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  ![](media/image1.png){width="1.3541666666666667in"   Department of the Interior\             ![](media/image2.png){width="1.4166666666666667in"
  height="1.3541666666666667in"}                       Bureau of Land Management               height="1.2291666666666667in"}

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**COMMUNICATIONS SITE PLAN**

**SOUTH RIM**

**PINEDALE FIELD OFFICE**

**Prepared by the United States Bureau of Land Management**

**Pinedale Field Office**

**State of Wyoming**

**Approved: [\_]{.underline}**[*/s/ Dennis R .
Stenger***\_\_\_\_\_\_\_**]{.underline}
[**\_***7/17/2006***\_\_\_**]{.underline}

**Field Manager Date**

**SOUTH RIM COMMUNICATIONS**

SITE PLAN

[I. INTRODUCTION 1](#introduction)

[A. Terms and Definitions 1](#terms-and-definitions)

[B. Purpose 2](#purpose)

[C. Site Description 2](#site-description)

[D. Area Served 2](#area-served)

[E. Access 3](#access)

[F. Site History and Development 3](#site-history-and-development)

[G. Goals and Objectives of Site Management Plan
3](#g.-goals-and-objectives-of-site-management-plan)

[II. AUTHORITY AND DIRECTION 3](#authority-and-direction)

[A. Authority 3](#authority)

[B. Relationship to Communications Site Lease
4](#relationship-to-communications-site-lease)

[III. GENERAL RESPONSIBILITIES 4](#general-responsibilities)

[A. The Bureau of Land Management
4](#the-bureau-of-land-management-retains-the-responsibility-for)

[B. Facility Owners and Facility Managers
4](#facility-owners-and-facility-managers-or-their-designated-representatives-are-responsible-for)

[C. FCC and NTIA/IRAC 5](#fcc-and-ntiairac-are-responsible-for)

[IV. AUTHORIZED USES AND USERS WITHIN A FACILITY
6](#authorized-uses-and-users-within-a-facility)

[A. Multiple User Facilities and Collocation
6](#multiple-user-facilities-and-collocation)

[V. FEES 6](#fees)

[VI. General Operation and Maintenance Direction
7](#general-operation-and-maintenance-direction)

[A. Unique Resource Considerations at this Communication Site
7](#unique-resource-considerations-at-this-communication-site)

[B. Wiring and Grounding 7](#wiring-and-grounding)

[C. Equipment 7](#equipment)

[D. RF Cables and Transmission Line (Wave Guides)
10](#rf-cables-and-transmission-line-wave-guides)

[E. Radiation 10](#radiation)

[F. Utilities-Availability of and Requirements for:
11](#utilities-availability-of-and-requirements-for)

[G. Sanitary Facilities 11](#sanitary-facilities)

[H. Security And Law Enforcement 12](#security-and-law-enforcement)

[I. Site Maintenance 12](#site-maintenance)

[J. Inspections 13](#inspections)

[K. Fire Prevention and Hazard Reduction Requirements
13](#fire-prevention-and-hazard-reduction-requirements)

[L. Access Maintenance and Restrictions
14](#access-maintenance-and-restrictions)

[VII. CONDITIONS FOR CONSTRUCTION, MODIFICATIONS OR EXPANSION
14](#conditions-for-construction-modifications-or-expansion)

[A. Responsibilities 14](#responsibilities)

[B. Construction Methods and Resource Protection
16](#construction-methods-and-resource-protection)

[C. Construction Inspection 17](#construction-inspection)

[D. New or Remodeled/Expanded Buildings
17](#new-or-remodeledexpanded-buildings)

[E. New or Remodeled/Expanded Towers
18](#new-or-remodeledexpanded-towers)

[VIII. SITE ASSOCIATION/ADVISORY GROUP
18](#site-associationadvisory-group)

[IX. APPENDICES 19](#appendices)

[A. Site Map 19](#site-map)

[B. Authorized Facilities 19](#authorized-facilities)

[C. Site Photographs 19](#site-photographs)

[D. Inspection Checklist 19](#inspection-checklist)

+-----------------------------------------------------------------------+
| # INTRODUCTION                                                        |
+-----------------------------------------------------------------------+

## Terms and Definitions

The terms used in this communication site plan conform to the
definitions listed in the October 27, 1995, Federal Register notice "Fee
Schedule for Communications Uses on Public Lands" and clarifications
provided in Bureau of Land Management Handbook 2860-1. In the event of a
conflict, between the plan and these sources, the Federal Register
notice and the Bureau of Land Management Handbook will govern.

The words "lease" and "lessee" as used in this plan refer to the
relationship between the Bureau of Land Management and the
communications use leaseholder, the lessee. The words "customer" and
"tenant" refer to the relationship between the lessee and the occupants
in the lessee's facilities.

LEASE -- An authorization issued to a communication facility owner or
facility manager, allowing for the use of Public Lands to construct and
or operate a communications facility and unless specifically prohibited,
to sublease to occupants in that facility.

LEASEHOLDER OR LESSEE -- Facility Owner/Facility Manager

CUSTOMER -- Entities that pay a facility owner, facility manager or
tenant for communications services and are not re-selling or
broadcasting communications services to others

TENANT -- A communications user who rents space in a communications
facility and operates communication equipment for the purpose of
re-selling, or broadcasting communications services to others for
profit.

COMMUNICATIONS SITE -- An area of Bureau of Land Management administered
public land designated through the land and resource management planning
process. A communications site may be limited to a single communications
facility, but most often encompasses more than one. Each site is
identified by name; usually a local prominent landmark, such as South
Rim Communications Site.

FACILITY MANAGER -- The holder of a Bureau of Land Management
communications use authorization who leases space for other
communication users. A facility manager does not directly provide
communications services to third parties.

FACILITY OWNER -- Individual, commercial activities, organizations, or
agencies that owns a communication facility on Federal land; own and
operate their own communications equipment; and hold a communication use
authorization.

NON-BROADCAST -- This category includes Commercial Mobile Radio Service
(CMRS), Facility Managers, Cellular Telephone, Private Mobile Radio
Service (PMRS), Microwave, Local Exchange Network, and Passive
Reflector.

