Paiute Pipeline Company

Second Revised Volume No. 1-A

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Effective Date: 11/01/1993, Docket: RS92- 75-004, Status: Effective

Original Sheet No. 127 Original Sheet No. 127 : Effective

GENERAL TERMS AND CONDITIONS

(Continued)

25.4 STANDARD FORM FOR REQUESTING DELIVERY AND RECEIPT POINT CHANGES

Shipper:__________________________________________________________________

Address:__________________________________________________________________

Contact Person:___________________________________________________________

Phone Number:_____________________________________________________________

Fax Number:_______________________________________________________________

Service Agreement number from which delivery or receipt points are to be

changed: _______________ (Number that Shipper uses for nomination purposes)

Date delivery or receipt point change is to begin:__________

Date delivery or receipt point change is to end:____________

Existing Delivery Point Replacement Delivery Point Volume (Dth)

_______________________ __________________________ ____________

_______________________ __________________________ ____________

_______________________ __________________________ ____________

_______________________ __________________________ ____________

_______________________ __________________________ ____________

_______________________ __________________________ ____________

_______________________ __________________________ ____________

Existing Receipt Point Replacement Receipt Point Volume (Dth)

_______________________ __________________________ ____________

_______________________ __________________________ ____________

_______________________ __________________________ ____________

_______________________ __________________________ ____________

_______________________ __________________________ ____________

_______________________ __________________________ ____________

_______________________ __________________________ ____________