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8/13/2019 Application for a Flow Line Licence
1/1
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#