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1 Control Number: Item Number: 28 Addendum StartPage: 0

2 / *ATER AND WASTEWATER UTILITIES ANNUAL REPORT Docket No.q (this I-limber will be assigned by the Public Utility Commission after your document is filed). of Walnut Creek Water Exact Legal Name of Utility/Respondent 1?464 Certificate bf Convenience and Necessity (CCN) No. C-3 Submitted to the I. for the Calendar Year Ended 2016, P5ge 1 of.7 9/1/2014 Previous TCEQ Form 20052

3 Section 1: Utility Information Utility Name Walnut Creek Water Addiess P.O. Box 1335 Pampa,,TX Please check this box if your Official Address, which is noted on the enclosed letter, has changed. Telephone Number (806) Fax Number (806) Address Contact Person Robert Jacobs Title Owner/Operator Check the business ownership entity of 'the utility as filed with the Internal Revenue Service ri Individual Z Partnership 1-7 Corporation Nonprofit Association Section 2: Uiility Background, Water CCN No. Number of PWSs TCEQ PWS ID No. TCEQ PWS lb No. (ifthe utility has More PWS1D Nos, please indicate in Section 10) Number of Wastewater Systems Sewer CCN No. TCEQ Sewer Discharge permit No. TCEQ Sewer Discharge Permit No. (if the utility has more Discharge penmt Nos., please indicate in Section 10) Page 2 of 7 9/1/2014_Previous TCEQ Form 20052

Section 3: Revenues Water Wastewater Total Water + Wastewater OPERATING REVENUES: Millell WI= Utility Service/Sales $ 31,352.00 $ 31,352.00 Fees (Tap, Reconnection, etc.) $ 0.00 OTHER REVENUES: 111.

4 Section 3: Revenues Water Wastewater Total Water + Wastewater OPERATING REVENUES: Millell WI= Utility Service/Sales $ 31, $ 31, Fees (Tap, Reconnection, etc.) $ 0.00 OTHER REVENUES: = Please Identify: $ 74, $ 74, TOTAL REVENUES $ 105, $ 0.00 $ 105, Section 4: Ex enses, Water Wastewater Total Water + Wastewater Salaries & Wages $ 3, $ 3, Contract Labor $ 0.00 Purchased Water,, $ o oo Chemicals for Treatment $ 2, $ 2, Utilities (electricity). $ 11, $ 11, Repairs/Maintenance/Supplies $ 5, $ 5, Office Expenses $ $ Professional Fees (Accounting, Legal) $ 0.00 Insurance $ 2, $ 2, Depreciation & Amortization $ 0.00 Miscellaneous (describe in remarks below) $ 0.00 Subtotal $ 26, $ 0.00 ' $ 26, Taxes: IIIIIIIIIIIIMIIII ' - Federal Income Taxes $ 0.00 Property and Other Taxes (Payroll, etc.) $ 0 00 RegulatOry Expenses (Rate Case, Permits) $ $ Other (describe in remarks below) $ 1, $ 1, TOTAL EXPENSES. $ 27, $ 0.00 $ 27, Remarks: Section 3: Revenues OTHER REVENUES: - *New Ground Storage Tank Installation Project* $74, Section 4: Expenses Taxes: Federal Income Tax - paid by Parent ComPany Section 4: Expenses Taxes: Other - 1% State Fee = $1, Page 3 of 7 9/1/2014_Previous TCEQ Forrri 20052

5 Section 5: Operatingitems Debt. Information: Anniial interest expenše on long and/or short term debt? $ o oo Annual principal payment on debt? $ 0.00 Annual interest rate on debt? Annual debt principal and interest? $ o oo Principal balance on outstanding debt at end of this. reporting period? $ o oo Regulatory Assessment Fee: What was the Regulatory Assessment fee amount submitted to TCEQ for the applicable Calendar Year $ 1, Rate Change: What was the effective date of the last Rate Change? 09/09/2006 Section 6: Customer Information Connection Type Water Number of Connections at Beginning of the End of the Calendar Year Calendar Year Total Connection Type Wastewater Number of Connections at Beginning of the End of the Calendar Year Calendar Year Total 0 0 Page 4 of 7 9/1/2014_Previous TCEQ Form 20052

6 Section 7: WatefProduction & Consumption A What is the total amount of water produced/pumped? 24,925, gallons B What is the total amount of water sold/billed? 24,176, gallons C How much water was lost? 628, gallons What is the total percent of water loss? 2.52 To calculate the above, please reference the atiached document Water anci Wastewater Utilities Annual Report Instructions. Comments? - Section 8: Wastewater Treated What is die total amount of wastewater treated? Comments? 0.00 gallons Section 9: Utility Management & Operations Assessment Utility Policy and Procedures F Do you have an Application Form or Formal Process for New Customers? n Yes No Do 'you have a copy of your approved tariff and drought contingency plan for customers to review? Do you have Written Operating Procedures for Routine Operations? Do you have Written Emergency Actions Plan(s)? Do you have Written Peisonnel Procedures? Do you have Risk Management & Safety Policies? Do you have Cgs- tomer Service Policies (including billing & collection)? Do you have a Written Budget (normallynpdated annually)? n Yes n No n Yes nyes rino l Yes nno Yes No [XIYes n No ilyes No Page 5 of 7 911/2014_Previous TCEQ FOrm 20052

7 Did you or any utility staff attend any other utility/business related conferences? ihis year? If so, please list them in Section 10. Do you record coinplaints or keep a complaint log? Is a customer service representative, water system employee, or answering iervice accessible by phone at all times to all custómers? Rules and Regulations Yes r i Yes No If you own/operate a public Water system, do you have a copy of or have access to 30 Texas Administrative Code (TAC) Chapter 290? If you own/operate a sewer system, do you have a copy of or have access to 30 TAC 30 Subchapter J, 30 TAC 217, 30 TAC 308, and 30 TAC 309? Do you hive a copy of or have access to the TAC 16?,,Do you have a copy of or have access to Texas Water Code Chapter 13? _, - Administrative Information nyes 0 No nyes n No FlYes FiNo X Yes I No A Do you notify customers prior to shutting down the system for repairs? riyes EiNo Sometimes IZI Only if greater than 2 hours M Billing Statements Other Fl Newsletter eellphone 1-1 Meetings Are water records kept separate from other business and personal records? Are records kept for additions to fixed assets? Yes FINo Yes ao How do you keep your customers informed? Is the financial position of the system reviewed at least quarterly? Are accounting records for water and 'Wastewater kept separately? OYes IANo EYesriNo Page 6 of 7 9/1/2014_Previous TCEQ Form 20052

8 Section 10: Remarks (please feel free to attach additional pages if necessary) Section 11: Sworn Statement I HEREBY CER I II-Y THAT THE INFORMATION PROVIDED IN THIS REPORT IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. (This document MUST be signed by the President or ()Wrier of the Utility) This 30 day of March', President or Owner: (Signature) Robert L. Jacobs (Printed name) Page 7 of 7 9/1/2014_Previous TCEQ Form 20052

BEFORE THE NORTH CAROLINA UTILITIES COMMISSION APPLICATION FOR A CERTIFICATE OF PUBLIC CONVENIENCE & NECESSITY AND FOR APPROVAL OF RATES INSTRUCTIONS

FORM REVISED 6/04 DOCKET NO. FILING FEE RECEIVED BEFORE THE NORTH CAROLINA UTILITIES COMMISSION APPLICATION FOR A CERTIFICATE OF PUBLIC CONVENIENCE & NECESSITY AND FOR APPROVAL OF RATES INSTRUCTIONS Notes