High Island Offshore System, L.L.C.
Third Revised Volume No. 1
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Effective Date: 12/15/2007, Docket: RP08- 65-000, Status: Effective
Seventh Revised Sheet No. 174 Seventh Revised Sheet No. 174 : Effective
Superseding: Sixth Revised Sheet No. 174
HIGH ISLAND OFFSHORE SYSTEM, L.L.C.
NOMINATION REQUEST FORM
----------------------------------- Time/Date Stamp: _______________________
Service Provider Name: ________________________________________
Service Provider ID #: ________________________________________
Service Requester Name: ________________________________________ Beginning Date: ______________________________
Service Requester ID#: ________________________________________ Beginning Time: ______________________________
Representative: ________________________________________ Ending Date: ______________________________
Telephone No.: ________________________________________ Ending Time: ______________________________
Facsimile No.: ________________________________________
Capacity Type Indicator (FT-1, FT-2, IT): __________________ Model Type: _____________________________________
Service Requester Contract Number: _____________________________ Quantity Type Indicator: ________________________
Longhaul: ____________________ Transaction Type: _______________________________
Shorthaul: ____________________
ALWAYS FACSIMILE NOMINATION REQUESTS TO THE FOLLOWING LOCATION:
High Island Offshore System, L.L.C.
P. O. Box 4324
Houston, Texas 77210-4324
Attn: Manager, Contract Administration
Facsimile No.: (713) 381-7996
Telephone No.: (713) 381-7940
Upstream Producer HIOS Electronic Downstream
Identifier Operator Measurement Lateral Downstream Contract Quantity
Code Name Location Dth/D Transporter Shipper Number Dth/D
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By signing this Nomination/Schedule, Shipper certifies that Shipper has title to the gas or right to deliver the gas which is to be transported by
HIOS.
By: __________________________________________
Title: __________________________________________