Electric Utility Industry PCB Voluntary Data Collection Site

*Your EPA or State Environmental Agency Number
*Name of Utility
*Street Address Line 1:
Street Address Line 2:
*City:
*State:	-- Please select a state -- Alaska Alabama American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Other
*Zip:
*Primary Contact First Name:
*Primary Contact Last Name:
*Office Phone:
Office Fax:
*Type of Utility:	-- Please select utility type -- Public Utility District Municipal Cooperative Investor Owned Other
*State in which headquarter resides:	-- Please select a state -- Alaska Alabama American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Other
*Size of Utility:   Annual Retail  kWh MWh   Sales for  2005 2004 2003 2002 2001 2000 - OR - *Number of Employees:   for  2005 2004 2003 2002 2001 2000
*E-mail Address:
*Password:
*Repeat Password:
*NWPPA Utility System ID #: (NWPPA assigned your utility this number)