responsibility: Activity Number: Date of Occurrence: Natural Gas Quantity: PHMSA Arrival Time & Date: N/A _X_ State Company ReportedApparent Cause: ATMOS Energy Corp., Mid-Tex Division 09-18-2011 unknown Total Damages $: - PHMSA _ NTSB unknown _Other Company Reported Sub-Cause (from PHMSA Form 7000-1/7I00.2): Corrosion X Natural Force Damage Excavation Damage Lightning Strike Other Outside Force Damage Material Failure (Pipe, Joint, Weld) Equipment Failure Incorrect Operation Other Accident/Incident Resulted in (check all that apply): Rupture Comments: X Leak Fire Explosion Evacuation Number of Persons: Area: Narrative Summary Short summary of the Incident/Accident scenario On Sunday, September 18, 2011, at approximately 11:30 p.m., a structure fire occurred at 331 W. Woodin Blvd., in Dallas, Texas. There were three injuries as a result of the incident, which required hospitalization. Subsequent investigation by Atmos Energy revealed that there was a natural gas leak in the alley on the main behind 331 W. Woodin Blvd. The leak was found on a six-inch natural gas distribution cast iron main, and was eliminated by installing a steel full circle band clamp. The natural gas distribution system is owned and operated by Atmos Energy. Region/State: R6/ TEXAS Principal Investigator: Date: 12-22-2011 Ruben Cepeda Reviewed by: Title: Inspector Date: Page 1 of 24 Form -11 Pipeline Failure Investigation Report (Rev. 03/17/2011 through Amdt. 192-116 & 195-95).. 0 Pipeline Failure Investigation Report Failure Location & Response Location (City, Township, Range, County/Parish): Dallas, Dallas County Address or M.P. on Pipeline: 331 West Woodin Blvd. f 1 Type of Area (Rural, City): City Coordinates of failure location (Latitude):. 32 43 20"N Date: (Acquire Map) t'1 (Longitude): 96 49' 39" W 09-18-2011 Time of Failure:, Time Detected: 1:15 a.m. CST ; 09-19-2011 How Located: Leak survey over the gas main after the incident occurred unknown Time Located: 1:15 a.m. CST; 09-19-2011 NRC Report #: Time Reported to NRC:: Reported by, 990183 10:48 a.m. CST; 09-20-2011 ATMOS-Michael Green Type of Pipeline:, Gas Distribution Gas Transmission - LP - Municipal _X_ Public Utility _ Master Meter Hazardous Liquid _ Interstate Gas _ Interstate Liquid _ Intrastate Gas _ Intrastate Liquid _ Gas Gathering _ Offshore Liquid _ Offshore Gas _ Liquid Gathering _ CO2 _ Low Stress Liquid HVL _ Offshore Gas - High H2S _ LNG Pipeline Configuration (Regulator Station, Pump Station, Pipeline, etc.):, A low pressure six-inch cast iron main supplying a one and one-quarter-inch steel service line. The main and service lines are located in the alley behind 331 W. Woodin Blvd., the meter is located at the property line on W. Louisiana Ave. Operator/Owner Information Owner: ATMOS Energy Corp., Mid-Tex Division Address: P.O. Box 223705 Dallas, Texas Operator: ATMOS Energy Corp., Mid-Tex Division Address: P.O. Box 223705 Dallas, Texas Company Official: Ms. Patti Richards Company Official: Ms. Patti Richards Phone No.: 214-206-2807 Phone No. 214-206-2807 Fax No.,, 214-206-2126 Fax No. 214-206-2126 Drug and Alcohol Testing Program Contacts _ N/A Drug Program Contact & Phone: Carlotta Brown, 5430 LBJ Freeway Suite 500, Dallas, TX 75240 -972-855-4048 Alcohol Program Contact & Phone: Carlotta Brown, 5430 LBJ Freeway Suite 500, Dallas, TX 75240 -972-855-4048 I Photo documentation Page 2 of 24 Form - 11 Pipeline Failure Investigation Report (Rev. 03/17/2011 through Amdt. 192-116 & 195-95). •Pipeline Failure lnvestigativReport Damages Product/Gas Loss or Spilltzl Amount Recovered unknown Estimated Property Damage $ 30,000 N/A Associated Damagest'1$ 91,700 Estimated Amount $ unknown Description.of Property Damage: The dwelling attached to the garage behind the house residing at 331 W. Woodin Blvd., Dallas, Texas was completely destroyed. Customers out of Service: X_ Yes No Suppliers out of Service: Yes X No Number: I Number: N/A Fatalities and Injuries N/A Fatalities: _ Yes _X_No Company; Contractor:, Public: Injuries - Hospitalization:, _X_Yes _No Companyt Contractor: Publ(c:3 _X No Company: Contractor: Public: Company: Contractor: Public: 3 Injuries - Non-Hospitalization:, - Yes Total Injuries (including Non-Hospitalization): Name 3 Yrs. w/ Comp. Job Function Yrs. Exp. Type of Injury Domingo Mantez Public N/A N/A Burned Juliana Mantez Public N/A N/A Burned Pablo Mantez Child N/A N/A Burned Drug/Alcokol Testing _X_ N/A Were all employees that could have contributed to the incident, post-accident tested within the 2 hour time frame for alcohol or the 32 hour time frame for all other drugs? Yes No Job Function Test Date & Ti me L ocati on System Description 2 Initial volume lost or spilled 3 Including cleanup