BROADCAST -- This category includes Television Broadcast, AM and FM
Radio Broadcast, Cable Television, Broadcast Translator, Low Power
Television, and Low Power FM Radio.

## Purpose

This plan is intended to be used by Bureau of Land Management officials
administering communication uses at South Rim, existing lessees, and
applicants desiring a lease or a lease amendment. The plan will be kept
updated by amending pages or sections of the plan rather than issuing a
revised edition of the plan. When a revision is necessary, the plan will
be amended by letter from the Pinedale Field Office Manager enclosing a
copy of revised pages or sections. The amendments will be consecutively
numbered.

General management direction for all land use is outlined in the
Pinedale Resource Area RMP adopted in 1988, the U.S. Code of Federal
Regulations (CFRs) and the BLM Handbook and applicable Instruction
Memoranda. Specific direction for site management planning on designated
communications site is contained in BLM Handbook 2860-1. Primary
regulations and policy pertaining to issuance of rights-of-way and
leases by the Bureau of Land Management are found in Title 43, Code of
Federal Regulations (CFR), Sections 2801- 2803 and BLM Handbook 2860-1.

The 1988 Pinedale Resource Management Plan, RMP, does not specifically
name South Rim but states that all existing communication rights-of-way
shall provide for subleasing, thus encouraging collocation. South Rim
was not included in any defined visual resource area in the 1988 RMP.
This RMP will be revised over the next 12-24 months. Any applicable
changes to this communications site plan as a result of the revised RMP
will be made to keep this activity plan consistent with the RMP.

South Rim will continue to be managed for low power radio, microwave,
cellular, broadcast translator, and amateur uses. The senior uses at
this site are the broadcast translators, microwave relay, cellular and
associated low-power UHF and VHF radio uses. The site provides key
microwave links into the Jackson Hole, Wyoming area.

No communications site plan has ever been prepared for this site. This
plan has technical standards for better management of the South Rim
communications site. This plan governs development and management of
South Rim and will be modified in the future as needs and conditions
warrant. Any future such uses must be designed, installed, operated, and
maintained to be compatible and not interfere with the primary uses.

This site-specific plan is administrative in nature and is Categorically
Excluded from further review under the National Environmental Policy Act
(NEPA) (516.DM2, Appendix 1.17). Any additional development of the site
will be addressed in a site-specific NEPA document.

## Site Description

The site is located on lands which are administered by the Pinedale
Field Office, and located north west of Pinedale, Wyoming in portions of
Section 9, Township 36 North, Range 112 West in the 6^th^ Principle
Meridian, Wyoming at approximately 43º 06' 22" North Latitude and 110º
13' 46" West Longitude. The elevation is approximately 8,522 feet above
mean sea level (msl). A site map is provided as Appendix A.

## Area Served

This site does not serve an RMA, Ranally Metro Area. The largest
community served is Pinedale, Wyoming. The population served from South
Rim, according to the 2000 Census, is less than 25,000. Fee
determination is based in part on the population zone which may be
adjusted annually based upon changes in population and growth or
designation of an RMA.

## Access

Access to the site is from US Highway 189. Access is across public and
the private lands of Miller Land and Livestock and Hoback Ranches. The
road is a primitive two track road which passes through five livestock
gates. Maintenance is users and the BLM as necessary.

## Site History and Development

South Rim communication site was first developed in 1983 with an
authorization to Wooster KTWO Radio. The second facility was authorized
to Union Telephone in 1991 for microwave relay and cellular.

Current building space and tower space appears to be adequate for the
foreseeable demand. If in the future, this existing space becomes
utilized to its optimum capacity, additional land area for future site
development is limited. Site specific NEPA analysis will be required
prior to any future facility modification or new facility construction.

## G. Goals and Objectives of Site Management Plan {#g.-goals-and-objectives-of-site-management-plan .unnumbered}

1\. South Rim Site will be managed as a low-power broadcast translator,
two-way radio, microwave, and cellular uses. The maximum power output
for the South Rim communications site is based on the maximum output
allowed for two-way radio under the Federal Communications Commission's
rules at Title 47, Code of Federal Regulations, Part 90. As of the 2003
regulation, that would be 500 watts ERP. Each use must operate at or
below the power level authorized by their respective FCC license as long
as it does not exceed the site limitation. This power limitation does
not preclude existing and new uses from being designed, operated and
maintained to meet other interference, noise floor, receive sensitivity,
or RFR standards included in this plan.

2\. Future authorizations and additional uses must be designed to
prevent degradation of the senior uses at this site.

3\. The overall appearance of the site and the integrity of the natural
environment will be improved through stringent maintenance requirements
and selection of authorized paint colors.

4.  The site will be systematically developed to maximize the number of
    compatible uses while ensuring safety and protection of resources.

5.  Development and maintenance of a fuel and fire reduction area around
    the communications facilities.

6.  New facilities will be developed only after appropriate
    site-specific NEPA analysis and coordination with current lease
    holders and users.

+-----------------------------------------------------------------------+
| # AUTHORITY AND DIRECTION                                             |
+-----------------------------------------------------------------------+

## Authority

Bureau of Land Management authority to authorize communications uses on
Resource Area (BLM) land is granted by the Federal Land Policy and
Management Act of 1976, 90 Stat. 2776 (43 U.S. C. 1761-1771) and is
reflected in Title 43, Code of Federal Regulations (CFR), Sections 2801-
2803

and WO IB 98-23.

Bureau of Land Management authority for communications site management
planning is contained in Bureau of Land Management Handbook 2801-1, Plan
of Development. Direction on and policy for communication use
authorizations is contained in Bureau of Land Management Manual (BLM
Manual) section 2860.

Authority for the issuance of authorizations and/or licenses for the
transmission and reception of electronic radiation for communication
purposes is granted by Congress and administered by the Federal
Communications Commission (FCC) and/or the National Telecommunication
and Information Administration -- Interagency Radio Advisory Committee
(NTIA/IRAC).

## Relationship to Communications Site Lease

This site plan will be incorporated into all leases now and in the
future issued for this communications site and must be used in
conjunction with the lease. **PROVISIONS OF THE SITE PLAN ARE ENFORCED
THROUGH THE LEASE.** Each lessee is expected to include the requirements
of the lease and the site plan into any documents, which describe the
business relationship between the lessee and the lessee\'s tenants and
customers. The lessee is responsible for enforcing those provisions.

