#  U.S. DEPARTMENT OF ENERGY

<table>
<colgroup>
<col style="width: 23%" />
<col style="width: 0%" />
<col style="width: 14%" />
<col style="width: 1%" />
<col style="width: 10%" />
<col style="width: 1%" />
<col style="width: 4%" />
<col style="width: 3%" />
<col style="width: 4%" />
<col style="width: 11%" />
<col style="width: 12%" />
<col style="width: 11%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="5"><p>1. To <em>(Enter name and address of property
administrator)</em></p>
<p><strong>ACQUISITION &amp; ASSISTANCE DIVISION</strong></p>
<p><strong>DOCUMENT CONTROL (M/S 921‑143)</strong></p>
<p><strong>U.S. DEPARTMENT OF ENERGY</strong></p>
<p><strong>NATIONAL ENERGY TECHNOLOGY LABORATORY</strong></p>
<p><strong>P.O. BOX 10940</strong></p>
<p><strong>PITTSBURGH, PA 15236-0940</strong></p></td>
<td colspan="7"><p>2. From <em>(Enter full name and address of
contractor)</em></p>
<p><strong>     </strong></p>
<p><strong>     </strong></p>
<p><strong>     </strong></p>
<p><strong>     </strong></p>
<p><strong>     </strong></p></td>
</tr>
<tr class="even">
<td colspan="12"><p>3. If Government-Owned, Contractor-Operated Plant,
Enter Government Name Of Plant</p>
<p>     </p></td>
</tr>
<tr class="odd">
<td><p>4. Contract No.</p>
<p><strong>     </strong></p></td>
<td colspan="3"><p>5.Contract Purpose</p></td>
<td colspan="4"><p>6. Business Type</p>
<p>(L, S, Or N)</p></td>
<td colspan="4"><blockquote>
<p>7. Official Name Of Parent Company</p>
<p><strong>     </strong></p>
</blockquote></td>
</tr>
<tr class="even">
<td colspan="7"><p>8. Property Location(S)</p>
<p><strong>     </strong></p></td>
<td colspan="5"><p>9. Plant Equipment Package</p>
<p><strong>     </strong></p></td>
</tr>
<tr class="odd">
<td colspan="2" rowspan="2"><p>A. Property</p>
<p><em>(Type Of Account)</em></p></td>
<td colspan="4">B. Balance Beginning Of Period</td>
<td colspan="3" rowspan="2"><p>C. Additions</p>
<p><em>(In Dollars)</em></p></td>
<td rowspan="2"><p>D. Deletions</p>
<p><em>(In Dollars)</em></p></td>
<td colspan="2">E. Balance End Of Period</td>
</tr>
<tr class="even">
<td><p>(1) Acquisition</p>
<p>Cost <em>(In Dollars)</em></p></td>
<td colspan="3"><p>(2) Quantity</p>
<p>(<em>Units Or Acres)</em></p></td>
<td><p>(1) Acquisition</p>
<p>Cost <em>(In Dollars)</em></p></td>
<td><p>(2) Quantity</p>
<p>(<em>Units Or Acres<strong>)</strong></em></p></td>
</tr>
<tr class="odd">
<td colspan="2">10. Land</td>
<td><strong>     </strong></td>
<td colspan="3"><strong>     </strong></td>
<td colspan="3"><strong>     </strong></td>
<td><strong>     </strong></td>
<td><strong>     </strong></td>
<td><strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="2">11. Other Real Property</td>
<td><strong>     </strong></td>
<td colspan="3"></td>
<td colspan="3"><strong>     </strong></td>
<td><strong>     </strong></td>
<td><strong>     </strong></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2"><p>12. Plant Equipment</p>
<blockquote>
<p>&gt; $50,000</p>
</blockquote></td>
<td><strong>     </strong></td>
<td colspan="3"><strong>     </strong></td>
<td colspan="3"><strong>     </strong></td>
<td><strong>     </strong></td>
<td><strong>     </strong></td>
<td><strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="2"><p>12.1 Plant Equipment =</p>
<blockquote>
<p>To Or &gt; $5,000 &lt; $49,999</p>
</blockquote></td>
<td><strong>     </strong></td>
<td colspan="3"><strong>     </strong></td>
<td colspan="3"><strong>     </strong></td>
<td><strong>     </strong></td>
<td><strong>     </strong></td>
<td><strong>     </strong></td>
</tr>
<tr class="odd">
<td colspan="2"><p>13. Plant Equipment</p>
<blockquote>
<p>&lt; $5,000</p>
</blockquote></td>
<td><strong>     </strong></td>
<td colspan="3"><strong>     </strong></td>
<td colspan="3"><strong>     </strong></td>
<td><strong>     </strong></td>
<td><strong>     </strong></td>
<td><strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="2"><p>14. Government Material</p>
<blockquote>
<p>Furnished = To</p>
<p>Or &gt; $50,000</p>
</blockquote></td>
<td><strong>     </strong></td>
<td colspan="3"></td>
<td colspan="3"></td>
<td></td>
<td><strong>     </strong></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2">15. Government Material Acquired &gt; $50,000</td>
<td><strong>     </strong></td>
<td colspan="3"></td>
<td colspan="3"></td>
<td></td>
<td><strong>     </strong></td>
<td></td>
</tr>
<tr class="even">
<td colspan="12"><p>Certification</p>
<p>I certify that this report was prepared under NETL requirements from
records maintained under</p>
<p>FAR 45.5 and DEAR 945.5</p></td>
</tr>
<tr class="odd">
<td colspan="12">16. Contractor Representative</td>
</tr>
<tr class="even">
<td colspan="3"><p>a. Typed Name <em>(Last, First, Middle
Initial)</em></p>
<p><strong>     </strong></p></td>
<td colspan="7">b. Signature</td>
<td colspan="2"><p>c. Date Signed</p>
<p><strong>     </strong></p></td>
</tr>
<tr class="odd">
<td colspan="12">17. DOE Property Representative</td>
</tr>
<tr class="even">
<td colspan="3"><p>a. Typed Name <em>(Last, First, Middle
Initial)</em></p>
<p><strong>     </strong></p></td>
<td colspan="7" rowspan="2">c. Signature</td>
<td colspan="2" rowspan="2"><p>d. Date Signed</p>
<p><strong>     </strong></p></td>
</tr>
<tr class="odd">
<td colspan="3"><p>b. Telephone Number</p>
<blockquote>
<p>Area Code (<strong>     </strong>)<strong>      -      </strong></p>
</blockquote></td>
</tr>
</tbody>
</table>

**ANNUAL REPORT OF PROPERTY IN THE CUSTODY OF CONTRACTORS FOR**

**PLANT EQUIPMENT \>\$50,000 (ITEM #12)**

+-----------+--------+-------------+--------------+---------+---------+
| **Line    | **A    | **Tag No.** | **Equipment  | **In-   | **Acqu  |
| No.**     | sset** |             | Item         | Service | isition |
|           |        |             | Description  | Date**  | Cost**  |
|           | **Type |             | (Brief)**    |         |         |
|           | No.**  |             |              |         |         |
+-----------+--------+-------------+--------------+---------+---------+
| **     ** | **     | **     **   | **     **    | **      | **      |
|           |     ** |             |              |      ** |      ** |