cost Page 3 of 24 Form -11 Pipeline Failure Investigation Report (Rev. 03/17/2011 through Amdt. 192-116 & 195-95). Results Pos Neg Type of Drug 0 Pipeline Failure lnvestigatio'7f Report System Description Describe the Operator's System: Atmos records were reviewed to obtain information regarding the operation of the pipeline. The natural gas distribution system is owned and operated by Atmos Energy Corp. At the time of the incident the line pressure was 5.1 o.s.i.g., as determined by the nearest regulator station on Ohio and R.L. Thornton Fwy, DRS No.151. The maximum allowable operating pressure (MAOP) is 12 o.s.i.g. The six-inch cast iron main supplying 331 W. Woodin Blvd. is located behind the residence in the dirt alley that crosses Woodin Blvd., and Louisiana Street. The original main installation is project number ER C-254-36. Archived Lone Star Gas (now Atmos) records indicate the project was completed on May 261h 1930. The service line supplying 331 W. Woodin Blvd. is one and one-quarter-inch steel pipe, the original service line installation information could not be located by Atmos Energy. Pipe.Failure Description Length of Failure (inches, feet, miles): - 19.5 inches t') Position (Top, Bottom, include position on pipe, 6 O'clock): f) Bottom side, fracture on pipe was seen from 11 O'clock counter clockwise to 1 O'clock. Laboratory Analysis: Performed by, N/A _X_ Yes Description of Failure (Corrosion Gouge, Seam Split): Graphitization: iron seeped out from metal resulting in a more brittle pipe wall. See attached report. -No Materials Analysis, Inc. Preservation of Failed Section or Component: _X_Yes No Atmos Energy Corp. welded four metal six-inch skinner clamps to a 63 inch flat metal frame. The framing was secured to the pipe prior to cutting. The section of natural gas pipe was cut using a chain cutter and hydrolic pump. Chains were secured to the framing and removed using a backhoe, the section of pipe was then photographed, measured, wrapped in seleophane, and secured to a trailer for transport. In Custody of, Unified Investigation and Sciences Inc. and Materials Analysis, Inc. Develop a sketch of the area including distances from roads, houses, stress inducing factors, pipe configurations, direction of flow, etc. Bar Hole Test Survey Plot, if included, should be outlined with concentrations at test points. Component Failure Description N/A Component Failed: Manufacturer: Model: Pressure Rating: Size: X (^) Other (Breakout Tank, Underground Storage): Pipe Data Material: Cast Iron Wall Thickness/SDR: 0.253 inch Diameter (O.D.): 6 inch Installation Date: May 26,1930 SMYS: N/A Manufacturer: unknown Page 4 of 24 Form -11 Pipeline Failure Investigation Report (Rev. 03/17/2011 through Amdt. 192-116 & 195-95). _ N/A •Pipeline Failure Investigation Report Longitudinal Seam: Pipe Data Type of Coating: N/A N/A. None Pipe Specifications (API 5L, ASTM A53, etc.): N/A . Joining N/A Type: Bell Joint Procedure: NDT Method: Inspectedt N/A Yes No Pressure @ Time of Failure @Failure Site Pressure @ Failure Site: 5.1 ounces N/A Elevation @ Failure Site: 56 ft Pressure Readings @ Various Locations: Direction from Failure Site Location/M.P./Station # Pressure (psig) Elevation (ft msl) Upstream Ohio & R.L. Thornton Fwy DRS 151 5.1 o.s.i.g. 56 ft Upstream Upstream Pump Station Data _X N/A Type of Product: API Gravity: Specific Gravity: Flow Rate: Pressure @ Time of Failure (4) Distance to Failure Site: High Pressure Set Point: Low Pressure Set Point: Upstream Compressor Station Data X_ N/A Specific Gravity: Flow Rate: Pressure @ Time of Failure (4) Distance to Failure Site: High Pressure Set Point: Low Pressure Set Point: Max. Allowable Operating Pressure: 12 o.s.i.g Downstream Operating Pressure Determination of MAOP: Pressure tested _ N/A Actual Operating Pressure: 5.1 o.s.i.g. Method of Over Pressure Protection: Monitor set at 7 o.s.i.g. - DRS 151 Relief Valve Set Point: None Capacity Adequate? _X_ Yes No Integrity Test After Failure - N/A Pressure test conducted in place? (Conducted on Failed Components or Associated Piping): If No, tested after removal? Method: Yes Pressure tested for 5 minutes at 5.25 o.s.i.g. on isolated section of pipe. 4 Obtain event logs and pressure recording charts Page 5 of 24 Form - 11 Pipeline Failure Investigation Report (Rev. 03/17/2011 through Amdt. 192-116 & 195-95). No X_ Yes No •Pipeline Failure Investigatio•Report Integrity Test After Failure N/A Describe any failures during the test. The isolated section of natural gas main and three service lines to the residents of 330 W. Louisiana Ave, 331 W. Woodin Blvd. and 326 W. Louisiana Ave. were pressure tested. This test included the section of pipe to be removed, with