Communication Site Technical Data Report - U.s. Department Of The Interior Page 3
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3Duplexer_________________________
Cavity___________
Age___________
Serial No. __________________________
New____ Model Year_______________
Number of Rx's on system_____________
Rack Mount? _______Yes ________No
Cabinet mount?________Yes _________No
Free Standing _____Yes ________No
Type of fittings used __N ___UHP ___BNC
23. Antenna and cable system Used for receiver
Same ____Yes ___No, if so please describe.
Antenna Mfg.____________________________
Cable Mfg.________________________________
Type____________________________________
Cable Dia.________________________________
Model___________________________________
Cable length inside Bldg.________________Ft
Cable length outside Bldg._______________Ft
Gain___________db Age______Years____New
Cable fittings type N____UHF_____BNC_____
Direction__________ Degrees
Cable Type_______________________________
Height(AGL) Top_________Ft
Bottom_______Ft.
Polarization Horizontal_____________
Vertical___________ Circular____________________
Number of Fitting adapters used in transmitter systems________________________________
24. Frequencies
Mhz, Ghz, Khz
25. Other related data:
I HEREBY CERTIFY, that I am of legal age and authorized to do business in the state and that I have personally examined
the information contained in the application and believe the information submitted is correct to the best of my
knowledge.
Signature of applicant
Date
Title 18, U.S.C. Section 1001, makes it a crime for any person to knowingly and willfully to make to any department or
agency of the United States any false, fictitious, or fraudulent statements, or representations as to any matter within
its jurisdiction.
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