+-----------------------------------------------------------------------+
| # GENERAL RESPONSIBILITIES                                            |
+-----------------------------------------------------------------------+

## The Bureau of Land Management retains the responsibility for:

Issuing and amending leases and existing rights-of-way to facility
owners and facility managers, only for the areas actually occupied by
the authorized improvements. Granting occupancy and use of Public Lands
rest exclusively with the Bureau of Land Management Title 43, CFR,
Sections 2801-2803

1.  . The issuance of a FCC license (authorization), or frequency
    assignment, does not authorize occupancy of Public Lands.

1\. Approving any new/modified facility(ies) at the site.

2.  Approving amendments to leases to qualified buyers of facilities on
    the site.

## Facility Owners and Facility Managers (or their designated representatives) are responsible for:

1.  Complying with their authorization and all sections of this Site
    Management Plan.

2.  Ensuring that all new facilities, expansions, or improvements are
    consistent with the Resource Management Plans, RMP; any
    environmental document(s)/decisions for the site; and, this Site
    Plan.

3.  Ensuring facilities/equipment not complying with Federal/State/local
    laws/regulations/ ordinances will be removed or modified within one
    year of the approval of this plan. Any modification needs
    pre-approval by the Bureau of Land Management.

4.  Keeping all facilities within the established limits of their
    authorized area. The authorized area and improvements will be shown
    on Autocad maps, as soon as they are available.

5.  Providing the Bureau of Land Management, with the name, address and
    phone number for a local contact person. The Facility Owner and
    Facility Manager and the contact person may be the same individual.
    The contact person will be available for emergencies and is in a
    position to respond to issues involving construction issues,
    facility maintenance and all equipment within the facility.

6.  Adhering to the terms of the Facility Owner/Manager Lease or
    Right-of-Way:

    a.  Facility Owners and Facility Managers are authorized to rent
        building/tower space to tenants and/or customers without prior
        written approval from the Bureau of Land Management.

    b.  Tenants and/or customers may not construct there own equipment
        shelter (building, shelter or cabinet) or antenna support
        structure (tower or mast). The facility owner/manager must own
        all communication shelters and towers under their lease. \[If
        that is not possible, a separate SF-299 application,
        cost-recovery deposit, analysis, and authorization are required.
        This will also result in the use being a tenant/customer of the
        original lease holder in additional to being a separate facility
        for billing purposes.\]

    c.  Tenants and/or customers using a facility covered by a Facility
        Lease/right-of-way will not have separate Bureau of Land
        Management permits to authorize the use.

    d.  Facility Owners and Facility Managers are responsible for
        complying with the terms and conditions of the Facility Lease or
        their valid right-of-way. Facility Owner/Managers are also
        responsible for ensuring that their tenants and customers are in
        compliance with the terms and conditions of the Lease or
        right-of-way, and applicable FCC or NTIA/IRAC license terms and
        conditions.

    e.  The Facility Owner and Facility Manager may not place any
        unreasonable restrictions nor any restriction restraining
        competition or trade practices on tenants and/or customers, or
        potential tenants and/or customers.

7.  Ensuring that all communications equipment is properly installed,
    operated, and maintained.

8.  Ensuring that all communication equipment meets ANSI, FCC and Bureau
    of Land Management regulations, guidelines and standards concerning
    radiation limitations.

    a.  Monitoring radiation levels at their facility and;

    b.  Immediately correcting any radiation levels that are, or could
        be a hazard to human health. (FCC 47CFR sections 1.1307(b),
        1.1310 and 2.1093) and FCC OET Bulletin 54, August 1999.

9.  Providing a certified copy of their use and the category of use
    along with the current phone numbers and addresses of all tenants
    and customers as of September 30 each year. This report is due by
    October 15^th^.

10. Keeping the premises around their buildings free of trash and
    debris.

11. Placing the BLM serial number in six inch lettering on the face of
    the building visible from the access road. This numbering system
    ties to the site map, Appendix A, and will be provide upon request
    to the County 911 emergency response system as a physical address in
    the case of emergencies.

## FCC and NTIA/IRAC are responsible for:

The responsibilities of the FCC and NTIA/IRAC are frequency management.
Correcting interference problems is the responsibility of the affected
licensees. The FCC and NTIA/IRAC are not normally responsible for the
resolution of conflicts when the licensees or agencies are operating
within the limits of the authorizations.

+-----------------------------------------------------------------------+
| # AUTHORIZED USES AND USERS WITHIN A FACILITY                         |
+-----------------------------------------------------------------------+

##  {#section .unnumbered}

## Multiple User Facilities and Collocation

Both facilities currently are designed to only accommodate the uses of
the facility owner. The capacity of the current facilities is limited on
both the towers and within the existing buildings for future
tenants/customers. Any future proposals must be designed to include
multiple users. This includes multiple uses of buildings, towers,
back-up generators, grounding systems, fuel containers, access ways and
parking areas.

Facility Owners and Facility Managers are not required to lease facility
space to others if they can prove to the authorized Bureau of Land
Management officer that:

1.  Space is not available;

2.  The use is incompatible with the existing facilities;

3.  Additional space is needed by the facility owner/manager;

4.  Additional users would violate system security needs; or,

5.  Potential interference is not resolvable.

+-----------------------------------------------------------------------+
| # FEES                                                                |
+-----------------------------------------------------------------------+

The Bureau of Land Management will charge Facility Owners and Facility
Managers annual fees based on the Fee Schedule for Communications Uses
on Public Lands as adjusted annually. These fees will be fair market
value for the use of Public Lands. Since this site is not within an
established RMA, Ranally Metro Area, the population zone is less than
25,000, Zone 9 will be used for these calculations unless specifically
agreed to by the authorizing officer and until populations or RMP
designations change.

Fees that Facility Owners and Facility Managers may charge their tenants
and "customers" are to be: reasonable (consistent with, and not in
excess of, other fees for similar facilities) and commensurate with the
uses and occupancy of the facilities and services provided to tenants
and "customers".