a temporary repair in place. No leaks were found. Soil/waterConditions @ Failure Site Condition of and Type of Soil around Failure Site (Color, Wet, Dry, Frost Depth): Dry, clay based soil N/A Type of Backfill (Size and Description): N/A Type of Water (Salt, Brackish): N/A Water Analysis _ Yes _X No External Pipe or Component Examination External Corrosion? _X_Yes _ No _ N/A Coating Condition (Disbonded, Non-existent): None Description of Corrosion: Lab report attached. Description of Failure Surface (Gouges, Are Burns, Wrinkle Bends, Cracks, Stress Cracks, Chevrons, Fracture Mode, Point of Origin): Crack along surface of pipeline. (see Attachments-photo page) Above Ground: _ Yes _X_ No Buried: Stress Inducing Factors: Unknown X Yes _ No Depth of Cover: 44 inches Cathodic Protection P/S (Interface): P/S (Surface): Soil Resistivity: pH: N/A Date of Installation: Method of Protection: Did the Operator have knowledge of Corrosion before the Incident? _ Yes _ No How Discovered? (Close Interval Survey, Instrumented Pig, Annual Survey, Rectifier Readings, ECDA, etc): Internal Corrosion: Yes Type of Inhibitors: Internal Pipe or Component Examination M Injected Inhibitors: - Yes No Testing: _ Yes 5 Attach copy of water analysis report Page 6 of 24 Form -11 Pipeline Failure Investigation Report (Rev. 03/17/2011 through Amdt. 192-116 & 195-95). _ No X N/A - No •Pipeline Failure Investigati•Report Internal Pipe or Component Examination Results (Coupon Test, Corrosion Resistance Probe): X N/A Description of Failure Surface (MIC, Pitting, Wall Thinning, Chevrons, Fracture Mode, Point of Origin): Cleaning Pig Program: _ Yes No Gas and/or Liquid Analysis; _ Yes _ No Results of Gas and/or Liquid Analysis Internal Inspection Survey: - Yes No Results Did the Operator have knowledge of Corrosion before the Incident? - Yes -No How Discovered? (Instrumented Pig, Coupon Testing, ICDA, etc.): Outside Force Damage Responsible Party: _X N/A Telephone No.: Address: Work Being Performed: Equipment Involved: Called One Call System? One Call Name: One Call Report # t$^ Notice Date: Response Date: Time: Time: Details of Response: Was Location Marked According to Procedures? Yes No Pipeline Marking Type: cation; 77 State Law Damage Prevention Program Followed? _ Yes 7 _ No _ No State Law 6 Attach copy of gas and/or liquid analysis report 7 Attach copy of internal inspection survey report 8 Attach copy of one-call report Page 7 of 24 Form -11 Pipeline Failure Investigation Report (Rev. 03/17/2011 through Amdt. 192-116 & 195-95). Yes _ No •Pipeline Failure Investigatio'7f Report Outside Force Damage Notice Required: _Yes No X N/A Response Required: _ Yes Was Operator Member of State One Call? _ Yes _ No _ No Was Operator on Site? - Yes _ No Did a deficiency in the Public Awareness Program contribute to the accident? _Yes - No Is OSHA Notification Required? _ Yes _ No Natural Forces N/A Description (Earthquake, Tornado, Flooding, Erosion): See attached Dallas Fire Department report for information regarding lightning. Failure Isolation N/A t') Squeeze Off/Stopple Location and Method: A six-inch band clamp was installed by Atmos Energy, as a temporary repair on September 19, 2011 at 5:30 a.m. Valve Closed - Upstream: N/A I.D.: Time: M.P.: Valve Closed - Downstream: N/A I.D.: Time: M.P,: Pipeline Shutdown Method: _ Manual Failed Section Bypassed or Isolated: _ Controller _ ESD Valve Spacing: N/A Odorization N/A Concentration of Odorant (Post Incident at Failure Site): _ No Method of Determination: - Yes _ No Odorant test Was Odorizer Working Prior to the Incident? _X_Yes _ SCADA N/A Performed By: Eddie Luis Gas Odorized: _X_Yes _ Automatic _No % LEL: - Yes _X_ No % Gas In Air: X_ Yes ^ No Time Taken: X_ Yes _ No Type of Odorizer (Wick, By-Pass): 12:22 PM Injection Odorant Manufacturer: Type of Odorant: Model: NJEX 8200 Serial No. 241 Scentinel0-10 Amount Injected: See below Monitoring Interval (Weekly): Annually Odorization History (Leaks Complaints, Low Odorant Levels, Monitoring Locations, Distances from Failure Site); Records indicate the last odorization test for this natural gas distribution system was performed on 08-19-2011with a threshold reading of .32% gas to air with a readily detectable reading of .66% gas to air. The odorant test was taken at 1111Kiest Blvd., Dallas, Texas. On Monday 09-19-2011at 12:22 a.m. CST Atmos Energy service tech. performed an odorant test at 330 W. Louisiana Ave., Dallas, Texas. The threshold reading of .28% gas to air was noted. The 1% gas in air was.strong. Page 8 of 24 Form -11 Pipeline Failure Investigation Report (Rev. 03/17/2011 through Amdt. 192-116 & 195-95). Pipeline Failure Investigati•Report Odorization N/A Dallas natural gas distribution system receives odorant from Odorizer No. 254, Location Kerens Gate. Dated 6/30/2011. Injection rate 87.61 Lbs since last reading. 