Viking Gas Transmission Company
First Revised Volume No. 1
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Effective Date: 09/01/1999, Docket: RP99-489-000, Status: Effective
Third Revised Sheet No. 117 Third Revised Sheet No. 117 : Superseded
Superseding: Second Sub Second Revised Sheet No. 1
CUSTOMER NOMINATION FORM
Viking Gas Transmission Company for
825 Rice Street Viking Gas Transmission
St. Paul, MN 55117
Telefax: (651) 229-2434
Service Number: _________________________________________ Type of Service: _______________________________
Customer Name: __________________________________________ Effective Date/Time: ______________________/________
Upstream Payback Downstream Payback
Meter Service No. MMBTU P/S Code Fuel Meter Service No. MMBTU P/S Code Rank
---------- --------------- ---------- -------- --------- ------- -------- ------------- --------- ----- --------- ------
__________ _______________ __________ ________ _________ _______ ________ _____________ _________ _____ _________ ______
__________ _______________ __________ ________ _________ _______ ________ _____________ _________ _____ _________ ______
__________ _______________ __________ ________ _________ _______ ________ _____________ _________ _____ _________ ______
__________ _______________ __________ ________ _________ _______ ________ _____________ _________ _____ _________ ______
Customer Contact: __________________________________________________
Title: __________________________________________________
Date: __________________________________________________
Phone #: __________________________________________________
Fax #: __________________________________________________
*Payback Code P/S Meter Indicator
0=None P=Primary I authorize Viking to act on my behalf for
1=Pre-Order 636 prior period S=Secondary (please check appropriate box)
2=Post-Order 636 prior period ____ Nominations
3=Current Month ____ Confirmations