+-----------------------------------------------------------------------+
| # General Operation and Maintenance Direction                         |
+-----------------------------------------------------------------------+

## Unique Resource Considerations at this Communication Site

1.  There are no currently identified special resource coordination
    considerations with on-site or adjacent resource values. Should
    special conditions arise through the revision process of the RMP,
    this plan will be amended accordingly.

## Wiring and Grounding 

> 1\. All equipment is to be installed within existing buildings and in
> metal equipment racks or within metal equipment cabinets and in
> accordance with manufacturer specifications. All equipment, racks,
> cabinets and overhead ladder trays are to be grounded and shielded in
> compliance to NEC code and in accordance with accepted industry
> standards of practice.
>
> 2\. All electrical wiring and grounding must meet the 'National
> Electrical Code" and applicable estate codes. All permanent wiring
> conducting AC current and wiring conducting DC current or 50 volts or
> more shall be installed in metallic conduit. Surge protection shall be
> installed between the electric service meter and the first power
> distribution panels.
>
> 3\. Lightening protection shall be in accordance with NEC part 810-20
> Antenna Discharge Units and part 810-21 Grounding conductors. Periodic
> bonding of the down conductor to the tower (Galvanized) steel shall be
> made with proper bonding connectors that are tin plated or made of
> brass.
>
> 4\. Each building of the lessee is to have its own separate grounding
> system for all users in that structure. Wherever practical,
> interconnection of individual grids and/or the simultaneous placement
> of a large sized copper ground wire with any new grounding systems
> that are buried on the site will be required.
>
> 5\. Site or facility grounding must be constructed of copper, with #2
> AWG or larger wire or 2" or larger solid copper strap, connected to an
> adequate site/facility ground electrode system. The site/facility
> ground electrode system shall be bonded to the power service entrance
> grounding electrode conductor. Guy wires should also be grounded using
> manufacturers approved methods to preclude bi-metallic junction and
> corrosion. All equipment on the site (buildings, towers, power units,
> transmitters, receivers, antennas, combiners, telephone systems, power
> cabinets, HVAC units, etc) must be connected to the site/facility
> ground by direct connection. Electrical system ground wiring is
> required for electrical ground fault protection and circuit breaker
> coordination. The grounding systems shall comply with applicable laws,
> codes and in accordance with standard engineering practice. Below
> ground connections must use either an exothermic welding process (i.e.
> Cadweld, Thermoweld, etc.), copper wedge pressure devices (i.e.
> Ampact, Burndy, Wrench-lock, etc.), or brazed copper connections in
> conjunction with a mechanical UL listed connector (to be used as a
> physical strength enhancement component). Brazing by itself is not an
> acceptable method of bonding below earth grade (buried).
> Communications Equipment

## Equipment

[Equipment Ownership]{.underline}

All equipment shall be labeled or the information be made available at
the site, as applicable, with:

1.  The owner's name;

2.  Transmitter frequency(ies);

3.  A valid FCC, or IRAF, authorization;

4.  Transmitting power output(s); and

5.  A current 24-hour phone contact number.

[Transmitting Equipment]{.underline}

All transmitters will have protective devices (shields, filters,
isolation components), designed into or externally installed, to prevent
interference with other users. All transmitters will meet FCC licensing
requirements. 2-way transmitters should have dual section isolators for
a total of 60 db of isolation.

The re-radiation of intercepted signals from any unprotected transmitter
and its associated antenna system will be prevented by the use of
appropriate filters (wide band and narrow band broadcast transmitters).

The direct radiation of out-of-band emissions (i.e. noise or spurious
harmonics) will be reduced to a level such that they may not be
identified as a source of interference as defined in the FCC Rules and
Regulations (e.g. Part 90.209(e)). (If electromagnetic noise becomes an
issue at this site, prior to any additional uses, noise threshold limits
must be established, and amended into the Site Plan.)

All transmitters not in immediate use and not specifically designated as
standby equipment shall be removed. Loads connected to circulators are
to be capable of dissipating the total power output of the transmitter.

[Receiving Equipment]{.underline}

A bandpass device (cavity, crystal filter, etc.) is recommended at the
input of all receiving devices. Cavity filters, or other protective
device, may be used at receiver inputs to reduce interference.

Where duplexing is used a bandpass cavity duplexer is required. Use of
the notch type device is not permitted.

[Tower]{.underline}

1.  Generally only one tower is authorized for each facility owner.
    Facility Owners and Facility Managers may obtain permission to
    construct the second tower only after submitting evidence that
    demonstrates that their existing tower(s) is/are completely filled
    and full use has been made of combining systems. When a single
    equipment building is required, multiple antenna support structures
    may need to be designed and authorized to accommodate all uses
    without interference.

2.  All new towers must be self supporting lattice or monopole or reduce
    visual impact, land occupied and reduce potential for interference.

3.  All towers will be left unpainted, if they are dull, galvanized
    steel. Paint is required, only if they have a shiny (i.e.
    reflective) surface. Only non-reflective, Bureau of Land Management
    approved dark gray to green colors will be approved unless FCC
    requires red/white striping. All towers will be treated for low to
    non-reflectance.

4.  Only lights, beacons or strobes specifically required by the FCC
    and/or the Federal Aviation Administration (FAA) will be allowed on
    towers (including antennas).

5.  The maximum tower height for this site is 80 feet which is the
    current highest tower. If future towers need to be higher, the
    height will be determined by the appropriate specific NEPA analysis
    and decision, but not to exceed 199 feet.

[Antennas]{.underline}

1.  Microwave (dish) antennas (other than ground mounted satellite
    dishes) will be limited to a maximum of twelve (12) feet in
    diameter. Smallest diameter dishes are preferred if technically
    feasible.

2.  All antennas must meet all OSHA safety standards. If an antenna
    exceeds FCC public or occupation standards (see FSS OET Bulletin
    57), it will be remedied within 24 hours after measures are taken or
    isolated (e.g., fencing, signing, relocation, lowering power levels
    are all possible remedies). Ground measurements of Radio Frequency
    Radiation, RFR, levels will be taken before mitigation measures are
    implemented.

3.  Color(s) for dish antennas, or covers, must be pre-approved by the
    Bureau of Land Management. New white dish antennas and/or covers
    will not be approved. Existing white dishes and covers must be
    repainted or replaced with grey as repairs or replacement become
    necessary.

