Form 3195-1
(November 2018)
OMB Control No.:
1004-0179
Expires:
October 31, 2021
Submit Form To:
BUREAU OF LAND MANAGEMENT
AMARILLO FIELD OFFICE
ATTN: Assistant Field Manager for Operations
801 S. Fillmore, Suite 500
Amarillo, Texas 79101
CALCULATION OF EXCESS REFINING CAPACITY
FISCAL YEAR:
Volumes in million scf/yr
DESCRIPTION REFINER’S FORECAST
YEAR END ACTUALS
(BLM Use Only)
FORECAST VS. ACTUAL
(BLM Use Only)
Operational Rening Capacity
(The total capacity available to rene
crude helium, including capacity that
could reasonably be put into operation
for the forecasted scal year.)
Planned Demand
(The planned demand for all crude
helium to be processed by the helium
rener. This includes crude helium from
the Federal Helium system, as well as
from all other sources.)
Equals: Excess Rening Capacity
(The reported total rening capacity
of the rener, minus the volume of
forecasted demand for a particular
scal year.)
I certify that the information provided above accurately describes the excess rening capacity, required by the Helium Stewardship Act of
2013. I understand that this information will be treated as business sensitive by the BLM, but will be aggregated with other reners’ data for
the BLM’s public reporting purposes.
Additionally, I understand that variations of this data (+/- 10%) must be reported to the BLM within 14 days of knowledge of the change.
Pursuant to terms and conditions of sale, as specied in the Helium Stewardship Act of 2013, I understand that failure to provide this
information or subsequent changes to this information, may bar the company from participation in helium auctions and/or sales.
Company Name: Title:
Telephone: Printed Name of Authorized Agent:
Email: Signature: Date:
(continued on page 2)
Form 3195-1
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