+-----------+--------+-------------+--------------+---------+---------+
| **     ** | **     | **     **   | **     **    | **      | **      |
|           |     ** |             |              |      ** |      ** |
+-----------+--------+-------------+--------------+---------+---------+
| **     ** | **     | **     **   | **     **    | **      | **      |
|           |     ** |             |              |      ** |      ** |
+-----------+--------+-------------+--------------+---------+---------+
| **     ** | **     | **     **   | **     **    | **      | **      |
|           |     ** |             |              |      ** |      ** |
+-----------+--------+-------------+--------------+---------+---------+
| **     ** | **     | **     **   | **     **    | **      | **      |
|           |     ** |             |              |      ** |      ** |
+-----------+--------+-------------+--------------+---------+---------+
| **     ** | **     | **     **   | **     **    | **      | **      |
|           |     ** |             |              |      ** |      ** |
+-----------+--------+-------------+--------------+---------+---------+
| **     ** | **     | **     **   | **     **    | **      | **      |
|           |     ** |             |              |      ** |      ** |
+-----------+--------+-------------+--------------+---------+---------+
| **     ** | **     | **     **   | **     **    | **      | **      |
|           |     ** |             |              |      ** |      ** |
+-----------+--------+-------------+--------------+---------+---------+
| **     ** | **     | **     **   | **     **    | **      | **      |
|           |     ** |             |              |      ** |      ** |
+-----------+--------+-------------+--------------+---------+---------+
| **     ** | **     | **     **   | **     **    | **      | **      |
|           |     ** |             |              |      ** |      ** |
+-----------+--------+-------------+--------------+---------+---------+
| **     ** | **     | **     **   | **     **    | **      | **      |
|           |     ** |             |              |      ** |      ** |
+-----------+--------+-------------+--------------+---------+---------+

+-----------+----------------------+-----------------------------------+
| NETL F    | ## RE                |                                   |
| 580.1-8   | PORTING INSTRUCTIONS |                                   |
|           |                      |                                   |
| (03/2001) |                      |                                   |
| OPI=BL60  |                      |                                   |
|           |                      |                                   |
| (Previous |                      |                                   |
| Editions  |                      |                                   |
| Obsolete) |                      |                                   |
+-----------+----------------------+-----------------------------------+
| [GEN      |                      | [ITEM 8 ‑ PROPERTY                |
| ERAL]{.un |                      | LOCATION(S)]{.underline}. Enter   |
| derline}. |                      | the primary location(s) of the    |
| The prime |                      | property if it is located at      |
| c         |                      | site(s) other than that of the    |
| ontractor |                      | Reporting Contractor, e.g.,       |
| shall     |                      | location of subcontract property  |
| report    |                      | or property at alternate sites of |
| all       |                      | the prime contractor. Location is |
| DOE/NETL  |                      | the City, State and Zip or the    |
| property  |                      | Military Installation or the      |
| *(as      |                      | Foreign site. Limit input to 69   |
| in        |                      | characters. NOTE: Can be used as  |
| dicated)* |                      | a \"REMARKS\" field.              |
| in its    |                      |                                   |
| custody   |                      | [ITEM 9 ‑ PLANT EQUIPMENT         |
| or in     |                      | UNIT/PROCESS]{.underline}. Enter  |
| that of   |                      | the Nomenclature and Use of a     |
| its       |                      | Plant Equipment Package if one    |
| subco     |                      | exists on this contract. Leave    |
| ntractors |                      | blank otherwise. Example: ACME    |
| as of     |                      | Proof-of-Concept.                 |
| Sep       |                      |                                   |
| tember 30 |                      | [ITEM 10 ‑ 15.b(1) ‑ ACQUISITION  |
| to the    |                      | COST (BALANCE AT THE BEGINNING OF |
| G         |                      | THE FISCAL YEAR)]{.underline}.    |
| overnment |                      | Enter the acquisition cost for    |
| Property  |                      | each type of property as defined  |
| Repre     |                      | in FAR 45.5. The amounts reported |
| sentative |                      | must agree with the amounts       |
| by        |                      | reported in the previous year for |
| O         |                      | BALANCE AT END OF PERIOD.         |
| ctober 15 |                      |                                   |
| of each   |                      | [ITEMS 10, 12‑13.b.(2) ‑ QUANTITY |
| year.     |                      | (BALANCE AT BEGINNING OF THE      |
| Report    |                      | FISCAL YEAR)]{.underline}. Enter  |
| zero      |                      | the quantity for all categories   |
| balances  |                      | of Government property except for |
| on        |                      | Other Real Property and Material  |
| contracts |                      | on hand at the beginning of the   |
| ac        |                      | fiscal year. The amounts reported |
| countable |                      | must agree with the amounts       |
| for       |                      | reported in the previous year for |
| DOE/NETL  |                      | BALANCE AT END OF PERIOD.         |
