Crossroads Pipeline Company

First Revised Volume No. 1

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Effective Date: 04/01/2004, Docket: RP00-333-005, Status: Effective

Second Revised Sheet No. 619 Second Revised Sheet No. 619 : Effective

Superseding: First Revised Sheet No. 619

REQUEST FOR SEGMENTATION

(Continued)

 

4. Identify receipt and delivery points on existing agreement for which

segmentation is requested. If service agreement has multiple receipt

and/or delivery points, Requestor must select one receipt and one delivery

point.

___________________ ____________________

___________________ ____________________

___________________ ____________________

___________________ ____________________

___________________ ____________________

 

5. Identify daily quantity (Dth) to be segmented

 

____________ Dth

 

6. Identify segments being requested.

(Receipt and delivery meters available through Transporter's EBB)

 

Segment Receipt Segment Delivery

Point MLI Point MLI

___________________ ____________________

___________________ ____________________

___________________ ____________________

___________________ ____________________

___________________ ____________________

 

General Comments

 

__________________________________________________________________________

 

__________________________________________________________________________

 

 

Requestor hereby certifies that the information contained in this Request

for Segmentation is complete and accurate to the best of Requestor's

knowledge, information and belief.

 

Requestor Company:_______________________________________________________

 

 

Signed By: _________________________________________________________

 

_________________________________________________________

Title

 

Date: ________________________________________________________