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For questions or comments related to NNG’s Integrity Management Program or submission of areas or locations that
may be considered or identified high consequence areas (HCA’s), please fill out the following form and submit to NNG.

If we need to respond to you, how do you prefer to be contacted?

Phone E-mail Mail
*First Name:
*Last Name:
E-mail:
Telephone:
Fax:
Mailing Address:
Company:
City:
State:

Please provide any additional information in the text box below. Please be as specific as possible.

For HCA- building or structure information , please provide us with the following:

Type of Structure or Building:
Name of Structure or Building:
Occupancy: (a, b, c) see below a b c
a = 20 or more people, 50 days per year.
b = 20 or more people, 5 days a week, 10 weeks per year.
c = less then 20 people per day.
Relation to Structure or Building: Owner Manager Supervisor
Employee  Neighbor  Other

Please submit street address/city/state/zip of the structure to be considered,
or contact information (if different from above) in the text box below.




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