| property  |                      |                                   |
| when they |                      | [ITEMS 10 ‑ 13.c. ‑               |
| close.    |                      | ADDITIONS]{.underline} *(in       |
|           |                      | dollars)*. For the property       |
| [REPORT   |                      | categories indicated, enter the   |
| AS OF 30  |                      | acquisition cost for the total    |
| SEP]{.u   |                      | additions to the contract from    |
| nderline} |                      | any source during the fiscal      |
| . Fill in |                      | year. Do not enter for Government |
| the       |                      | Material. NOTE: For Item 12,      |
| ap        |                      | \>\$25K, use attachment.          |
| propriate |                      |                                   |
| year *(or |                      | [ITEMS 10 ‑ 13.d. ‑               |
| other     |                      | DELETIONS]{.underline} *(in       |
| date)*.   |                      | dollars)*. For property           |
|           |                      | categories indicated, enter the   |
| [ITEM 1 ‑ |                      | acquisition cost for the total    |
| TO]{.un   |                      | deletions from the contract       |
| derline}. |                      | during the fiscal year. Do not    |
| Enter the |                      | enter for Government Material.    |
| name of   |                      | NOTE: For Items \>\$25K, use      |
| the       |                      | attachment.                       |
| G         |                      |                                   |
| overnment |                      | [ITEMS 10 ‑ 15.e.(1) ‑            |
| Property  |                      | ACQUISITION COST (BALANCE AT THE  |
| Repres    |                      | END OF THE FISCAL                 |
| entative, |                      | YEAR)]{.underline}. Enter the     |
| the       |                      | acquisition cost for each type of |
| Contract  |                      | property as defined in FAR 45.5.  |
| Admin     |                      |                                   |
| istration |                      | [ITEMS 10, 12, 13.e.(2) ‑         |
| Office or |                      | QUANTITY (BALANCE AT END OF       |
| other     |                      | FISCAL YEAR)]{.underline}. Enter  |
| office    |                      | the quantity for all categories   |
| the       |                      | of Government Property except for |
| G         |                      | Other Real Property and Material  |
| overnment |                      | on hand at the end of the fiscal  |
| Property  |                      | year. These will be carried       |
| Repre     |                      | forward to reflect the balance at |
| sentative |                      | the beginning of the following    |
| works     |                      | year.                             |
| for, and  |                      |                                   |
| the full  |                      | [ITEM 16 ‑ CONTRACTOR             |
| mailing   |                      | REPRESENTATIVE]{.underline}. Type |
| address   |                      | the name of the contractor        |
| *(        |                      | representative authorized by the  |
| including |                      | property control system to sign   |
| City,     |                      | this report. This will be the     |
| State,    |                      | person certifying the report was  |
| and       |                      | prepared under DOE/NETL reporting |
| Z         |                      | requirements from records         |
| IP + 4)*. |                      | maintained by the contractor      |
|           |                      | under FAR 45.5. Date and          |
| [ITEM 2 ‑ |                      | signature of person indicated in  |
| FROM]{.un |                      | Item 16.a.                        |
| derline}. |                      |                                   |
| Enter the |                      | [ITEM 17 ‑ DOE PROPERTY           |
| full name |                      | REPRESENTATIVE]{.underline}. Type |
| and       |                      | the name of the DOE/NETL Property |
| address   |                      | Administrator or other Authorized |
| of the    |                      | Property Representative, plus     |
| reporting |                      | that individual\'s commercial     |
| c         |                      | area code and telephone number.   |
| ontractor |                      | Sign and date.                    |
| with the  |                      |                                   |
| Division  |                      | [NOTE TO CONTRACTOR]{.underline}: |
| name      |                      | When reporting more than one      |
| stated    |                      | contract from the same location   |
| after the |                      | and the same contractor, you may  |
| Corporate |                      | elect to fill out Data            |
| name. Use |                      | Elements 1, 3, 6, 7, and 16 only  |
| the name  |                      | once as long as each form can be  |
| as it     |                      | readily identified if any form.   |
| appears   |                      |                                   |
| on the    |                      |                                   |
| contract  |                      |                                   |
| but omit  |                      |                                   |
| articles  |                      |                                   |
| and       |                      |                                   |
| insert    |                      |                                   |
| spaces    |                      |                                   |
| between   |                      |                                   |
| company   |                      |                                   |
| names     |                      |                                   |
| that are  |                      |                                   |