59.2 MMCF, 1.480 MMCF odorized gas injected. Dated 7/29/2011. Injection rate 255.76 Lbs since last reading. 210 MMCF. 1.2180 MMCF odorized gas Injected Weather Conditions Wind (Direction & Speed): Temperature: Climate (Snow, Rain): Clear Sunny _ N/A Humidity: Was Incident preceded by a rapid weather change? _ Yes _X_ No Weather Conditions Prior to Incident (Cloud Cover, Ceiling Heights, Snow, Rain, Fog): A recorded rainfall of 0.17 inches was reported for September 18, 2011 for Dallas County. Gas Migration Survey Bar Hole Test of Area: X Yes No N/A Equipment Used: Sensit Gold, RMLD Method of Survey (Foundations, Curbs, Manholes, Driveways, Mains, Services) (9) (1) Bar hole testing and a Remote Methane Leak Detector (RMLD) survey was performed along the Main and Services. Atmos Energy retained records of all bar- test data post incident. At the time the incident was reported, Atmos onsite supervisor reported to RRC Investigator R.Cepeda that the initial leak survey detected 88% natural gas over the main. Atmos graded this natural gas leak to a hazardous leak, Grade 1. Bar hole testing could only be done after the water had dissipated. Bar testing was performed along the main and service to 331 W. Woodin Blvd. The reading at the vent stack and sewer clean out was 0%. Environment Sensitivity Impact X N/A Location (Nearest Rivers, Body of Water, Marshlands, Wildlife Refuge, City Water Supplies that could be or were affected by the medium loss): OPA Contingency Plan Available? - Yes _ No Followed? - Yes _ No Class Location/High Consequence Area Class Location: 1 2_ 3_X 4 Determination: Residential distribution Odorization Required? _X_ Yes HCA Area? Determination: _ No _ Yes - N/A 9 Plot on site description page Page 9 of 24 Form -11 Pipeline Failure Investigation Report (Rev. 03/17/2011 through Amdt. 192-116 & 195-95). tt/ X N/A _ No X_ N/A •Pipeline Failure InvestigatioTfReport Pressure Test History _ N/A (Expand List as Necessary) Req'd (10)Assessment Deadline Date Test Date Test Medium Pressure (psig) Duration (hrs) % SMYS N/A unknown unknown unknown unknown unknown N/A 9/20/2011 Gas 5.25o.s.i.g. 5mins N/A Installation Next Next Most Recent Describe any problems experienced during the pressure tests. No records could be found on the pressure test data for the main and service lines. The main and service lines were installed prior to applicable code. 7nternalLineInspection/OtherAssessmentHistory - " Req'd t101 Assessment Deadline Date ' X N/A (Expand List as Necessary) Assessment Date Type of ILI Tool t tl Other Assessment Method t12l Initial Indicated Anomaly If yes, describe below Yes _ No Next i Yes _ No Next Yes _ No _ Yes No Most Recent Describe any previously indicated anomalies at the failed pipe, and any subsequent pipe inspections (anomaly digs) and remedial actions. Pre-Failure Conditions andActions - X N/A Was there a known pre-failure condition requiring t101 the operator to schedule evaluation and remediation? Yes (describe below or on attachment) - No If there was such a known pre-failure condition, had the operator established and adhered to a required t101 evaluation and remediation schedule? Describe below or on attachment, - Yes _ No - N/A Prior to the failure, had the operator performed the required t101 actions to address the threats that are now known to be related to the cause of this failure? Yes _ No _ N/A List below or on an attachment such operator-identified threats, and operator actions taken prior to the accident. Describe any previously indicated anomalies at the failed pipe, and any subsequent pipe inspections (anomaly digs) and remedial actions. 10 As required of Pipeline Integrity Management regulations in 49CFR Parts 192 and 195 11 MFL, TFI, UT, Combination, Geometry, etc. 12 ECDA, ICDA, SCCDA, "other technology," etc, Page 10 of 24 Form -11 Pipeline Failure Investigation Report (Rev. 03/17/2011 through Amdt. 192-116 & 195-95). *Pipeline Failure InvestigatAReport Maps & Records _X_ Yes _ No N/A Are Maps and Records Current? (r;) Comments: The Atmos map survey sheet for 331 W. Woodin Blvd is 5464. The map sheet includes the end street Brookhaven from W. Woodin to the alley way. The map sheet 5464 also includes the two-block area where a special leak survey was performed post incident. Leak Survey History N/'fl Leak Survey History (Trend Analysis, Leak Plots): Pipe Type Units Services Type Job Number Date Completed Brown, Bill -HC Cl 2730 22 LSA 614010 12108/2009 Brown, Bitl -HC Cl 2730 22 LSA 520550 03127/2008 Inspector Atmos Energy personnel performed additional leak