Gas Quality Incident Report

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Gas Quality Incident Report

Location*
Utility Name*
Contact Name*
Contact Phone Number*
Contact Email*

Date of Incident*	//
Time of Incident*
Minute*
AM/PM*
Incident/Problem Location
	RMO Station
	Reg Station
	Distribution System (Sales Meter)
Tap Number*
TCPL Number*
Legal Land Description
LSD*
Quarter*
Section*
Township*
Range*
Meridian*
Description of the Incident/Problem
What happened? (provide detailed description)*
How did affect the system? (e.g. freeze off, hydrates, condensates, compressor oil, dew point, etc.)*
Was there an outage?
	No
	Yes

Has the incident/problem been rectified?
	No
	Yes
If yes, provide details on how
If no, what actions are being taken to rectify the ongoing situation
How was the unsatisfactory gas condition verified? (e.g. gas sample, visual inspection, etc.)
Was a sample collected?
	No
	Yes
If yes, was the sample analyzed?
	No
	Yes
If yes, what were the report results?
Please provide a copy of the report if available

Was there a release of gas to atmosphere?
	No
	Yes
If yes, was it reported to the appropriate government body? (e.g. Rural Utilities, Alberta Energy Regulator (AER), Canadian Energy Regulator (CER))?
	No
	Yes

Are you submitting a claim for eligible cost reimbursement?
	No
	Yes
If yes, please provide a detailed invoice
Note: In order to submit a claim, The incident must meet the eligibility requirements set out in the Utility Tap Facility (UTF) Gas Quality Incident Response Procedures. These procedures state that the gas quality incident must have resulted in a loss of service at the UTF. The report must be received within 90 calendar days of the incident. Additional documentation may also be requested such as information and/or drawings pertaining to the tap/meter station design, records or logs of maintenance activities, and pictures related to the incident.
Additional Comments

Date Report Completed*
Date Report Submitted*

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Gas Quality Incident Report

Incident/Problem Location

Legal Land Description

Description of the Incident/Problem

How was the unsatisfactory gas condition verified?

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