| made up   |                      |                                   |
| of        |                      |                                   |
| letters   |                      |                                   |
| like ABC  |                      |                                   |
| Inte      |                      |                                   |
| rnational |                      |                                   |
| Inc., for |                      |                                   |
| example.  |                      |                                   |
|           |                      |                                   |
| [ITEM     |                      |                                   |
| 3]{.un    |                      |                                   |
| derline}. |                      |                                   |
| Enter the |                      |                                   |
| G         |                      |                                   |
| overnment |                      |                                   |
| name of   |                      |                                   |
| the plant |                      |                                   |
| if the    |                      |                                   |
| plant is  |                      |                                   |
| Governm   |                      |                                   |
| ent-owned |                      |                                   |
| and       |                      |                                   |
| Co        |                      |                                   |
| ntractor- |                      |                                   |
| operated. |                      |                                   |
| Leave     |                      |                                   |
| blank if  |                      |                                   |
| it is a   |                      |                                   |
| contrac   |                      |                                   |
| tor-owned |                      |                                   |
| plant.    |                      |                                   |
|           |                      |                                   |
| [ITEM 4 ‑ |                      |                                   |
| CONTRACT  |                      |                                   |
| NO.]{.u   |                      |                                   |
| nderline} |                      |                                   |
| Enter the |                      |                                   |
| 15‑digit  |                      |                                   |
| contract  |                      |                                   |
| number    |                      |                                   |
| under     |                      |                                   |
| which the |                      |                                   |
| G         |                      |                                   |
| overnment |                      |                                   |
| property  |                      |                                   |
| is        |                      |                                   |
| acc       |                      |                                   |
| ountable. |                      |                                   |
| Use       |                      |                                   |
| format    |                      |                                   |
| DE‑XXXX‑X |                      |                                   |
| XXXXXXXX. |                      |                                   |
|           |                      |                                   |
| [ITEM 5 ‑ |                      |                                   |
| CONTRACT  |                      |                                   |
| PUR       |                      |                                   |
| POSE]{.un |                      |                                   |
| derline}. |                      |                                   |
| Enter one |                      |                                   |
| of the    |                      |                                   |
| following |                      |                                   |
| 1‑        |                      |                                   |
| character |                      |                                   |
| a         |                      |                                   |
| lphabetic |                      |                                   |
| codes to  |                      |                                   |
| identify  |                      |                                   |
| the       |                      |                                   |
| general   |                      |                                   |
| purposes  |                      |                                   |
| of the    |                      |                                   |
| contract: |                      |                                   |
|           |                      |                                   |
| > a\.     |                      |                                   |
| >         |                      |                                   |
|  Research |                      |                                   |
| > and     |                      |                                   |
| > Dev     |                      |                                   |
| elopment. |                      |                                   |
| >         |                      |                                   |
| > b\.     |                      |                                   |
| >         |                      |                                   |
|  Supplies |                      |                                   |
| > and     |                      |                                   |
| >         |                      |                                   |
