High Island Offshore System, L.L.C.

Third Revised Volume No. 1

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Effective Date: 11/27/2005, Docket: RP06- 53-000, Status: Effective

First Revised Sheet No. 195 First Revised Sheet No. 195 : Effective

Superseding: Substitute Original Sheet No. 195

 

 

HIGH ISLAND OFFSHORE SYSTEM, L.L.C.

CAPACITY RELEASE REQUEST FORM

Prospective Replacement

-----------------------

(Continued)

 

 

 

10. Maximum Reservation Charge per Dth to be paid for released capacity

 

$____________________ per Dth

 

11. Specify Terms or Conditions (Refer to subsections 17.2(d) and 17.12(e) of the

General Terms and Condition of this Tariff)

_____________________________________________________________________________

 

_____________________________________________________________________________

 

_____________________________________________________________________________

 

_____________________________________________________________________________

 

_____________________________________________________________________________

 

_____________________________________________________________________________

 

_____________________________________________________________________________

 

_____________________________________________________________________________

 

12. Nature and Extent of Gas Supplier's Affiliation with HIOS or Any Member in HIOS

(if known): _________________________________________________________________

 

13. State(s) of Ultimate End Use of the Gas: ___________________________________

 

14. (To be completed only if Shipper is affiliated with HIOS or any Member in HIOS,

and will be marketing the gas to be transported.) Amount By Which the Gas Will

Be Sold At a Loss ($/Dth): _______________

 

15. Certified Statement

 

By submitting this request, Shipper certifies that Shipper has or will have by

the time of execution of an Agreement with Transporter, title to the Gas or the

right to deliver the Gas which is to be transported and owns facilities or has

contractual rights which will cause such Gas to be delivered to and received

from Transporter.

 

 

 

THIS RELEASED CAPACITY REQUEST IS HEREBY SUBMITTED

 

this _________ day of _________________________, ____

 

 

 

By ____________________________________________________

 

Title _________________________________________________

 

Telephone: (_____)_____________________________________