surveys of Map Sheet no.5464, 5456 on September 19,2011. During the leak survey, one leak was detected behind the meter index at 341 W. Woodin Blvd, Dallas, Texas. The meter was replaced by Atmos Energy on September 27, 2011. The service order number is 8009433792. Pipeline Operation History N/A Description (Repair or Leak Reports, Exposed Pipe Reports): Atmos records were reviewed for un-repaired leaks, and there were no open leaks found for 331 W. Woodin Blvd. Repaired leaks were also reviewed and there have been no previous repairs made at 331 W. Woodin Blvd. Leak Investigation Orders (LIO's) were reviewed for the 300 block of W. Woodin.Blvd, W. Louisiana St. and Brookhaven Dr., Dallas, Texas, from October 2004 to present. On September 18, 2011 an LIO number 8009407602 was created for 335 W. Woodin Blvd., Dallas Texas. On September 19, 2011, LIO Number 8009407975 was created for 332 W. Woodin Blvd., Dallas, Texas. Did a Safety Related Condition Exist Prior to Failure? _ Yes _X_ No Reported? - Yes _ No Unaccounted For Gas: The Dallas distribution system lost and unaccounted for gas (LUG) was 3.39% for the 12 month June 2011 ending period. Over & Short/Line Balance (24 hr., Weekly, Monthly/Trend): N/A 13 Obtain copies of maps and records Page 11 of 24 Form -11 Pipeline Failure Investigation Report (Rev. 03/17/2011 through Amdt. 192-116 & 195-95). .Pipeline Failure InvestigatiOReport Operator/ContractorError _X N/A Name: Job Function: Title: Years of Experience: Training (Type of Training, Background): Was the person "Operator Qualified" as applicable to a precursor abnormal operating condition? Was qualified individual suspended from performing covered task _ Yes Yes _ No N/A No - N/A Type of Error (Inadvertent Operation of a Valve): Procedures that are required: Actions that were taken: Pre-Job Meeting (Construction, Maintenance, Blow Down, Purging, Isolation): Prevention of Accidental Ignition (Tag & Lock Out, Hot Weld Permit): Procedures conducted for AccidentalIgnition: Was a Company Inspector on the Job? - Yes _ No Was an Inspection conducted on this portion of the job? - Yes - No Additional Actions (Contributing factors may include number of hours at work prior to failure or time of day work being conducted): Training Procedures: Operation Procedures: Controller Activities: Name Title Years Experience Alarm Parameters: High/Low Pressure Shutdown: Flow Rate: Procedures for Clearing Alarms: Type of Alarm: Company Response Procedures for Abnormal Operations: Page 12 of 24 Form -11 Pipeline Failure Investigation Report (Rev. 03/17/2011 through Amdt. 192-116 & 195-95). Hours on Duty Prior to Failure Shift • Pipeline Failure lnvestigatiOReport Operator/Contractor Error Over/Short Line Balance Procedures: Frequency of Over/Short Line Balance: Additional Actions: Page 13 of 24 Form -11 Pipeline Failure Investigation Report (Rev. 03/17/2011 through Amdt. 192-116 & 195-95). _X N/A ' 01Pipeline Failure InvestigatiOReport AdditionalActions Taken by the Operator N/A Make notes regarding the emergency and Failure Investigation Procedures (Pressure reduction, Reinforced Squeeze Off, Clean Up, Use of Evacuators, Line Purging, closing Additional Valves, Double Block and Bleed, Continue Operating downstream Pumps): On Sunday, September 18,2011 Atmos Energy service technician arrived on site to remove customer meter during a structure fire and after performing the leak survey a "Grade 1" leak was detected. A crew was called in and the main was excavated. Atmos installed a band clamp as a temporary repair. The isolated section of natural gas main and three service lines to the residents of 330 Louisiana, 331 Woodin and 326 Louisiana were pressure tested. This test included the section of pipe to be removed, with a temporary repair in place. No leaks were found. Poly pipeline was installed above ground for temporary service and the hazardous areas were barricaded when workers were not on-site. Operator personnel stayed on-site for 24 hour supervision of the incident area. The cast-iron main was sectioned off towards the east end. Approximately 40 feet of pipeline was abandoned in place. 249 feet of four inch poly main was installed, with a total of seven services on September 26n' 2011: The temporary service replacement was buried and made permanent. No other hazardous leakage was determined in the vicinity. Photo Documentation l1^ Overall Area from best possible view, Pictures from the four points of the compass. Failed Component, Operator Action, Damages in Area, Address Markings, etc. Photo No. Description Photo No. 1 Incident site, 331 W. Woodin Blvd., Dallas TX. 16 2 Damage to the dwelling shown behind residence. 17 3 Band clamp installed, prior to RRC arrival. 