U-T Offshore System, L.L.C.

Third Revised Volume No. 1

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Effective Date: 06/01/1997, Docket: RP97-146-001, Status: Effective

Second Revised Sheet No. 107 Second Revised Sheet No. 107 : Superseded

Superseding: First Revised Sheet No. 107

 

U-T OFFSHORE SYSTEM

TRANSPORTATION SERVICE REQUEST FORM

(Continued)

 

 

State in Which Shipper is Organized or Incorporated: ____________________________

_________________________________________________________________________________

_________________________________________________________________________________

 

 

Shipper's Affiliation With U-TOS or Any Partner in U-TOS, and the extent of the

affiliation, if any:

_________________________________________________________________________________

_________________________________________________________________________________

Address for ____________________________________________________________________

Statements & ____________________________________________________________________

 

Invoices ____________________________________________________________________

Attention: _____________________________ Telephone: __________________________

 

Dispatch & Control Representative _______________________________________________

 

Telephone No._____________________________ Telecopier: _________________________

 

 

For All ____________________________________________________________________

Other Matters____________________________________________________________________

Attention: _____________________________ Telephone: __________________________

 

 

3. Term of Service

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

 

Date service is requested to commence: ________________________________________

Date service is requested to terminate: ________________________________________

 

 

4. This request is for: (Check One)

__________ Interruptible Service under Rate Schedule IT

__________ Firm Service under Rate Schedule FT

 

5. Requested Maximum Daily Quantity (MDQ)

 

_________________ Dth per day

 

 

6. Requested total quantity for initial term

 

_________________ Dth per day

 

 

7. Liquids & Liquefiables

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

Is Shipper requesting transportation of Associated Liquids? or Liquefiables?

 

YES ___________ NO ____________

 

 

If yes, name and location of Processing Plant or Separation Facilty

_______________________________________________________________________________