{"operation":"document","citation":"14 A.A.C. 5, Exhibit A (Form MM-04)","title":"Form MM-04 - Annual Report for Small Operators of Gas Distribution System","source_type":"regulation","agency":"Arizona Corporation Commission","status":"current","official":true,"published_on":"2024-06-30","effective_on":"2024-05-02","summary":"WILL NOT BE DELIVERED WITHOUT PROPER POSTAGE ARIZONA CORPORATION COMMISSION OFFICE OF PIPELINE SAFETY - GAS SAFETY PROGRAM 1300 WEST WASHINGTON STREET, SUITE 220 PHOENIX, ARIZONA 85007 fold here fold here June 30, 2024 Supp. 24-2 Page 33 Exhibit A. Form MM-04 ARIZONA CORPORATION COMMISSION PIPELINE ","machine_formats":{"json":"https://regulus.evalyn.ai/document/az-aac-14-5-exhibit-a-mm-04.json","markdown":"https://regulus.evalyn.ai/document/az-aac-14-5-exhibit-a-mm-04.md"},"app_url":"https://regulus.evalyn.ai/document/az-aac-14-5-exhibit-a-mm-04","source_url":"https://apps.azsos.gov/public_services/Title_14/14-05.pdf","body":"WILL NOT BE DELIVERED WITHOUT PROPER POSTAGE\n\nARIZONA CORPORATION COMMISSION\n\nOFFICE OF PIPELINE SAFETY - GAS SAFETY PROGRAM 1300 WEST WASHINGTON STREET, SUITE 220\n\nPHOENIX, ARIZONA 85007\n\nfold here\n\nfold here\n\nJune 30, 2024 Supp. 24-2 Page 33\n\nExhibit A.\n\nForm MM-04\n\nARIZONA CORPORATION COMMISSION PIPELINE SAFETY\n\nTO BE FILED FOR EACH CALENDAR YEAR, DUE BETWEEN JANUARY 1 AND APRIL 15 OF THE FOLLOWING CALENDAR YEAR\n\nANNUAL REPORT FOR CALENDAR YEAR\n\nSMALL OPERATORS OF GAS DISTRIBUTION SYSTEM\n\nFACILITY INFORMATION\n\nOQPERATOR/OWNER\n\nNAME OF FACILITY\n\nNAME\n\nADDRESS OF FACILITY\n\nADDRESS\n\nCITY\n\nCOUNTY\n\nCITY\n\nSTATE\n\nZIP CODE\n\nSTATE\n\nZIP CODE\n\nFACILITY E-MAIL ADDRESS\n\nOPERATOR E-MAIL ADDRESS\n\nAREA CODE\n\nTELEPHONE\n\nAREA CODE\n\nTELEPHONE\n\nFACILITY TYPE: MHP APT/CONDO SCHOOL BUSINESS # OF BLDG\n\nFOR UNDERGROUND STEEL SYSTEMS\n\nSYSTEM INFORMATION\n\nFEET OF\n\nDATE OF LAST C/P CHECK IN CAL. YR\n\nPIPE\n\nXf _____\n\n/\n\n/\n\nUNDERGROUND STEEL PIPE\n\n(If no tests were conducted in, please write \"None Conducted\")\n\nABOVEGROUND STEEL PIPE\n\nDATE OF LEAK SURVEY CONDUCTED\n\nIN CAL. YR.\n\nUNDERGROUND PE PLASTIC PIPE\n\n/\n\n/\n\n(if no tests were conducted in, please write \"None Conducted\")\n\nUNDERGROUND PVC PLASTIC PIPE\n\nTOTAL LEAKS IN SYSTEM\n\nDURING LAST CAL. YEAR\n\nTOTAL FEET OF PIPE IN SYSTEM\n\nCAUSE:\n\nCORROSION\n\nNOTE: (if you have any comments or concerns, please note in this box)\n\nTHIRD PARTY DAMAGE\n\nCONSTRUCTION DEFECT\n\nMATERIAL DEFECT\n\nOTHER\n\nNUMBER OF KNOWN LEAKS\n\nAT END OF YEAR\n\nPREPARED BY (TYPE OR PRINT)\n\nAREA CODE\n\nTELEPHONE\n\nNAME AND TITLE PERSON SIGNING\n\nAUTHORIZED SIGNATURE\n\nMAIL TO: 1300 W. Washington St., Suite 220, Phoenix, Arizona 85007\n\nFAX TO: (602) 262-5620 -OR EMAIL TO: safety@azcc.gov\n\nArizona Administrative Code 14 A.A.C. 5\n\nHistorical Note\n\nExhibit A made by final rulemaking at 20 A.A.R. 75, effective December 16, 2013 (Supp. 13-4). Amended by final rulemaking at 30 A.A.R. 1085 (May 24, 2024), with an immediate effective date of May 2, 2024 (Supp. 24-2).\n\nJune 30, 2024 Supp. 24-2 Page 35","truncated":false,"body_characters":2001}