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acknowledgement of gas tank removal (signed).pdf

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Removal of Tank Date: 08/01/2025 I Earl V. Co (homeowner) authorizes Hawaii Gas to remove the Gas Tank at Full Name the following premise location 85-104 Alawa Pl, Waianae, HI 96792 Please initial the following request: X Address I Will be returning to gas I authorize Hawaii Gas to complete the above request. I understand by choosing to remove the gas tank from my property I will be returning to gas. I understand if the tank is to be relocated I may be responsible the associated fees and cost as deemed by the sales representative following a site visit. I Will NOT be returning to gas I authorize Hawaii Gas to complete the above request. I understand by choosing to remove the tank from my property I will be responsible for all associated fees and cost if I choose to reinstall the tank at a later date. By signing this form I agree to the above Earl V. Co Print Name For Office Use Only Signature 08/01/2025 Date Date: Gas Account Number: Account Name: 1 Customer Service Rep: Additional Information: Point of Contact for Scheduling Removal: Earl Co 518-588-4428 Phone Number: _____________________________________ alawaplace@gmail.com Email Address: ______________________________________ August 20, 2025 Requested Removal Date: _____________________________ Name: ____________________________________________ * Please note once we receive the request it may take up to 6-8 weeks from the date of receiving your request to schedule the meter/line removal* 2