4.  Antennas will be treated for low to non-reflectance as repairs or
    replacement become necessary.

[Interference]{.underline}

The responsibility for correcting interference problems is a matter for
resolution between the permit/lease holder of the facility(ies), the
user causing the interference, and the affected party(ies). Generally,
the first users on a site have seniority with respect to the resolution
of interference complaints. Senior holders have an obligation to
maintain their equipment to industry standards, to operate their systems
in accordance with the terms of both the FCC license and NTIA/IRAC
frequency authorization, and to comply with the Bureau of Land
Management authorization. New users on a site must correct, at their
expense, interference problems that they create. They must cease
operation of the suspect equipment until the problem is corrected. If
interference problems cannot be resolved or corrected within a
reasonable time, the new use that is causing the interference may be
terminated and the equipment removed.

The Bureau of Land Management does not have authority for correcting
interference problems, but can act as a mediator to help all affected
parties. Interference problems must be coordinated with the FCC or
NTIA/IRAC, whichever is appropriate.

Interference with law enforcement and/or emergency communications must
be corrected immediately. The operation of equipment covered by this
Site Plan shall not interfere with United States Government radio or
electronic operations already in existence on public land within two (2)
miles of the site to which this authorization refers. The user causing
this interference, shall, at its own expense, take all action necessary
to prevent or eliminate such interferences. If it does not eliminate
such interference within ten (10) days after receipt of notice from the
Bureau of Land Management to do so, this use will be terminated.

(If electromagnetic noise becomes an issue, noise thresholds will be
established and appended to this Plan.)

## RF Cables and Transmission Line (Wave Guides)

All new cabling will be jacketed and shielded and shall either be
flexible or semi-rigid type. Existing substandard cables will be
upgraded as repairs or replacement become necessary.

Cables will be properly installed and will be strapped and fastened
down.

All transmission lines (wave guides) are to be supported in accordance
with manufacturer's specifications.

Unjacketed transmission line of any type is prohibited. No transmission
lines shall be left unterminated.

Double shielded braided, or solid shielded cable will be used. No RG-8
type cable is permitted. No connector-type adapters will be used on
transmission lines. Only correct connectors that will mate to connected
devices are to be used.

## Radiation

All communications uses must meet ANSI, FCC and Bureau of Land
Management regulations guidelines and standards concerning radiation
limitations. This site is considered uncontrolled for purposes of
compliance with the RFR standards.

Monitoring radiation levels at the site is the responsibility of all
site users and will occur at intervals to comply with FCC regulations
and guidelines. A copy of the monitoring report will be provided to the
Bureau of Land Management within 30 days of its completion.

Onsite RFR measurements will be taken using appropriate equipment that
can adequately measure both on-tower and on the ground levels before
mitigation measures related to RFR are implemented.

Security fences with RFR notice signs are required around ground areas
that exceed public use levels. Tower anti-climbing ladder devices with
RFR notice signs or fencing are required on towers with RFR measurements
that exceed public use levels. All fencing location and design will be
pre-approved by the Bureau of Land Management.

Warning signs will comply with ANSI C95.2 color, symbol, and content
conventions. Contact information including name and telephone number
will also be included on new warning signs. Existing warning signs
compliant with FCC 47 CFR 1.1307(b) which do not currently include name
and telephone number will be accepted as long as the name and telephone
number is clearly posted on other signage at the Lessee's site.

Lowering power levels for on-tower access during maintenance will be
coordinated between affected users.

Any identified RFR radiation problems that are, or could be, a human
health hazard must be corrected within 24 hours after measurement tests
have been completed or be removed from the site by the site user(s). If
the proposed corrective action involves any new ground disturbance, it
must be pre-approved by the BLM.

## Utilities-Availability of and Requirements for:

[Commercial Electrical Power]{.underline}

Commercial power is provided to the site under permit to Pacific Power &
Light. The distribution line and portions of the service drops are
aerial. Future service drops or modifications will be buried.

[Telephone Service]{.underline}

No commercial telephone service is provided to this site.

[Fuel Tanks]{.underline}

All facility owners are responsible for providing fuel storage (propane
or diesel) and emergency power for their tenants. No tenants will be
authorized their own fuel tank and/or generator. Fuel storage will
preferably be consolidated into a tank large enough in size to
accommodate all tenants by each facility owner. At a minimum, tanks will
be grouped together in a consolidated area adjacent to their facilities.
All fuel, storage tanks (e.g. LPG, propane) must meet current fire
department, Federal, State and local government safety and hazardous
materials requirements.

1.  All tanks will be:

> a\. Signed in red letters, "SMOKING OR OPEN FLAME PROHIBITED WITHIN 20
> FEET";
>
> b\. In conformance with National Fire Protection Association (NFPA)
> requirements; and,
>
> c\. Painted an approved color, or screened by an enclosure to blend in
> with the natural environment. LPG tanks are universally recognized to
> be a dull white paint finish. If there is visual impact from the
> location of the LPG tank, then they must be enclosed in an enclosure
> to blend in with the natural environment. (If an enclosure is used, it
> must be pre-approved and painted an approved color).
>
> 2\. Diesel tanks will also be:
>
> a\. Enclosed in Bureau of Land Management and fire department approved
> secondary containment vaults that are painted a Bureau of Land
> Management approved color.
>
> b\. Constructed with underground fuel lines. Fuel line must be
> constructed of black, treated pipe and fittings, and must be posted.

## Sanitary Facilities

Plans for any sanitary facilities must be pre-approved by the Bureau of
Land Management. If it is determined by the Bureau of Land Management
that the user needs such facilities, they will be provided by the
applicant/holder in a manner and location satisfactory to the Bureau of
Land Management and within the requirements of the Borough Health
Department.

## Security And Law Enforcement 

The County Sheriff's Department is the key law enforcement agency for
the area. They are responsible for most civil and criminal matters. The
Bureau of Land Management will be responsible for enforcing matters
related to uses of BLM lands (e.g. resource protection issues).

Patrol and policing for security purposes is the holder's
responsibility. If holders desire to have the protection of fencing,
Bureau of Land Management approval must be obtained first. To reduce
visual clutter and efficiently utilize existing space, fencing groups of
buildings will be encouraged.

Any access gates must be adequate for Bureau of Land Management and
County Fire Department access needs.

