NGVPRELIMINARY SITEEVALUATIONFORM

PURPOSEOFTHEFORM

Toassistpotentialbuilders,ownersandoperators ofNaturalGasVehicle(NGV)refuelingstations inunderstandingthepreliminarygas serviceoptionscurrentlyavailableforvariousloadscenarios ataspecificsitewithintheserviceterritoryoftheSouthernCaliforniaGasCompany(SoCalGas®).

CustomerNotices

• SoCalGasdoes notguaranteeaminimumdeliverypressure.Anychanges indeliverypressurethatimpactcustomer

operationsaretheresponsibilityofthecustomer.

•TheSoCalGaspipelinesystemisdynamicandoperationalconditionscanchange.InformationprovidedintheNGVPreliminarySiteEvaluationForm isonlyvalidforsixmonthsfromthedatetheNGVPreliminarySiteEvaluationForm isprovidedtothecustomer.

•TheNGVPreliminarySiteEvaluationshouldonlybeusedtoassistwithpreliminaryprojectassessment.CustomergasequipmentspecificationsorpurchasesshouldnotbefinalizedbasedoninformationprovidedintheNGVPreliminarySiteEvaluationForm.Anypurchasesofequipmentshallbeatthecustomer’s own risk,andSoCalGasshallnotberesponsibleforcustomer’s gasequipmentspecificationsorpurchases.

•Customergasequipmentspecificationsorpurchasescanbefinalizedaftersubmittinga”RequestforNon-ResidentialGasFacilities”(Form5)andsubsequentlyreceiving,signingandreturningaSoCalGas“PressureLetter”.ThePressureLetterinformationisonlyvalidforone yearfromthedateofthePressureLetter.SoCalGaswillproceedwithserviceconstructiononcethecustomerreceives,signsandreturnsa“LineExtensionContract”andpayment(ifnecessary).

• SoCalGas’determinationofthesourceandmethodofgasserviceshallbeinaccordancewithallapplicableSoCalGas

tariffsandCaliforniaPublicUtilities Commissionrules andregulations.

• TheNGVPreliminarySiteEvaluationFormmustberequestedbythelegalownerofthepremises,oraccompaniedby

writtenpermissiongrantedbythelegal ownerofthepremisestotherequestor.

•ThereisnocostfortheinitialanalysisprovidedintheNGVPreliminarySiteEvaluationForm.Theinitialanalysismayconsistofuptofourscenarios.Customermayrequestadditionalanalysiswhichmaybesubjecttoanadditionalcharge.Please seeyouraccountexecutivefordetails.

(Continuedinside)

FORM1079

PAGE1

RevisedonJanuary9,2014

NameofRequestingOrganization
Click here to enter text. / Date
Click here to enter text.
AddressofRequestingOrganization
Click here to enter text. / ZIPCode
Click here to enter text.
KeyContactName
Click here to enter text.
KeyContactTelephoneNumber
Click here to enter text.
KeyContactEmailAddress
Click here to enter text.
NameofEndUserOrganization
Click here to enter text.
NGVStationPropertyAddress1
Click here to enter text. / ZIPCode
Click here to enter text.
ClosestIntersectionorCrossStreet
Click here to enter text.
MaximumFlowCapacityRequired,
instandardcubicfeetperminute(scfm): / Scenario#1 / Scenario#2 / Scenario#3 / Scenario#4
Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /
CompressorType: / ☐ElectricDrivenor☐NaturalGasDriven
Ifcompressorisnaturalgas-driven, providenaturalgasenginemaximum fuelconsumption,inscfm:
PotentialforFutureGrowth? / ☐Yesor☐No
IfYes,providedetail(capacityinscfm andfutureyear)inthe“Comments”sectionbelow.
Comments:Click here to enter text.

1Aplotplan ofthepropertyshouldbeprovidedwiththelocationoftheNGVrefuelingstation,adjacent roadsanddesired gasmeterlocationtoavoiderrorsanddelays.

Scenario#1 / Scenario#2 / Scenario#3 / Scenario#4
PressureDistrictorSupplyLine#: / Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /
MaximumFlowCapacity(scfm): / Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /
EstimatedInlet PressureatMeter SetAssembly (MSA)(psig): / Minimum / Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Winter / Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Summer / Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /
DesignMaximumInletPressure atMSA(psig): / Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /
EstimatedOutletPressureatMSA—
Minimum (psig): / Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /
EstimatedServiceDiameter(inches)
andLength(feet): / Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /
EstimatedMainDiameter(inches)
andLength(feet): / Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Comments: / Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /
EngineerPerforming Review: / Click here to enter text. /
AccountExecutive: / Click here to enter text. /
AccountExecutiveTelephoneNumber: / Click here to enter text. /
AccountExecutiveEmailAddress: / Click here to enter text. /
DateReceivedfromCustomer: / Click here to enter text. /
DateReturnedtoCustomer: / Click here to enter text. /

(Continuedon back)

PLOTPLANOFTHEPROPERTY

NOTE:Please use the insert image option to attach your plot plan.Ifunabletousethisfunction,pleaseattachyourimageasaseparatefile.

socalgas.com1-800-427-2000

PAGE4

Visituson:

©2014SouthernCaliforniaGasCompany.Trademarksarethepropertyoftheirrespectiveowners.Allrightsreserved.EPrintedonrecycled paper.

Somematerialsusedunderlicense,withallrightsreservedbythelicensor. N14600010214300