Document 4 Emma 12 53 00 WSubmimd to DOE ELECTRIC EMERGENCY INCEENTAND- DISMBANCE REPORT NOTICE This report is mandatory under 131 th law 93 275 Failure to comply may result in nes tivii penalties and other sandions as provided by law For the sanctions and the prowmons concerning the con dentiality ofln armatim submitted on this form see General Information pdition of the 1 15de Tide 18 USC 1091 makes it a criminal offense for any person knowingly and oii ngly to make to an Agency oi Department of the United States any one ctitious or fraudulent statements as to any matter within its jurisdiction RESPONSE DUE Within i hour ofth'e incident submit Schednle I and tines Q to Schedule 2 as anEmergeocy Alert report if criteria 1-8 are met Within 6 hours of the retitled - submit Sthednie I and lines schedule 2 as a Norman Roped if only criteria 9' 12 are met By the later of24 hours aha the recognition ofthe incident OR by the end ofthe next business day submit- Schedule 35 lines in Schedule 2 as a System Report ifattazn 13 24 are met Note 4 0015 local me will be wandered tho and offita deafness 12'in Submit updates as ocedcd audio 3- nal report all ofSchedoles 1 and 2 Within 72 hours ofthe incident Eur NERO reporting entities registered in the United States NEEC has appsowed that the lth OE417 meets the silhotittai requirements for NERC There may be other applicable regionai state and focal reporting requirements OF FILING RESEGVSE Retail 4- insisted copy eras moist your les Galina 3th form via online submission at net doe govaE rl'l f FAX IFAX Form to the following facsimile number 202 5363435 Alt rnate Ifyou are tumble to submit online or by fax foams may he emaiied to docigoy or call and report the information to the I'following telephone number 202 586-8100 ' SCHEDULE 1 ALERT CRITERIA Page 1 054 for Filing Check all that apply See Instructions For more Infoi'mahon l Physical attack that causes major interruptions or mpacts to critical in astmdure facilities or to operations 2 Cyber event that causes interruptions of electrical system operations EMERGENCY ALERT File within 3 Complete operational Indore or shut-down of the trensmasmn andfor distribution electrical system 4 Electrical System Separation blending where part or parts of a power grid rmln Operational in an otherwise 'Ifanybox13 ontheri'ghtis checked this rm must be blacked out area or the partial failure of an integrated electrical system led within 1 hour of the 1nd dent Che ck EmergencY 5 Eiggolled loss of 300 Megawatts or more of rm system loads for 15 mmotes or more from a Single Aim to the Alert Slams on Line A below 6 I 1 From load shedding of 100 Megawatts or more implemented made emergency operational policy 7 I System-wide voltage reductions of 3 percent or more 3 I Pubiic appeai to reduce the use of electricity for purposes of maintaining the continuity ofthe Bull Biscuit System RERORT Filawithin Gallons 9 Physical attack that could potentially impact electric power system adequacy or reliability or vandalism which targets components ofany security system Ifanybox9 12 on the'xight is checked AND none ofihe 10 Cyher eVent that could potentially impact electric power system adequacy or reliability boxes 13 are checked this form must he led withm 6-11 loss ofelectric service to more than 50 000 distomers for 1 hour ormore hours of the incident check Normal Report for the Alert 12 I Fuel supply emergencies that could hoped electric power system adequacy or reliability Stand on Line A below SCHEDULE 1 -- ALERT CRITERIA CONTINUED Page 2 of 4 13 1 Damage or destruction of a within its Reliability Coordinator Area Balancing Authority Area or Transmission Operator Area that results in action s to avoid in Bulk Electric System Emergency 1-4 Damage or destruction ofits Faci ty that results actual or suspected inXeiitionai human action 15 Physicai threat to its Facility exciuding weather or natural disaster related tine-Ms which has the potential to degrade the normal operation ofthe Facility 01' suspicious device or activity at its Facility 16 1 Physical threat to its Bt k control center excluding weather or natural disaster related threats which has the potential to degade the normal operation of the coaxial center 0 suspicions device or activity at its Bulk Electric System control center Hany box 13-24 011 113 ght i5 I Bulk Electric System Emorgency remitting in voltage deviation on a Facility A voltage deviation equal to or checked AND 39119 9f 31 5 greater man 10% ofnominal voltage sustained for greater than or equai to 15 continuous miimtes checked his fonn inner-be led'by ie'letier 13 Uncontrolled loss of 200 Megawatts