[Fencing]{.underline}

None of the facilities are currently fenced for security purposes. Any
future security fencing must meet the following criteria:

> 1\. All fences must meet health and safety requirements.
>
> 2\. All fence locations and design require Bureau of Land Management
> pre-approval. The standard fencing type will be chain-link (i.e.
> cyclone).
>
> 3\. The standard fence height will be eight (8) feet.
>
> 4\. Fencing will be designed, maintained, and of a type to minimize
> interference issues.
>
> 5\. Fences will be signed with RFR notices if RFR is above public
> levels.

## Site Maintenance 

The objective of maintenance activities is to present a clean, neat, and
orderly appearance at the site and have all of the authorized
improvements safe for workers and the public. All users will keep up the
overall appearance of the site.

Miscellaneous debris remaining after any construction and/or equipment
installation, removal or modification, is not only a hazard, but can
cause interference or intermodulation problems. In particular, all loose
wire or metal objects are to be removed from the site.

The users of the Site will remove all graffiti within 10 working days of
finding it, weather permitting. If graffiti is on natural features (e.g.
rocks), the graffiti will be removed in a method approved by the Bureau
of Land Management Authorized Officer.

Holders will not be permitted to leave or dispose of trash, garbage or
cut brush on public lands. No outside trash or litter containers will be
provided. Site users (i.e. holders) will remove litter from the site as
it is produced.

Policing of litter in common areas (i.e. areas between buildings and
developed sites) is the shared responsibility of those holders bordering
these areas.

During construction and/or maintenance, paintbrushes will not be cleaned
off on the rocks around the site and excess materials (e.g. cement) will
be removed from public lands.

Peeling paint on buildings and/or towers will be re-painted within
thirty (30) days of notification of the holder by the BLM; or scheduled
during summer months if notified when it is too cold to paint. A
response will be required from the lessee as to when the maintenance
will be completed if it is too cold to complete the maintenance action
within the designated time frame.

The Lessee is responsible for the abatement and control of noxious weeks
within the bounds of their lease site and common use areas. Abatement
practices are to be implemented in accordance with the Pinedale Field
Office Weed Abatement programs, as coordinated with Sublette County Weed
and Pest.

## Inspections

Unless waived in writing by the Bureau of Land Management, the holder is
to provide, annually, a certified inspection of the facilities and
equipment covered by the authorization. The inspection will include
technical review that assures that authorized equipment is operating
within the specifics of this Site Plan, the FCC authorization, ANSI
Standards, and the manufacturer's specifications. In addition, the
inspection must assure that the authorized equipment is secure, free of
rust, properly grounded, and otherwise properly operated and maintained.
This inspection should also review general good \"housekeeping\". A copy
of the inspection report, certified by a telecommunication specialist,
is to be provided to the Bureau of Land Management within 30 days of
completion. Appendix D provides an example of the inspection checklist.

The Bureau of Land Management may also conduct un-announced periodic
reviews to monitor for authorization compliance.

## Fire Prevention and Hazard Reduction Requirements 

Facility owners and managers will be required to maintain to mowed, or
graveled area, a minimum of thirty (30) feet clearance around their
buildings and a minimum of ten (10) feet clearance around any propane
tanks. Identified threatened, endangered, or sensitive plant species
must remain within the minimum clearance areas.

A site specific fuels and firebreak needs to be developed in conjunction
with the Pinedale Office Fuels Program so the this site can be
defensible in the event of a crown fire.

Smoking is prohibited while walking in flammable vegetation.

The roof structure shall be kept reasonably clear of leaves, twigs, and
other debris at all times.

No explosives will be stored at this site. Flammable materials shall be
stored in conformance with the requirements of local fire regulations.
Flammables will be placed in closed containers and stored away from
sources of ignition and combustible materials. If flammables are stored
within a building, the building will be locked, properly signed and well
ventilated.

Approved spark arresters will be required and maintained on all internal
combustion engines.

At least one (1) U.L. rated 40 A:B:C dry chemical fire extinguisher is
required inside at least one of the Lease holder's buildings at their
site. Prior to each June, fire extinguisher(s) shall be inspected and
refilled by holders, if necessary. This requirement may also be met by
the presence of a fully serviceable comparably rated fire extinguisher
in the vehicle of the responsible party visiting their site.

Any fire will be immediately reported to "911", the nearest Bureau of
Land Management office or the County Sheriff.

Periodic fire prevention inspections are made by Bureau of Land
Management Officers. They will call to your attention any lack of
compliance with the above regulations, plus any other existing hazards.
Compliance with these inspections is required within the time limits
specified.

All fire protection standards must be accomplished by the beginning of
fire season unless otherwise agreed to, and then maintained throughout
the fire season.

For new construction, the Bureau of Land Management will provide the
Holder with a separate Construction Fire Plan which will be prepared at
that time as applicable.

## Access Maintenance and Restrictions

[Roads]{.underline}

Access to the site is one from US Highway 189. The road is primarily a
low level two track access from the highway approximately 4.5 miles to
the site. Approximately 2.16 miles is on public land and the remainder
on private property belonging to Miller Land and Livestock and Hoback
Ranches. The road goes through 5 range fences with wire gates that must
be kept closed.

Holders who damage or disturb the access road, or any associated
structures, such as ditches, culverts, roadside vegetation, signs and/or
underground utilities or facilities, will be required to repair the road
or associated structures to conditions equal to or superior to those
prior to any damage or disturbance. These actions may require a new NEPA
analysis.

[Interior Site Driveways/ Parking Areas]{.underline}

Roads within the communications site will be maintained by the site
users. Interior roads will be planned and approved during establishment
of new facilities. Interior roads will be maintained in a manner to
allow only one entrance to the site. The intent is to discourage
off-road vehicle use in and around the site.

[Road Closures]{.underline}

Native surface roads are subject to periodic closures to entry during
periods of extreme fire danger, inclement weather, or wet conditions.
Authorized site users may use the site during these periods, but should
use judgment and may need to seek advance approval from the Bureau of
Land Management.