18 4 Section of main removed. 19 5 Pipe section removed for transport. 20 6 Pipe main secured under custody of Unified Investigations & Sciences, Inc. 21 7 Replaced cast-iron main with 4 inch poly. 22 8 Band clamp removed, crack on main exposed. 23 9 24 10 25 11 26 12 27 13 28 14 29 15 30 Camera Type: Cannon Power Shot Page 14 of 24 Form -11 Pipeline Failure Investigation Report (Rev. 03/17/2011 through Amdt. 192-116 & 195-95). Description loPipeline Failure InvestigatiOReport Photo 1: 331 W. Woodin Blvd, Dallas TX. Incident site. Photo 2: Damage to Dwelling. Page 15 of 24 Form -11 Pipeline Failure Investigation Report (Rev. 03/17/2011 through Amdt. 192-116 & 195-95). OPipeline Failure InvestigatJOReport Photo 3: Band clamp shown on cast-iron main. Photo 4: Section of main removed by chain-cutter. Page 16 of 24 Form -11 Pipeline Failure Investigation Report (Rev. 03/17/2011 through Amdt. 192-116 & 195-95). *Pipeline Failure InvestigatJOReport Photo 5: Pipe section removed for transport. Photo 6: Secured for transport Page 17 of 24 Form -11 Pipeline Failure Investigation Report (Rev. 03/17/2011 through Amdt. 192-116 & 195-95). *Pipeline Failure InvestigatiOReport Photo 7: Replaced cast-iron main with 4 inch Poly. Photo 8: Band clamp removed, fracture on main exposed. Page 18 of 24 Form -11 Pipeline Failure Investigation Report (Rev. 03/17/2011 through Amdt. 192-116 & 195-95). 10Pipeline Failure InvestigatiWeport Photo 9: Surface facture on main. Page 19 of 24 Form -11 Pipeline Failure Investigation Report (Rev. 03/17/2011 through Amdt. 192-116 & 195-95). OPipeline Failure lnvestigatiOReport Additional Information Sources Agency Title Phone Number Investigators 214-670-4312 Name Police: Fire Dept.: Dallas Nichols / Batchelar State Fire Marshall: State Agency: NTSB: EPA: USCG: FBI: ATF: OSHA: Insurance Co.: FRA: MMS: Television: Newspaper: Other: Persons Interviewed Name Michael Green Title Operations Supervisor Page 20 of 24 Form -11 Pipeline Failure Investigation Report (Rev. 03/17/2011 through Amdt. 192-116 & 195-95). Phone Number 214-316-4626 •Pipeline Failure InvestigatieReport Event Log Sequence of events prior, during, and after the incident by time, (Consider the events of all parties involved in the incident, Fire Department and Police reports, Operator Logs and other government agencies.) Time / Date Event 9-18-11 11:01PM 11:31PM Dallas Fire Department receives an emergency call about possible house explosion at 331 Woodin Blvd. Atmos Emergency Call Center receives notification of a house explosion at 331 Woodin Blvd. 11:39PM Atmos service technician en-route to incident site 11:55AM Atmos service technician arrives on-site and begins to perform leak check. The technician could not bar test due to wet soil conditions, from water used to extinguish the fire. 9-19-11 1:18 AM Atmos service technician found a leak in the alley behind 331 Woodin Blvd. Called for C&M crew. 3:00 AM Atmos crew arrived on-site. 5:30 AM "Grade 1" leak eliminated by a six inch steel band clamp. 7:30 AM Atmos supervisor arrived on-site 7:55 AM Atmos reports incident to Railroad Commission of Texas (RRC) emergency line. 8:40 AM Atmos survey technicians start surveying and checking sewers 9:10 AM No natural gas was found on survey or sewers 9:30 AM Incident area was re-evaluated for gas migration by Atmos Energy, no migration was found 11:00 AM Rail Road Commission personnel arrive on-site 11:08 AM Odorant test performed by Atmos technician on meter at 330 W. Louisiana Ave., witnessed by RRC 1:50 PM Incident area was re-evaluated for gas migration by Atmos Energy, no migration was found Special survey of surrounding area was performed by Atmos Energy. 3-5:00 PM 3:15PM 9:15 PM Incident area was re-evaluated for gas migration by Atmos Energy, no migration was found Incident area was bar hole tested and surveyed by Atmos Energy. 9-20-11 6:30AM Incident area was bar hole tested and surveyed by Atmos Energy 8:15 AM Rail Road Commission arrived on-site 10:22 AM Soil samples taken surrounding section of pipe to be removed. 