Page 1 Screener ID:

DUE DATE: within 30 days of receipt

YOUR RESPONSE IS REQUIRED

BY LAW. Title 33, United States Code, requires businesses and other organizations that receive this questionnaire to answer the questions and return the report to the U.S. Environmental Protection Agency.

By the same law, you may claim confidentiality . See Instruction Guide

for further information

. 

## 2008 COALBED METHANE

INDUSTRY SCREENER

INSTRUCTIONS:

**•** Please refer to the accompanying I nstruction Guid e for help in answering specific questions. Frequently asked questions regarding the screener can be found at http://www.epa.gov/guide/cbm

**•** More information is available from EPA’s contractor by electronic mail at cbmscreener@pgenv.com or by telephone at 1

- 800

- 764

- 4414

**•** If you would like an electronic version of the screener questionnaire, it is available on the EPA Website at http://www.epa.gov/guide/cbm

Item A ESTABLISHMENT NAME

Is the establishment name shown above in the mailing address correct?



## □ Yes



## □ No

– Enter establishment name

Item B CONTACT INFORMATION

If we have any questions about your response, who may we contact?

Name: _____________________________________________________

Street Address: _

_____________________________________________ City, State, Zip Code: _________________________________________

Phone: __________________________

e-Mail: __________________________ OMB 2040

- 0279

( Expires February 29,

2012 )Page 2 Screener ID:

Item C OPERATING STATUS IN 200 8

At any time i n 2008, did your establis hment own or operate any coalbed methane wells ?



## □ Yes → Go to Item D



## □ No → Check the box, and return the survey to the address in the Instruction

Guide.

Item D BUSINESS SIZE AND FINANCIAL DATA AVAILABILITY

1. In 2008, was your highest level of corporate ownership a small business? (See common

size standards below or contact the telephone helpline at 1 -800-764-4414 or e- mail cbmscreener@pgenv.com for additional assistance. )



## □ Yes



## □ No

NAICS Name of Industry Small Business Administration ( SBA ) Size Stand ard

211xxx Oil and Gas Extraction < 500 employees

21211x Coal Mining < 500 employees

213111 Drilling Oil and Gas Wells < 500 employees

213112 Support Activities for Oil and Gas Operations < $6.5 million annual revenues

213113 Support Activities for Coal M ining < $6.5 million annual revenues

22111x Electric Power Generation <4 million m egawatt

- h ou rs/year

221112 Fossil Fuels Electric Power Generation <4 million m egawatt

- h ou rs/year

22112x Electric Power, Transmission, Control and

Distribution <4 million m eg awatt

- h ou rs/year

22121x Natural Gas Distribution < 500 employees

32411x Petroleum Refineries < 1,500 employees

486110 Pipeline Transportation of Crude Oil < 1,500 employees

486210 Pipeline Transportation of Natural Gas < $6.5 million annual revenues

2. W hen will your financial data for fiscal year 2008 be available? (EPA will accept either audited or unaudited financial data.)

Month: , 2009

Item E NUMBER OF CBM PROJECTS

A project in this survey is defined as a well, group of wells, lease, group of leases, or some other recognized unit that your establishment operates as an economic unit when making production

decisions.

In 2008, how many CBM projects did your establishment own or operate?

ProjectsPage 3 Screener ID:

Item F CBM PROJECT INFORMATION

For each CBM project that you owned and/or operated in 2008, provide the following

information.

Note: Additional copies of this page are available at www.epa.gov/guide/cbm

. I f you have many projects, you may prefer to report this information in a tabular format. A spreadsheet version of this page is

available at www.epa.gov/guide/cbm and may be used instead of provid ing one page per project.

1. What is the name or identifier that you use for this project? → (If none exists, then assign identifiers A, B, C, etc.)

2. Where is this project located:

Basin (e.g., Powder River):

State ( 2-letter abbreviation ):

3. Did you buy or sell this project during 2008?



## □ Yes → What month?



## □ No

4. What was the m aximum number of CBM wells producing gas and/or water during 2008?

Number:

5. What was the combined gas production f rom the se wells to date in 2008?

6. In 2008, how did you manage your produced water ? Check all that apply.



## □ Discharge to surface water (e.g., lake, river, stream, creek)



## □ Discharge to publicly owned treatment works



## □ Land a pplication (with or without crop production)



## □ Underground i njection



## □ Evaporation or infiltration pond



## □ Livestock or wildlife watering



## □ Trucked or transported off site to a third party



## □ No water produced by the project ⁫ Thousands of Cubic Feet ( M cf)

⁫ Other

– Enter other reporting units → ____________________Page 4 Screener ID:

7

. In order to avoid asking you for detailed information about all of your projects, EPA intends to statistically select a limited number of projects to receive a Detailed Q uestionnaire. If thi s project is selected to receive a Detailed Questionnaire , where should we send the Detailed Questionnaire?



## □ To the s ame contact person identified in Item B.



## □ To the s ame contact person identified in the previous project.



## □ To the following contact per son:

Name: _____________________________________________________

Employer (for example, name of your establishment or consulting firm):

______________________________________________________ Street Address: _______________________________________________

City, State, Z ip Code: __________________________________________

Phone: __________________________

e-Mail: __________________________

REMARKS : Please use this space to clarify your responses, if appropriate. Please cross

reference your remarks by identifying the survey section (and/or project) that you are referring to in your remarks.

Please keep a copy and return th e original to:

U.S. Environmental Protection Agency CBM Industry Screener

c/o PG Environmental, LLC 570 Herndon Parkway

Suite 500 Herndon, VA 20170

THANK YOU.