PART 1:  PRODUCER CONTACT INFORMATION

     Date:

     Company Name:

     Company Address incl. Postal Code:

     Contact Person:

     Title:

     Contact: Office Cell Fax

     E‐mail:

     Field Foreman Name / E‐mail: E‐mail

     Field Foreman Contact: Office Cell Fax

     Facilities Engineering Contact: Office Cell Fax

     Marketing Contact: Office Cell Fax

     Production Accounting Contact: Office Cell Fax

PART 2:  WELL DETAIL

     Well Name:

     Well UWI:

     Field Name: Field Code:

     Pool Name: Pool Code:

     Licensee:

Well Ownership Percentages:

Company Name Working Interest %

Service(s) Required:

     Other (Explain): _____________________

Take‐in‐Kind:

     Construction Start Date:

     Expected Production Date:

     Delivery Method:

PART 3:  PRODUCTION INFORMATION

Producing Zone:

     Type:

     Classification:

     H2S Content: mol/kmol

Analysis:

     Gas:

     Oil:

     Condensate:

     Water:

THIRD PARTY TIE‐IN REQUEST FORM

YesYes

YesYes

NoNoNoNo

Gas Processing Compression

Trucking Existing Flowline New Flowline

Gas OilSweet Sour CBM

Attached to FormAttached to FormAttached to FormAttached to Form

Transportation Other

SWD Contract OpEffluent Treating Prod Accounting

Yes No ACL to Market Product

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Karve Facility or Battery Location:

THIRD PARTY TIE‐IN REQUEST FORM

PART 4: WELL PERFORMANCE

     Estimated Production Rate: Gas (103m3/d) Water (m3/d)

Oil API   Sulphur (%)

     Well Shut‐in Pressure (kPag):

     Well Flowing Pressure (kPag):

     Well Flowing Temperature (oC):

PART 5: PIPELINE DESIGN

     Pipeline Start Location:

     Pipeline End Location:

     Size (mm OD):

     Wall Thickness (mm):

     MOP (kPag):

     Linepipe Grade:

     Linepipe Category:

     Pigging Facilities:

     Tie‐in Detail:

PART 6: WELLSITE PRODUCTION EQUIPMENT

     Design Standard:

     Wellsite/Facility ESD:

Process Equipment:

     Metering:

     Separator:

     Lineheater:

     Compression:

     Dehydration:

Liquids Handling:

     Water:

     Condensate:

Materials:

     Temperature Rating

Metering (Gas):

     Meter Run Size (mm OD):

Fuel Gas Source:

Cathodic Protection:

     Insulation Kit at Tie‐in Point:

     Insulation Kit at Wellsite:

     Cathodic Protection required from __________

Annual Pipeline Review / Assessment to be 

    completed by __________

Type of Meter: ___________________________________________

YesYesYesYesYes

NoNoNoNoNo

YesYesYes

NoNoNo

290 359Category 1YesAbove Ground Tie-in Below Ground Hot TapBelow Ground Cold Cut

Category 2No

CSA Z662Yes

B31.3No

TankTank

PipelinePipeline

Low Temperature

Well

Standard Temperature

Yes

Yes

No

No

Other Source

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Email form to: 3rdpartyrequests@karveenergy.com