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Revision Date: SA11g~ <br />Western Pipel'nea fv <br />u ColoBdo Inlarotata Cab CO. <br />n <br />LJ Et Pada Natural Gas Co. <br />^ Mojave Plpeilna Operating Co. <br />^ Wyoming !nlar6lau Ccmpeny <br />Pemrt Raqueexd Dy <br />Name <br />AdtlreSS <br />Phone( )~ <br />Your gas cdmpeny repreaantadva <br />elpaso <br />(CoIbC Calls AueDtedl <br />PJYCRORCNNE LOCATION <br />SECTION: TOWNSHIP: RANGE: QOl1NTY: T: PM: <br />LATITUDE: LONGITliOF: LENGTH: STA tON N0: <br />LINE LIST NO.: ROW WIDTH: ALIGhpdENT Sr1EET <br />NO.: <br />ENCROACHMENT OGSgIIPTION <br /> <br />One Call number for your area is <br />('Grantof) neretry grants a permit to ineWtt. maintain and pperate the ebove-refererlced encroach.menl Factdaac <br />('DarmYled Facany~ on the aeova-rofaranced Company easement or atner cropeM t`he Property"). This Dartn.t o gronled subjaa ro the tenn3, <br />ragquameN3, ana tAndltl0ne fihOwn balpvr and YlriCtty h BCdORWnG9 w'lln ins general regdlrement5 end Ilem(3) <br />d lhs enrxeaehman: aperficalbns inavn an the fattdwing page(r). <br />DAMAGi PRkVENTION: Pemtdtee agrees roar it snap no: oeg)n <br />eomtmttion upon End elcng [he Property until Ptarmittba first prcvldes <br />Grantor with plane antl spe~tztions and until Yuch plans and <br />soedficatlons have been apprpved try Grants. Pemyittea further agrees <br />to tanta~ the foaowvtg the 6letewtde assoclatlon9 (One CaY) within Its <br />area al least MiD wdfKleg days prior l0 fns canmenrement or <br />construction on too property. Suers wnsWtGon shalt be mace Dory when <br />e representative of Grantor ie present at tna Gme ana p!aee df <br />canatruRia+. The inbttudion3 d ouch representative relating 10 the <br />safety o' Iha Dlpafnes ar IXher Md6f.es o! Grantor sheY Da fdlbwad by <br />the Pemtittee, its agents and employees. Any Damage dons t0 Grantors <br />}acUYies Incurred due to Parmiaee's failure to adhere to rho state 'CALL <br />SE'GRE YOU DIG" taw, or Incurred during ddnewetton of u+e <br />Pannltled Facility, 6ha1 be paid tot Of repotted e[ the espenae d the <br />Permdla6. <br />Tnb Permit eheY lx reveaeDle M 'he avert of nonmmRlipnca of any <br />terms, mquiromentm ccnd'RiOne,~ and apaeificetione hareo° upon wNlen <br />notice given to Perm aim and for owner of rooofd. <br />INDEMNIFICATION: Permutes oovanants and adreec ro at all times <br />prgtact Intlemnl(y, rt0td hemlpu5, and defend GmMor, iN aKcera, <br />agenp or emDlgyaea, from any Iiebi(tty or eNense. Mauding attorneys' <br />fEBS. arfging (torn CUfm9 a33ertad by any peSCn m pela0n5 for personal <br />injures, death dr proparry damage IncNding ou: not IimINO to amptcyees <br />Of the Pennlttee 0r ib ooniractge, SVbrdntractwa or :hair employees, <br />arising from or growlrtg om of the consln,ctlon, ex4tenca, ma rurtance, <br />dperethm or removal Of the Permuted FeoYRy. <br />ENVIRONMENTAL ANO SAFETY LAWS: aerminee shall comply with <br />all federal, state, and local laws, rules and regmadgns, zgenry pollcle5. <br />guidencb oOWmOnte or common law including, huttoLlirineq to, U.ose <br />totaled to safety or polWtion or proleUbn of the public haalN and the <br />anvirogment Nat povorn :ne emission, diachargs, rotsase, marufeclure, <br />proceseing. tlistnoutlon, use, treatment, handNng, aarega, disposal, or <br />Iren6portation of haxargous or ncMldiard0us suostanC~, nalenals, <br />00lutant5. CaniB/nlnanls, CnEgnKdls, and/or Seale. <br />arirel~raa~r~ <br />I acanovAeage roar I am eumorked to esetWe Nis Encmrhmem Permit <br />COMPANY: for tM aDOVa Stated entity and that ( have carefulh road the <br />nqukemante, IBffn6 a00 tpntllti0nb of lnl3 Fertnit. 19130 undenlfaRd fhb <br />proviebns and praccrioatl penalties n3 provided uMer the laws <br />Ry regarding eYCdvanon. <br />GPANT04 <br />By' <br />PERMITTEE <br />~khrbl~! ,`I rr <br />