+-----------------------------------------------------------------------+
| # CONDITIONS FOR CONSTRUCTION, MODIFICATIONS OR EXPANSION             |
+-----------------------------------------------------------------------+

## Responsibilities

> In addition to the responsibilities listed in Section III, New
> Facility Owners and Facility Managers are responsible for:
>
> 1\. Arrange a preapplication meeting the a Pinedale Field Office
> Realty Specialist.
>
> 2\. Submitting a complete application to the Pinedale Field Office
> prior to any new construction, or modifications to existing
> improvements (ATTN: "Realty Specialist"). The application must
> include:
>
> a\. Submitting the appropriate Cost Recovery fees in connection with
> the application.
>
> b\. A copy of the approved Site Plan Base Map showing all of the
> proposed (new) facilities including structures, towers, and auxiliary
> equipment;
>
> c\. Completed drawings/plans prepared by a registered engineer and
> approved by the Bureau of Land Management;
>
> d\. Identification of any microwave beam paths, a plot of their
> azimuth(s), and their proposed elevation(s) on the tower;
>
> e\. All proposals must include documentation that shows that proposed
> facilities will not be obstructing, or interfering with, any existing
> fixed point to point antennas, omni directional broadcast antennas, or
> microwave beam paths in the directions of primary population targets.
> Proposed beam path needs must be shown on Site Plan Base Map; and,
>
> f\. Any needed recommendations, changes or modifications to their
> original proposal, based on any required resource surveys and/or
> reports.
>
> 3\. Demonstrating that their proposals will not cause undue
> interference with any existing uses before new facilities can be
> approved by the Bureau of Land Management, the applicant has the
> responsibility to demonstrate that they will not cause undue
> interference with any existing uses. In addition, it is the
> applicant's responsibility to show that any new facilities will make
> the most efficient use of the limited amount of space at the site.
>
> 4\. Showing that their proposals will provide for future users without
> additional construction are encouraged.
>
> 5\. Providing engineering and geotechnical investigations for
> development of specific foundation designs and grading plans.
>
> 6\. Providing an Erosion Control Plan prior to construction
> activities. At a minimum, the Erosion Control Plan must include:
> sediment control, stipulations that cut/fill slopes will be graded and
> contoured to prevent erosion and/or excessive runoff, and
> recommendations for temporary erosion control measures, (e.g. netting,
> silt fences, swales, and/or sediment collection areas).
>
> 7\. Coordinating with other Federal (e.g., FCC and FAA), State and
> Borough agencies and obtainment of all required approvals and/or
> permits.
>
> 8\. Providing 30-day notice to all facility owners/managers at the
> site, as well as the Bureau of Land Management, of all new frequencies
> proposed for the site. A completed BLM technical data sheet or
> equivalent must be sent with the 30-day notice to allow for comment of
> potential interference. This would be for new frequencies for
> themselves and their tenants.
>
> 9\. Insuring that all written approvals have been obtained from the
> Bureau of Land Management prior to construction. In addition, new
> and/or modified facilities will not obstruct existing fixed
> point-to-point antennas or omni-directional broadcast antennas in
> directions of primary population targets.

## Construction Methods and Resource Protection

Plans submitted by an applicant for any new construction or
modifications shall specify provisions for soil rehabilitation measures
including, but not limited to, soil replacement and stabilization and
for proper handling of runoff from buildings, parking area, access
roads, and undeveloped common areas.

The following methods and resource protection measures will be required
to minimize impacts during construction:

> 1\. Avoid and protect sensitive resource areas, as identified by the
> Bureau of Land Management.
>
> 2\. Compliance with the Erosion Control Plan.
>
> 3\. During construction and/or maintenance, paintbrushes will not be
> cleaned off on rocks around site and no marks of any kind (including
> survey marks) will be permitted on rocks.
>
> 4\. Minimize ground disturbance and vegetation removal as much as
> possible during construction activities. All ground-disturbing
> activities require Bureau of Land Management pre-approval.
>
> 5\. Any extensive cut and fill slopes will be re-vegetated with
> vegetation species approved by BLM as soon as possible after
> construction. All re-vegetation requires Bureau of Land Management
> pre-approval. If necessary, reseeding will be required until
> vegetation is successfully established as determined by the Bureau of
> Land Management.
>
> 6\. No grading material will be cast off during
> construction/reconstruction activities. Excess soil can be used for
> fill material on road and/or building/tower pads.
>
> 7\. Temporary, on-site storage of construction materials will require
> pre-approval by the Bureau of Land Management.
>
> 8\. Construction materials and supplies, except for hazardous
> materials (see number 10. below) may be left unattended at the
> construction site at the end of each workday, but at the owner's risk.
>
> 9\. Hazardous materials, including, but not limited to all fuels,
> oils, and lubricants are not to be left unattended at the site at any
> time. During construction, these materials are to be removed from the
> site at the end of each workday, or temporarily stored inside a locked
> and signed building until the following workday.
>
> 10\. All surplus construction materials and/or waste debris must be
> removed from the site no later than thirty (30) days after
> construction has been completed.
>
> 11\. Any earth moving or heavy equipment (e.g. dozers, graders,
> cranes, backhoes, etc.) leaving the designated roadway and/or approved
> parking area(s) to perform authorized activities at the site, will be
> washed off prior to being brought onto public land to prevent the
> introduction and spread of noxious weeds into the area.

## Construction Inspection

1\. All new construction, reconstruction, or major modification shall
conform to the established technical standards and accepted engineering
practices (i.e., the Uniform Building Code).

2\. Any construction inspections required by other applicable agencies
are the responsibility of the holder. Copies of completed inspections
are to be provided to the Field Manager, either as they occur or as part
of the final as-built plan. Inspection information shall become a
permanent part of the proponent's special-use file.

3\. The Holder agrees that corrective work detailed in Bureau of Land
Management, or other agency required compliance inspections, would be
completed by the scheduled completion date. If the Holder disagrees or
has questions about specific items, the Holder must contact the Bureau
of Land Management in order that the disagreement or item may be
resolved.

4\. A final set of as-built plans will be submitted to the Field Manager
within 90 days of acceptance of structure (if contracted) or of
completion date.

## New or Remodeled/Expanded Buildings

1.  Any new buildings must be designed to accommodate multiple users
    along with fitting into the physical environment as defined in a
    site-specific environmental analysis developed at the time of the
    proposal.

