PIPELINE APPLICATION: IOWA, CHICAGO & EASTERN RAILROAD
CORPORATION
Application to the Iowa, Chicago
& Eastern Railroad Corporation for permission to construct and maintain a
pipeline on the right-of-way
of
the Railroad Corporation.
1.
Full
legal name of applicant:_______________________________________________________
(as it should appear on license)
2.
Mailing
address & telephone number:________________________________________________
3. Check one: ( ) Individual (
) Partnership ( ) Corporation ( ) Municipality
3A. Incorporated in State of
___________________ have Corporation Seal
( ) Yes ( ) No
3B. Name and address of each partner:
__________________________________________________
______________________________________________________________________________.
4. Location of
pipeline:_____________________________________________________________
(nearest city, or county, section, township &
range)
4A. Distance from fixed orientation point on railway, i.e.,
culvert, section line, center of street crossing,
etc.:___________________________________________________________________________
______________________________________________________________________________.
(Transportation Company does not allow placement through our
bridge structure)
Furnish following construction details: Carrier Pipe Casing Pipe_
5. Contents to be handled ____________ ____________
6. Maximum operating pressure ____________ ____________
7. Inside diameter ____________ ____________
8. Outside diameter joints or couplings ____________ ____________
9. Wall thickness ____________ ____________
10. Material and type of pipe ____________ ____________
11. Specification and grade or class pipe ____________ ____________
12. Minimum yield point of material ____________ ____________
13. Process and/or name of manufacturer ____________ ____________
14. Type of joints ____________ ____________
15.
Length
of casing pipe:_____________________________________________________
16. Will casing pipe be
vented?______________________ Size:____________________________
17. Will casing pipe be cathodically
protected?___________________________________________
18.
Will
casing pipe have a protective coating?___________________________________________
19. Protection at ends of casing: Both ends_________ One end _________ Type____________
20. Direction of flow and
grade:_______________________________________________________
21. Method of installation:___________________________________________________________
22.
Depth
from base of rail to top of
casing:_____________________________________________
(5 1/2 ft. minimum required)
23.
General
depth of Railway property:_________________________________________________
24.
Depth
in ditch area:______________________________________________________________
25.
Applicant
to furnish two (2) copies of fully dimensioned construction print or sketch
indicating location, full specifications, clearances, and cross section along
pipeline showing relation to actual profile of ground and tracks.
26.
Furnish
license preparation fee ($300.00 minimum fee).
27.
If
application is granted, the undersigned agrees to execute the Transportation
Company's standard form of license when submitted, and to observe all the terms
and conditions thereof:
By:_________________________________________
Title:________________________________________
Date:________________________________________
28.
Remarks:______________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
29.
Sealed
Bulkheads?_______________ Both
Ends?_______________
TMC:rsr(tmc\icepipe.doc)