| Equipment |                      |                                   |
| > (de     |                      |                                   |
| liverable |                      |                                   |
| > end     |                      |                                   |
| > items)  |                      |                                   |
| >         |                      |                                   |
| > c\.     |                      |                                   |
| > F       |                      |                                   |
| acilities |                      |                                   |
| >         |                      |                                   |
|  Contract |                      |                                   |
| >         |                      |                                   |
| > d\.     |                      |                                   |
| > Lease   |                      |                                   |
| > of      |                      |                                   |
| > f       |                      |                                   |
| acilities |                      |                                   |
| > by the  |                      |                                   |
| > c       |                      |                                   |
| ontractor |                      |                                   |
| >         |                      |                                   |
| > e\.     |                      |                                   |
| > Mai     |                      |                                   |
| ntenance, |                      |                                   |
| > Repair, |                      |                                   |
| > Modi    |                      |                                   |
| fication, |                      |                                   |
| > or      |                      |                                   |
| > R       |                      |                                   |
| ebuilding |                      |                                   |
| > of      |                      |                                   |
| >         |                      |                                   |
| Equipment |                      |                                   |
| >         |                      |                                   |
| > f\.     |                      |                                   |
| >         |                      |                                   |
| Operation |                      |                                   |
| > of a    |                      |                                   |
| > Governm |                      |                                   |
| ent-Owned |                      |                                   |
| > Plant   |                      |                                   |
| > or      |                      |                                   |
| > F       |                      |                                   |
| acilities |                      |                                   |
| >         |                      |                                   |
| including |                      |                                   |
| > test    |                      |                                   |
| > sites,  |                      |                                   |
| > ranges, |                      |                                   |
| > inst    |                      |                                   |
| allations |                      |                                   |
| >         |                      |                                   |
| > g\.     |                      |                                   |
| > Service |                      |                                   |
| >         |                      |                                   |
|  contract |                      |                                   |
| >         |                      |                                   |
| performed |                      |                                   |
| >         |                      |                                   |
| primarily |                      |                                   |
| > on      |                      |                                   |
| >         |                      |                                   |
|  Military |                      |                                   |
| > Insta   |                      |                                   |
| llations, |                      |                                   |
| > test    |                      |                                   |
| > fa      |                      |                                   |
| cilities, |                      |                                   |
| > ranges  |                      |                                   |
| > or      |                      |                                   |
| > sites   |                      |                                   |
| >         |                      |                                   |
| > h\.     |                      |                                   |
| >         |                      |                                   |
|  Contract |                      |                                   |
| > for     |                      |                                   |
| > storage |                      |                                   |
| > of      |                      |                                   |
| > G       |                      |                                   |
| overnment |                      |                                   |
| >         |                      |                                   |
|  Property |                      |                                   |
| >         |                      |                                   |
| > i\.     |                      |                                   |
| > Others  |                      |                                   |
