Western Gas Interstate Company

Third Revised Volume No. 1

Effective Date: 06/01/1993, Docket: RS92- 53-003, Status: Effective

Revised Original Sheet No. 405 Revised Original Sheet No. 405 : Superseded

TRANSPORTATION REQUEST FORM

(continued)

13. Name and description of Delivery Point(s) where Western will

redeliver the gas and the Maximum Daily Quantities expressed in

MMBTU to be redelivered by Western for each point:

__________________________________________________

14. The name of the entity delivering gas into Western's system and

the name of the entity taking gas off Western's system;

Western Receipt Point Name/Delivering Entity

________________________ ________________________

Western Delivery Point Name/Taking Entity

________________________ ________________________