Steuben Gas Storage Company
Original Volume No. 1
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Effective Date: 06/27/1996, Docket: CP96- 35-002, Status: Effective
Original Sheet No. 157 Original Sheet No. 157 : Effective
Steuben Gas Storage Company
STORAGE SERVICE REQUEST FORM
(ADRIAN STORAGE FIELD)
Send to: Steuben Gas Storage Company (STEUBEN)
C/O Arlington Storage Corporation
535 Boylston Street
Boston, MA 02116 Date Received
Attention: Mr Joseph Shandling
Telecopier No.: (617) 536-4396
Verification: (617) 267-7600
NOTE: A check, if required by Section 2.1, must accompany each
Storage Service Request to be valid.
INFORMATION REQUIRED FOR VALID STORAGE REQUEST
NOTE: ANY CHANGE IN THE FACTS SET FORTH BELOW, WHETHER BEFORE OR
AFTER SERVICE BEGINS, MUST BE PROMPTLY COMMUNICATED TO
STEUBEN IN WRITING.
1. Requestor: (Do not complete if same as Customer, see No. 3 below)
Requestor's Name:_____________________________________
2. Is Requestor affiliated with STEUBEN? YES _____ NO _____
If yes, type of affiliation and the percentage of ownership between
Steuben and Requestor__________________________________________
3. Customer's Name and Address: (Note: The "Customer" is the party
which proposes to execute the Storage Agreement with STEUBEN).
_________________________________________________________________
_________________________________________________________________
Attention: ______________________ Telephone ( )________________
Address for _____________________________________________________
Statements _____________________________________________________
& Invoices _____________________________________________________
Attention: ____________________ Telephone ( )________________
For All _____________________________________________________
Other Matters_____________________________________________________
Attention: ____________________ Telephone ( )________________
Dispatch & Control Representative ________________________________
Telephone No. ( )______________ Telecopier ( )_______________