Riverside Pipeline Company, L. P.

First Revised Volume No. 1

Effective Date: 10/01/1993, Docket: RS92- 48-001, Status: Effective

Original Sheet No. 123 Original Sheet No. 123 : Effective

GENERAL TERMS AND CONDITIONS

APPENDIX A

SERVICE REQUEST FORM

(cont'd)

b. Address of Shipper:

___________________________________________________________

c. Type of legal entity, state of incorporation and location of

principal office:

___________________________________________________________

d. Type of company:

_____ Local Distribution Co. _____ End-User

_____ Intrastate Pipeline _____ Marketer

_____ Interstate Pipeline _____ Other(fill in)__________

_____ Producer _______________________

3. Requested Form of Service:

____ 311*(284B) ____ 284G (Interstate)** ____ 284G (Other)

4. "On Behalf of" Entity Information

a.* Section 311 service will be "On Behalf Of," pursuant to Subpart B

of Part 284 of the Federal Regulations:

(Legal Name)________________________________, which is an:

____LDC _____Intrastate