Riverside Pipeline Company, L. P.

First Revised Volume No. 1

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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