or more of rm system loads for 15 minutes or more from a singie incident for $34 ours entities with previous year's peak demand less than or equal to 3 000 Megawatts recitgtiition f mimid h 'gg - by the Edef e lm-13115111935 19 Total generation loss within one minute of greater than or equal to 2 000 Megawatts in the Eastern or Western day - Noto 4 0091n10ca1 151118 Interconnection or greater than or equal to lAOOMegawatts in the ERCOT Intercminection wit be mn5 s1 hd th $9 6 the h i c s day Ch hk 20 Complete loss ofo wsite power LOOP affecting a nuclear generating station per the Nuclear Plant Interface fortiie Aim Requirements Sims M'Linee bride 23 1 Unexpected Transmission loss within its area contrary to design ofthree or more Built Eiecixic System caused by a common disturbance minding successful automatic reciosing 22 Unplanned evacuation from its Bulk Electric System controi center facility for 30 continuous minutes or more 23 1 Complete toss of Interpersonal Communication and Aimtive Interpersonal Connmmication a ec ting its staffed Bulk Electric System control center for 30 continuous minutes or more 24 I Cmiete loss ofmnoitoiing or control capability at its staged Butt Electiic System contra-I center for 30 continuous minutes or more E'sigui cm changes haveoccmd Writing the initial mm mm the ram with the and check Updme exec-Aim Stamina Line A wow - 12 rm must be wales withinvz 1mm offhahcidmt wiih when mibimation and Final Aim Status A ibcion'nhewdated Emergency Alert Nomi Report System Report Final A AlertStetus moxie I i 1 Hour 1 Business Day 72 Hours SPower B Organization Name 2180 South 1300 East Suite 600 Sat Lake City Utah 84106 C Address of Principal Business Of ce 31912919 12 53 00 PM Submitted toms ELECTRIC EMERGENCY WCIDENTAW DISTUKBANCE REPORT 1 Geographic-A1835 Affected 3313-0111132 Ken Comfy L03 Angeies County Utah Sat Like County Convene County COunty State Dntc 'ime maiden Began - mi 32 Eastem Central Menuhin nam dd-Wihhm using 244mm clock mo dd yy 13 Paci c 3 Alaska 1 Hawaii Date-Hm Incident Ended 3 - 15 jg 52 Eastem Centtal Mountain mm diary hi1 nun using 24-hour clock mo dd yy M I 1 Paci c Basing 1 Hawaii Did the incident diamante onginen in your check one Yes i I No 1 Unknown --Est_i1na_le of mnunt ofDemand Involved H i Peak Megewe s Zen Unknown 1 1 EstimateofNu'n acr nfCuslomets Affected Zero Unknown Check all that apply J Canoe Kimmie L Action Taken None Control cents 1055 Mute or evacuation 3 Loss OI degradation of control center moaitoring or commu catinn systems 3 mm 3 Damage 0 destruction ofa facility Physical attack 8 Eminent system separation minding 3 None E3 moot attack 8 Wm mm 3 Sim Finn Load Load shoddtog of 100 E3 Vandalitnn mm mum or more impiemented'unda 3 Theft Major 103 interruption three or magency npexationn policy manually Suspicious aczivity elmlenls or automaticaliy via UPLS or remediai 3 Cyber event information technology 13 Major distribution system mtmpuon action scheme a Cybc event opuationnl technology Cl Uncomm ed E055 Of 200 of more of nn Public apnea to reduce the use of Fuei supply emergencies intumptiom or system loads for 5 tea or more electricity for the pmpose of maintaining de ci 3 Loss ofeiecmc sermon to more than 50 000 the nit of the 1me E1 '3th loss or failure not due to le snppiy man for 1 hour or more sysiexn intermptinn or de ciency or transmission E3 Systemwidc voltage reductions or 3 patent or Inmlememcd a warning ale or failure more can ngency plan CI Transmission equipment failure not inciuding Voltage dewatwn on an mxinndual 1 th 0f 3 Voltage reduction substation oo switchyard 310Shed Load 3 Faiiure at high voltage substation or swimhyard 1 me dew 5m 3 1 or restored 3 Weather or natural disaster CI capaaty 1955 1 400 or more 3 Mitigation implemented to action s Cl Generating chacity loss of 2 000 MW or more Other 3 Other C3 Complete 1055 of off-site power to a nuclear Additional Informatitme is a mono Mmch-mm sown Wat revealed that a Mail ambit was Eiely n iized to Other exploited whenebi ty Mama 3me amid Manned the rem storetm lowing to an wmximainiy 5 minute or has mnmim nns outage Additional Fare-am reboots matted in hunt winged approxmmy 5 nimnes or less Wen Enid devices at sites and 3 191201 9 12 53 00 PM Submitted to DOE AND DISIWBANCE 11 8303 SCHEDULE 2 NARRATIVE DESCRIPTION Page 4 of- 4 wanna for designated as C -caf Energy hfarmarimr Inky-mafia an Schedufe 2 will not be discIGSed to the public to the extent that it ma a Hm cnteria'fp exemprfoifr- under the madam af ifoma on Act a g gimpnans r can den al commercial in maiz'on and made 23mm tag- am f mation at mid sqfegv qfcm fudividzaaf- or 13 7X5