8/13/2019 Application for a Flow Line Licence

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Petroleum BranchAPPLICATION FOR A FLOW LINE LICENCE

In accordance with Subsection 146(1,a) of The Oil and Gas Act, no one shall construct a flow line without the written approvalof an inspector. This application ust be subOffice prior to coencin" construction of a flow line, and ust include all pertinent inforation as listed in Subsection #$(1) of the !rillin" and %roduction &e"ulation.For assistance in completing this form please contact the Virden office at 204-748-4260 or the Waskada office at 204-673-2472

In compliance with Drilling and Production Regulation 93(1), application is made for a flow line licence by

!ith regard to this application the contact person is(copan' nae) (nae)

FlowLineLic #

From surfacelocation:

From:Lic#

Well/Bat

Type:Grp/Tst/

Inj/FL

To surfacelocation:

To:Lic#

Well/Bat

Type:Grp/Tst/

Inj/FL

PipeManufacturer

PipeCoe

!ominalPipe

I" mm$

PipeMaterial

Pipe%pecification

series or &rae

*Grade* is re+uired for steel pipe -Series* for nonferrous line. AO%/ Anticipated Operatin" %ressure. The a0iu pressure the line will be subected to under noral operations, includin" pi""in

Please inicate if t(e followin& re,uire su-missions are attac(e:

"egal sur#ey (1$%%%) &es 'o omplete manufacturers pipe specif icat ion &es 'o *pil l mitigation detai ls &es

Detailed tie+in drawings &es 'o scaled plan #iew - cross section of all crossings &es 'o '. orrosion mitigation details &es

%urface ri&(ts o-taine: &es 'o Flow line -urie .0 m or Construction Contractor:

!n e"cavation permit m#st $e o$tained from the district office prior to an% worker entering a trench

)ppro1al to construct t(e a-o1e liste flow lines:

(date) (si"nature of applicant) (date) (si"nature of inspector)

To t(e *perator: onstruction may proceed upon receipt of signed app

F/L 23ca1ation Permit !o:

2lowline Application 2or &e3ised une $, 5#