Approved by OMB

3060-0433

**FEDERAL COMMUNICATIONS COMMISSION**

**Washington, D.C. 20554**

**BASIC SIGNAL LEAKAGE PERFORMANCE REPORT**

**FORM 320**

Note: FCC Privacy Act and Paperwork Reduction Act statements are at the
end of the FCC Form 320

Instructions.

**SECTION I \-- GENERAL INFORMATION**

\(1\) Cable System Owner:  **[     ]{.underline}**

Phone Number: **[   ]{.underline}**-**[   ]{.underline}** -
**[    ]{.underline}**

Address: **[     ]{.underline}**

**[     ]{.underline}** **[  ]{.underline}** **[     ]{.underline}** -
**[    ]{.underline}**

(City) (State) (ZIP)

\(2\) Community Served: **[     ]{.underline}**

\(3\) Community Unit No.: **[     ]{.underline}** (4) Physical System
Id: **[     ]{.underline}**

**SECTION II \-- LOCAL SYSTEM INFORMATION**

\(1\) Person(s) Resonsible for the report:

Name: **[     ]{.underline}** **[     ]{.underline}**
**[ ]{.underline}**

(Last) (First) (M)

Phone Number:
**[   ]{.underline}**-**[   ]{.underline}**-**[    ]{.underline}**

Address: **[     ]{.underline}**

**[     ]{.underline}** **[  ]{.underline}** **[     ]{.underline}**
-**[    ]{.underline}**

(City) (State) (ZIP)

\(2\) Are aeronautical frequencies (i.e., 108-137 or 225-400 MHz) used
by this cable television system?

Yes: No:

\(a\) If No, complete Section IV below and return to FCC.

\(b\) If Yes, attach as Exhibit A all precisely offsetted aeronautical
frequencies used by this Community Unit.

\(3\) TEST RESULTS: CLI: 10logIoo: **[   .    ]{.underline}**
10LogI3000: **[   .    ]{.underline}**

Airspace: Passed: Failed:

**SECTION III \-- LEAKAGE PERFORMANCE CRITERIA**

For operators conducting measurments on a geographical areas that
contain more than one Community Unit,(e.g., headends that serve more
than one community unit) fill in the measurment information below. NOTE:
The submission of the accompanying exhibits, either B or C, may be
incorporated by refrence to another Community unit filing that had
undergone the same measurment tests as this Community Unit. That
Community Unit must be identified by its Community Unit Code Number in
response to Question (2) or (4) below.

\(1\) GROUND-BASED MEASURMENTS: (if used)

\(a\) Person(s) Responsible for the test:

Name: **[     ]{.underline}** **[     ]{.underline}**
**[ ]{.underline}**

(Last) (First) (M)

Phone Number:
**[   ]{.underline}**-**[   ]{.underline}**-**[    ]{.underline}**

\(b\) Miles of plant tested & % of total plant tested:
**[     ]{.underline}** m; **[   .    ]{.underline}** %

**FCC Form 320**

**January 2000**

**BASIC SIGNAL LEAKAGE PERFORMANCE REPORT**

Page 2

**SECTION III \-- LEAKAGE PERFORMANCE CRITERIA**

(Continued)

\(C\) Time period of the test: From : [**  ** /**  **
/**    **]{.underline} TO: [**  **/**  ** /**    **]{.underline}

(MM /DD/YR) (MM /DD/YR)

\(d\) Equipment Used : **[     ]{.underline}** **[     ]{.underline}**
[**   **.**    **]{.underline}(MHz)

(Make) (Model) (Test Frequency)

\(e\) Attach as **[Exhibit B,]{.underline}** the CLI calculation &
Result including all parameters used.

(Identify in this Exhibit all leaks ≥ 50 uV/m, and show their repaired
dates, if any)

\(2\) If Exhibit B is incorporated by reference, provide the community
Unit No. **[     ]{.underline}** of the Form 320 with which

Exhibit B was filed.

\(3\) **AIRSPACE MEASUREMENTS:** (if used)

\(a\) Person / Company Responsible for the test:

Name : **[     ]{.underline}**

(Last, First, M, or Company Name)

Phone Number :
(**[   ]{.underline}**)**[   ]{.underline}**-**[    ]{.underline}**

\(b\) Dates of Test-From: [**  **/**  **/**    **]{.underline} To:
[**  **/**  **/**    **]{.underline}

(MM /DD/YR) (MM /DD/YR)

Test Freq. : [**   **.**    **]{.underline} (MHz)

\(c\) Attach as **Exhibit C**, a full description of the test procedure,
a list of the equipment used for the

airspace measurements and a detailed description of the area covered by
these airspace measurements.

(Set forth in this Exhibit all leaks detected during these airspace
measurements that were subsequently

repaired and their repair dates, if any.)

\(d\) Recorded data and its analysis:

\(i\) If analog recordings, include in **Exhibit C**, a graph of the
results and indicate the value

of the smoothed out peak values [     ]{.underline} uV/m.

\(ii\) If digitized recordings, include in **Exhibit C**, a plot of the
results and indicate % of point

recorded digitally below 10 uV/m [: **   **.**    ** %]{.underline}

\(4\) If Exhibit C is incorporated by reference, provide the community
Unit No. **[     ]{.underline}** of the form 320 which

Exhibit C was filed.

**SECTION IV \-- CERTIFICATION**

By signing below the operator certifies that in the case of an
individual operator, he or she is not subject to a denial of federal
benefits that includes FCC benefits pursuant to section 5301 of the
Anti-Drug Abuse Act of 1988, 21, U. S. C. 862, or in the case of a
non-individual operator (e. g. corporation, partnership, or other
unincorporated association), no party to the operator is subject to a
denial of federal benefit that includes FCC benefits pursuant to that
section. For the definition of a "party" for these purposes, see 47 CFR,
Section 1.2002(b).

I certify that I am **[     ]{.underline}** (Official Title),

of **[     ]{.underline}** (Legal Name of cable System Owner), that I
have examined this Report and that, to the best of my knowledge and
belief, all statements in this report are true, correct and complete,
and are made in good faith.

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**
(Signature) **[     ]{.underline}** , 20**[  ]{.underline}** (Date).

WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR
IMPRISONMENT (U.S. CODE, TITLE 18, §1001) AND/OR REVOCATION OF ANY
STATION LICENSE (U.S. CODE, TITLE 47, §312(A)(1)), AND OR FORFEITURE
(U.S. CODE, TITLE 47, SECTION 503).

**FCC Form 320**

January 2000