Road-Use Dispute – Request for Resolution Public Lands Administration Regulation, Section 98

F008 – December 2014 Alberta Energy Regulator Suite 1000, 250 – 5 Street SW, Calgary, Alberta T2P 0R4 Page 1 of 2

Attach additional pages if needed. Commercial User

First name: Last name:

Company name:

Street address:

Phone number: Fax number:

E-mail address:

Attach a copy of the valid disposition or authorization for the activity that requires use of the road(s).

Check to indicate that a copy of the disposition or authorization is attached:

Licence of Occupation Holder (Licensee)

First name: Last name:

Company name:

Street address:

Phone number: Fax number:

E-mail address:

Licence of occupation (LOC) number for each road: Location of each road:

F008 – December 2014

Alberta Energy Regulator Suite 1000, 250 – 5 Street SW, Calgary, Alberta T2P 0R4 Page 2 of 2

Dispute Details For each LOC, length of road required (in kilometres): Describe the activity that requires road use: Types of vehicles that would be used:

Frequency of use requested:

Length of time road use would be required:

Details of all negotiations that have taken place with the licensee and information about specific items on which agreement has been reached: Details of any alternative roads that have been considered: Advise of any urgency with respect to the dispute: Any additional information:

Submit this form by e-mail to roaduse@aer.ca, by fax to 403-297-7031, or by regular mail to

Alberta Energy Regulator Law Branch, Road-Use Disputes Suite 1000, 250 – 5 Street SW Calgary, Alberta T2P 0R4