Arlington Storage Company, LLC

Original Volume No. 1

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Effective Date: 08/24/2009, Docket: RP09-872-000, Status: Effective

Original Sheet No. 161 Original Sheet No. 161

GENERAL TERMS AND CONDITIONS

(Continued)

33.4 Requested Interruptible Storage Services under Rate Schedule ISS or IHBS:

(a) Request Quantities

Maximum Storage Quantity (MSQ) _____________________

Maximum Daily Injection Quantity (MDIQ) _____________________

Maximum Daily Withdrawal Quantity (MDWQ) _____________________

Maximum Hourly Deviation (IHBS only) _____________________

Transporter Name: _________________________________________________________

(b) Rate prospective Customer proposes to pay for storage service under Rate

Schedule ISS or IHBS:

Hourly Balancing Charge (IHBS only):

_____________________

Storage Inventory Charge:

_____________________

Injection Charge:

_____________________

Withdrawal Charge:

_____________________

Fuel Reimbursement:

_____________________

(c) Term of Service:

Commencement Date:

_____________________

Termination Date:

_____________________