Williston Basin Interstate Pipeline Co.
Second Revised Volume No. 1
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Effective Date: 11/01/2002, Docket: RP00-463-004, Status: Effective
Original Sheet No. 386 Original Sheet No. 386 : Effective
GENERAL TERMS AND CONDITIONS (Continued)
50.8 Segmentation Request Form
FROM: Name: _____________________________________________________
Company: __________________________________________________
Telephone No.: _____________________________________________
Facsimile No.: _____________________________________________
Email Address: ____________________________________________
TO: Williston Basin Interstate Pipeline Company
Attention: Contracts
Facsimile No: (701) 530-1698
1) Shipper requests the following Segmentation of Service:
Transportation Contract No. _________________________________
Effective Date of Segmentation: _____________________________
Termination Date of Segmentation: ___________________________
(If different than contract termination date)
Primary Receipt Point Primary Delivery Point MDDQ
Point # Description Point # Description (eqv. dkt/d)
------- ----------- ------- ----------- -----------
Segmented Receipt Point Segmented Delivery Point MDDQ *
Point # Description Point # Description (eqv. dkt/d)
------- ----------- ------- ------------ -----------
*Requested quantities in total must be equal to or less than Shipper's
MDDQ for the primary receipt and/or delivery point(s) on the effective
request date of segmentation.
2) Will you accept approval of individually segmented receipt and
delivery point combinations: []Yes []No
3) Will you accept lesser quantities: []Yes []No
Disapproval to be designated above by Transporter denoted by an X.
Requested by: ________________________ Date: __________________
Title: ______________________________
Confirmation of segmented request by Transporter:
By: __________________________________ Date: ___________________