10:30 AM Department of Transportation (DOT) was notified by Atmos, report number 990183 11:10 AM Excavation on pipeline began 12:13 PM Odorant test performed on meter of 330 W. Louisiana Ave., witnessed by RRC and Dallas Fire Dept. 2:00 PM Gas was shut off for 330 W. Louisiana Ave. and 336 W. Louisiana Ave. 2:47 PM Gas shut off at tap Page 21 of 24 Form -11 Pipeline Failure Investigation Report (Rev. 03/17/2011 through Amdt. 192-116 & 195-95). •Pipeline Failure lnvestigatiOReport Event Log Sequence of events prior, during, and after the incident by time. (Consider the events of all parties involved in the incident, Fire Department and Police reports, Operator Logs and other government agencies.) Time / Date Event 9-20-11 3:46 PM Pipe section cut by cutting chain 5:12 PM Temporary service tested 5:30 PM Tested damaged section of pipeline, five minute test performed 5:40 PM Relit pilot light for 330 W Louisiana Ave. 6:25 PM Installed clamps for excavation 7:21 PM Separation of pipeline section was completed 7:33 PM Removal of pipeline section 86.5 inches of 6 inch cast-iron main. 8:05 PM Secured section of pipe for transport under custody of Unified Investigations & Sciences, Inc. 8:52 PM Purging and Foam line completed for East end section of pipe. 9:15 PM Purging and Foam line completed for West section of Pipe. 12-13-11 Texas Rail Road Commission witnessed testing of removed pipe section at Materials Analysis, Inc., in Dallas, Texas 12-14-11 Texas Rail Road Commission witnessed testing of removed pipe section at Materials Analysis, Inc., in Dallas, Texas Investigation Contact Log Time Date Name Description Page 22 of 24 Form -11 Pipeline Failure Investigation Report (Rev. 03/17/2011 through Amdt. 192-116 & 195-95). OPipeline Failure lnvestigatioReport Failure Investigation Documentation Log Operator: Unit #s Appendix CPF #: D ocumentat i on D escript i on Number Date: Date Received Note: Operator records are reviewed and used to complete the report but are not retained. FOJA applies to federal agencies A Odor test 09-20-11 B 30 Day Report 11-01-11 C NRC Report 09-19-11 D Dallas Fire Department Report 12-22-11 E Leak Report 09-21-11 F Examination Protocol 12-13-11 G Lab Test Results 01-10-12 Page 23 of 24 Form -11 Pipeline Failure Investigation Report (Rev. 03/1712011 through Amdt. 192-116 & 195-95). FOIA Yes No OPipeline Failure InvestigatiReport Site Description Provide a sketch of the area including distances from roads, houses, stress inducing factors, pipe configurations, etc. Bar Hole Test Survey Plot should be outlined with concentrations at test points. Photos should be taken from all angles with each photo documented. Additional areas may be needed in any area of this guideline. Page 24 of 24 Form -11 Pipeline Failure Investigation Report (Rev. 03/17/2011 through Amdt. 192-116 & 195-95). A DIVISION OF J. T. ADAMS CO., INC. 4520 WILLOW PARKWAY CLEVELAND, OHIO 44125 PHONE (216) 641-3290 FAX (216) 641-1223 www.tensile.com TT/^1L ^^ ^ TE NSILE TESTING METALLURGICALLABORATORY CERTIFIED TEST REPORT Materials Analysis Inc 10338 Miller Road Dallas TX 75238 1208 Job No.; Date: Cust. PO#: Description: 1 sample Spec: ASTM A716-95 Verbal -Rich ID# MA5370 --°------------------------------------- Requirements (Min.): B 1-361-624 1-12-12 TESTRESlJLTS -------- --------------------------------- "I'ensile, ksi 60 Yield,.2% ksi 42 Elon>r„ % in 4D 10 18.9 18.0 0.5 Test Method: ASTM A370-1 0 Product Analysis of Elements in % ( OES per TTML C-01) (Leco per TTML C-02): Leco Carbon 3,75 Silicon Manganese 1.32 0.54 Phosphorus Leco Sulfur Chromium Molybdenum Nickel 0.008 0.056 0.03 <0.01 <0.01 Aluminum <0.001 Copper Columbium Titanium Vanadium 0.01 <0.001 0.04 0.05 The above Does Not Conform to specifications listed. Page 1 of I This Report May Not Be Reproduced Except In Full This report represents Tensile Testing interpretation of the results obtained from the test and is not to be construed as a Guaranty or ACCRECrITEO Warranty of the condition of the materials tested. Tensile Testing shall not be held liable for misinterpretation of conditions, loss, ^ damage, injury or death arising from or attributable to delay preceding a test or subsequent to performance of a test. 6230 Regency Parkway Norcross, GA 30071 36442G Inspection of a Gas Pipeline Examination Protocol Subject: Metallurgical examination of a gas pipeline Date and'Time: December 13-14, 2011, 9:00 a.m. Location: Materials Analysis, Inc., 10338 Miller Road, Dallas, TX 75238 Procedures: 1) Photographically document the as-received subject components (Unified evidence Items 5 through'9). 2) Dimensionally document the subject components. 3) Remove band clamp from Unified evidence Item 8. 4) Examine and document the subject components via optical microscopy if possible. If neces§ary, the subject components may be cleaned to facilitate examination. 5) Develop and document a sectioning plan to facilitate optical microscopy, scanning electron microscopy (SEM) with energy dispersive spectroscopy (EDS), and metallographic evaluation. 6) Section the subject components as needed. 7) Examine sections via optical microscopy as needed. 8) Examine sections via SEM/EDS. 9) Ultrasonically clean sections as needed. 10) Re-examine and document the cleaned sections. 11) Prepare and document the metallographic specimens with the appropriate etchant as needed. 