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 ( )_______________