|           |                      |                                   |
| [ITEM 6 ‑ |                      |                                   |
| TYPE OF   |                      |                                   |
| BUSI      |                      |                                   |
| NESS]{.un |                      |                                   |
| derline}. |                      |                                   |
| Enter a   |                      |                                   |
| 1‑        |                      |                                   |
| character |                      |                                   |
| a         |                      |                                   |
| lphabetic |                      |                                   |
| code      |                      |                                   |
| i         |                      |                                   |
| ndicating |                      |                                   |
| the type  |                      |                                   |
| of        |                      |                                   |
| business  |                      |                                   |
| concern:  |                      |                                   |
|           |                      |                                   |
| > L =     |                      |                                   |
| > Large   |                      |                                   |
| > S =     |                      |                                   |
| > Small   |                      |                                   |
| > N =     |                      |                                   |
| > N       |                      |                                   |
| on-profit |                      |                                   |
|           |                      |                                   |
| *(See FAR |                      |                                   |
| Part 19   |                      |                                   |
| for       |                      |                                   |
| d         |                      |                                   |
| efinition |                      |                                   |
| of Small  |                      |                                   |
| and       |                      |                                   |
| F         |                      |                                   |
| AR 31.701 |                      |                                   |
| for       |                      |                                   |
| d         |                      |                                   |
| efinition |                      |                                   |
| of        |                      |                                   |
| Non-      |                      |                                   |
| Profit.)* |                      |                                   |
|           |                      |                                   |
| [IT       |                      |                                   |
| EM 7]{.un |                      |                                   |
| derline}. |                      |                                   |
| Enter the |                      |                                   |
| name of   |                      |                                   |
| the       |                      |                                   |
| Parent    |                      |                                   |
| Co        |                      |                                   |
| rporation |                      |                                   |
| of the    |                      |                                   |
| Reporting |                      |                                   |
| Co        |                      |                                   |
| ntractor. |                      |                                   |
| The       |                      |                                   |
| Parent    |                      |                                   |
| Co        |                      |                                   |
| rporation |                      |                                   |
| is the    |                      |                                   |
| one in    |                      |                                   |
| which     |                      |                                   |
| common    |                      |                                   |
| stock has |                      |                                   |
| been      |                      |                                   |
| issued    |                      |                                   |
| irr       |                      |                                   |
| espective |                      |                                   |
| of        |                      |                                   |
| whether   |                      |                                   |
| the stock |                      |                                   |
| is        |                      |                                   |
| publicly  |                      |                                   |
| traded or |                      |                                   |
| not and   |                      |                                   |
| which is  |                      |                                   |
| not a     |                      |                                   |
| s         |                      |                                   |
| ubsidiary |                      |                                   |
| of        |                      |                                   |
| another   |                      |                                   |
| cor       |                      |                                   |
| poration. |                      |                                   |
+-----------+----------------------+-----------------------------------+