12) Examine and document metallographic specimens via optical microscopy, and SEM/EDS as needed. General: • Information learned at any stage of the inspections may dictate modifications of fiuther work and, therefore, departures from the above protocol. Any such protocol modifications will be agreed upon by all parties present prior to proceeding. www,esi•weGsite,cmn Phone: (678) 990•3280 a Fax: (678) 990-3285 m Toll Free: (866) 696-3994 LealcNumber: Town: 0 490764 LPAK RE, POI2T Dallas AdiYress: 331 W WOODINBLVD Date Pound: 9/19/2011 Technician: Gas Detected: Metcr 71: Grade: I Allen, Jesse Probable Source: CGITest: LIO N:940975 BfleCY(µSyE Time Graded: 1:15AM Main rl Assistance Requested: 1:30AM Assistance Arrived: 2: f 5AM Condition Eliminated: 5:30 AM Soil 88 000258163 WAiERPll.nVER Mapsheet: 5379 Bar Tested each direction to 0% No migration indicated BMAGE BUqnFD Bn\ Ni Mapseo: 54Q Surface Over Leak: Soil Surface Over Main: Soil Business District: Probable Pipe Type: Dugtrptnletriser: No Class 4 Location: Coated Steel . No No TemporaryRepair Type: Temp Repair Date: Transaction Date: Installed Clemp 9/19/2011 Lat: Long: Cross Refrenec N: County: Dallas Linc Locate ft: 112620021 Leak Repaired On: Main Type: Pipe Material: Castlron Pipe squeezed: External Corrosion: External Pits: External Coating: EFC: Min Pit Depth: PlpeSizef 6.00 Pressure: Causc of Lealr: Ground Movement Statlon Plus: Min Length of Pit: Internal Corrosion: Technician: CGI Test % Gaso CGI Test Tcch: 0 Luhrs, Eddie Soap Test: Soap Test Tech: Compression Coupling Information 1 Nianufacturer: 14lodel / Style: Type: Odorant Detected: RepnirStatus: Soil Type: Temp Repah• Type: Pullout: Separated: Permanent Temp Repair Tech: Anode Installed Main $: Wt.: Anode installed Service So Anode Installed Technician: Wt: TcstStation: 'festStation: Test Station Stntion Plus: Pipe to soil7Yfain: Left: N/A Rectified: Pipe to soil Service: Left: N/A Rectified: Pipe to soil Technician: Date: 09/20/2011 LeakRepaired By: Luhrs, Eddie Main Repnir: Repaired on Project Pressure Test of; TestMedlum: Tecf Pressure: Test Duration: Technician: Specified: Top: Side: Bottom: I Instnfled Sizc: Minutes Wall Thickness Top: Side: Bottom: Pound: Pipclnfo Renroved Size: Feet: 02 Level: Permanent Repair Tech : Monitored Date psig Hours Feel: Luhrs, Eddie MonitoredBy -------------MigrationPattern-----Change Description . Percent Gas Leak Grade New LeakNamber Lcak Number: 490764 LEakRepaired On., Type: *EAK REPORT - Additional Repair Data Main Material: Pipe squeezed: External Corrosion: Extcrnal Pits: External Coating: EFC: Mh: Pit Deptit: Pipe Size: Min Length of Pit: Pressure: Internal Corrosion: Cause of Leak: Sta,Pills: Technician: Compression Coupling : Type: Manufacturer: Soil Type: Model /Stylc: Pullout:• Anode Installed Main No Anode Installed Service !{: Wt.: wt: Separated: Test Station: Test Stationt Anode Installcd Technieian: Test Station Station Plus: Pipe to soil l4lain: Left: NIA Rectified: Pipe to soil Service: Left: N/A Rectitied; CGI Test % Gas: CGITestTech: Soap Test: Soap Test Tech: Odorant Detected: Repair Status: Temp Repair Type: Temp Repair Tech: Pressure Test of: T est Me di um: Test Pressure: TestDuration: Technician: Specified: Top: Side: Bottom: Temporary Installed Clamp Luhrs, Lddie psig Iiours Minutes WallThickness Found: Top: Side: Bottom: Pipe to soll Technician: ILUInlled Date: 09/19/2011 Main Repair: 02 Level: PermanentRepnir Tech: Leatc Repaired By: Pipelnfo Removed Luhrs, Eddie Temporary / Installed Clamp Size: Size: Feet: Feet: 0 0 fiIRE INVESTIGATION REPORT DALLAS FIRG-RESCUi•sDEPARTMENT Fire Investigation and Explosive Ordnance Disposal Division 1551 Baylor Street #500 Phono Number: (214) 670-4312 Da11as,Texas 75226: ' FaxNumbor: Time ofAlarm: 23:01 Date: 9/18/11 , Iqcident Num6er: 201118575X Address: District/Shift: , 6B Investi ator s: (214)670-0650 1VIa seo: 54Q Nichols / Batchelar 331 W Woodin Blvd. Apartment / Suite Number: Exposure: Same Buildin c. Busin'ess Name: . , Pro er Owner: Mendez Domin o Re : Occupant: Mendez, Domingo Jr. e of Incident: Structure .. Re :: ,. :...: Description of Incident: 1-old-frame-dwelling Non-Structure 0 Criminal Attempt Injury 2-11 Year 3-11 Make ^ Death Number of i'uries Multiple Alarm Vehicle o Cause Terroristic Threat 4-11 Model 5-11 False Alarm Number of deaths 6-11 7-11 State/License Number Out Taps VIN Lightning Strike Fire Loss Information Building / Vehicle 30000 91700 Loss Estimate Estimated Value Insurance Coverage Contents 5000 5000 Insured Loss Insurance Company Policy Number / Date Adjuster's Loss Estimate Company Adjuster Public Adjuster Insurance Agent Assigned DFD 300 Reviewed Fd Entered ___P/ Completed EZ Sup. Review ti1/