EIA-878 (Schedule Motor Gasoline Price Survey (Schedule B)

U.S. DEPARTMENT OF ENERGY U.S. ENERGY INFORMATION ADMINISTRATION Washington, DC 20585

OMB No. 1905-0174 Expiration Date: xx/xx/xxxx Burden: 6.5 minutes

EIA-878: MOTOR GASOLINE PRICE SURVEY

Schedule B

This report is mandatory under the Federal Energy Administration Act of 1974 (Public Law 93‑275). Failure to comply may result in criminal fines, civil penalties and other sanctions as provided by law. Title 18 USC 1001 makes it a criminal offense for any person knowingly and willingly to make to any agency or Department of the United States any false, fictitious, or fraudulent statements as to any matter within its jurisdiction. See Instructions for further details on the sanctions and the provisions concerning the confidentiality of information submitted on this form.
If you have any questions, please call: 1-800-638-8812			PART 1. IDENTIFICATION DATA
			1. Company Name (only if different than the label)
			2. Station Name (If different than company name)
			3. Station’s Physical Address
			4. Station City		5. Station State		6. Station ZIP Code
			7. Station Telephone Number
			8. Name of Contact Person
			9. Contact’s Telephone Number			10. Contact’s Email Address
			11. Mailing/Contact’s Address
			12. Contact’s City		13. Contact’s State		14. Contact’s ZIP Code
The information you provide on Form EIA-878 will be used for statistical purposes only. Your responses will be kept confidential and will not be disclosed in identifiable form. Per the Federal Cybersecurity Enhancement Act of 2015, Federal information systems are protected from malicious activities through cybersecurity screening of transmitted data. By law, every EIA employee, as well as every agent, is subject to a jail term, a fine, or both if he or she makes public ANY identifiable information you reported.
PART 2. ANNUAL RETAIL MOTOR GASOLINE SALES DATA				PART 3. NUMBER OF MOTOR GASOLINE PUMPS
Enter your station’s total annual sales volume for the last full calendar year				Enter the number of motor gasoline pumps (fueling dispensers) at this station: _____________
Grade	Ethanol Content (%)	Annual Sales Volume (in gallons)
Regular (85, 86, 87 octane)				PART 4. COMMENTS
Midgrade (88, 89, 90 octane)
Premium (91+ octane)
Other__________________ (specify octane rating)
Other__________________ (specify octane rating)