All entries in the box below MUST be filled in. 

Name
Company
Address
City    State    Zip
Phone
E-mail

Chamber Size:
Length  Width  Height 

Any limitations in parent building?

Chamber Type:
Emissions Test Facility. Please state compliance specifications in space provided below:

Susceptibility Test Facility. Please state compliance specifications in space provided below:

Test Zone Size:

Frequency of Operation:

Required Performance Level:
A.  Full Compliance (State Specifications):

B.  Pre-Compliance (State Specifications):

Chamber Registration with FCC?	Yes    No
Registration with other Governing Body?	Yes    No

Installation:

By Cuming Corporation?	Yes    No
Absorber layout drawing by  Cuming Corporation, but installation by customer.	Yes    No

Chamber Verification Testing Required?
Yes    No 

Are you planning to use an existing shielded chamber?
Yes    No 

If yes, please specify size:
Length  Width  Height 

Is a new shielded enclosure required?

Modular shielding	Yes    No
Welded shielding	Yes    No
Screen shielding	Yes    No

Shielding Performance:

Personnel door, 3 ft. x 7 ft.	Qty.
Equipment door, 4 ft. x 7 ft.	Qty.
Equipment double door, 6 ft. x 7 ft.	Qty.

Filtered Power:
Single phase
  V    Amp    Qty. 

Three phase
  V    Amp    Qty. 

Lighting:
Recessed Highhat, 150 watt with vent
Yes   Qty.   No 

Spot lights, 150 watt
Yes   Qty.   No

Structural Support:

Are electrically isolated ceiling hangers from the parent building acceptable?	Yes    No
Is a pit for positioner or turntable required?	Yes    No
Is sprinkling required?	Yes    No
Are telescoping sprinklers required?	Yes    No
Any special air conditioning or airflow requirement?	Yes    No
Any special alarms or interlock required?	Yes    No
Please describe briefly:
Location – ground floor or other?	Yes    No
Loading dock access?	Yes    No
Staging space availability?	Yes    No

As part of the installation, would you like Cuming Microwave Corporation to provide the following? If yes, provide details if available.

 Turntable: Yes  No 
    Diameter:       Load Capacity: 

Antenna Mast: Yes  No 

Antennas: Yes  No 
 

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