2.  Buildings are required to be one-story. The roof must be metal or
    covered with metal or other fire resistant material. Roofs can be
    equipped with antenna support structures, such as poles and railings
    that can extend up to 25-feet above ground level.

3.  Facility Owners and Facility Managers are encouraged to construct
    the interior of their buildings in a modular fashion, so that they
    can:

> a\. Sublease sections to others;
>
> b\. Provide tenants and customers with internal separation and
> security;
>
> c\. Reduce physical interference; and
>
> d\. Increase management effectiveness.

4.  The following materials are approved for construction of new
    facilities (i.e. buildings)

#### a. Floors -- Concrete slab with drainage. {#a.-floors-concrete-slab-with-drainage. .unnumbered}

> b\. Walls -- Concrete block, pre-fabricated concrete, or other
> pre-approved fire resistant materials.
>
> c\. Roof -- Metal, or concrete, if painted to eliminate shiny
> surfaces, or other fireproof material as approved by the Bureau of
> Land Management. Proposals for wooden roofs will not be approved.
>
> d\. Partitions -- If it is felt partitions are necessary in buildings,
> ensure they are constructed with fire resistant material (e.g.,
> concrete block, reinforced concrete, or properly grounded expanded
> metal.
>
> e\. Color -- Proposed color for use on all exterior building surfaces
> must be pre-approved by the Bureau of Land Management. The goal of the
> color selection for the facilities is to make the building as
> inconspicuous as possible and make buildings located on the skyline
> look inconspicuous when viewed from a distance. The intent is to
> reduce or eliminate glare from reflective and/or illuminated surfaces
> such as windowpanes, sheeting and reflective paints. Non-reflective,
> Bureau of Land Management approved earth tone colors will be used on
> equipment buildings.
>
> f\. Pre-fabricated equipment shelters which meet the above
> requirements may be approved.

5.  Building entry lights must:

> a\. Only light the immediate area in the vicinity of the door;
>
> b\. Be motion activated and have a limited time duration (e.g., 3-5
> minutes); and
>
> c\. Have a shielded beam that is pointed at the building door.
>
> Requests for all-night (i.e. "dusk-to-dawn") lighting, or entry
> lighting that would be visible from outside of the site will not be
> approved.

## New or Remodeled/Expanded Towers

1.  All new construction, reconstruction, and modifications to towers
    will be pre-approved by the Bureau of Land Management prior to
    implementation.

2.  It is the applicant/holder's responsibility to assure that a new, or
    modified, structure will not unduly interfere electronically or
    physically with any existing equipment at the site. Towers must be
    spaced, so as to prevent ground level radiation and/or interference
    problems. This must be clearly demonstrated in writing to the Bureau
    of Land Management prior to issuance of a lease, permit, or
    amendment.

3.  All new towers will comply with current structural and safety
    specifications and design standards, including safety-climbing
    devices. Towers should be as narrow and "open" as safety and
    structural integrity allow. New towers will be designed using
    maximum wind, snow, and/or tower loading anticipated for the site.

+-----------------------------------------------------------------------+
| # SITE ASSOCIATION/ADVISORY GROUP                                     |
+-----------------------------------------------------------------------+

A Site Association is not needed for the South Rim Communication Site at
this time. If issues arise in the future, an Association may be required
for more user coordination. If formed in the future, the Site
Association would be responsible for obtaining access, maintenance and
upkeep of internal roads and parking areas. The Site Association would
also be responsible for ensuring cooperation between users for on-tower
access. A Site Safety officer would be identified within the Site
Association. The Site Association would be expected to develop a
Radiofrequency Radiation Plan/Agreement and recommend measures to reduce
interference issues (e.g., through use of filters).

The goal of the Site Association would also be to maximize the effective
use of the site. The objective of a sanctioned association will be to
represent all site users as a group when dealing with the Pinedale Field
Office on matters relating to the Site administration. The association
would be able to work in cooperation with the Bureau of Land Management
(BLM), and Sublette County to identify problems or opportunities and
make recommendations to these entities for any changes in management
strategies at the site. The association could also provide input to
these entities regarding the future addition of equipment and facilities
at the site. While the advice and recommendations of the association
would not be binding on these entities, they could use the input for
administration of the site. The BLM and County or their representatives
would be a member of such a group and would help jointly develop the
charter (i.e., the ground rules).

In the absence of a formal Site Association, the BLM may utilize a Site
Advisory Group that can make suggestions and/or recommendations to
specific problems associated with the administration of the site.

+-----------------------------------------------------------------------+
| # APPENDICES                                                          |
+-----------------------------------------------------------------------+

## Site Map

## Authorized Facilities

## Site Photographs

## Inspection Checklist

**APPENDIX A**

**SOUTH RIM**

**SITE MAP**

![](media/image3.png){width="6.5in" height="4.0993055555555555in"}

**APPENDIX B**

**AUTHORIZED FACILITIES**

+------------+--------+------+-------+---------+-----------+--------+
|            | **     | **U  | **    | **      | **Access/ | **O    |
|            | Auth** | se** | Build | Tower** | Parking** | ther** |
|            |        |      | ing** |         |           |        |
|            | **\#** |      |       |         |           |        |
+============+========+======+=======+=========+===========+========+
| **Facility | **     | **   | **7'x | **78'   | **Access  |        |
| 1**        | WYW-07 | BT** | 9'    | guyed** | and       |        |
|            | 9464** |      | w     |         | parking** |        |
| **GoComm   |        |      | ood** | **20'   |           |        |
| Commun     |        |      |       | la      |           |        |
| ications** |        |      |       | ttice** |           |        |
|            |        |      |       |         |           |        |
|            |        |      |       | **15'   |           |        |
|            |        |      |       | la      |           |        |
|            |        |      |       | ttice** |           |        |
+------------+--------+------+-------+---------+-----------+--------+
|            |        |      |       |         |           |        |
+------------+--------+------+-------+---------+-----------+--------+
| **Facility | **     | **C  | **8'x | **50'   | **Access  | **500  |
| 2**        | WYW-11 | EL/M | 16'   | la      | and       | gal    |
|            | 6028** | IC** | fi    | ttice** | parking** | pro    |
| **Union    |        |      | bergl |         |           | pane** |
| T          |        |      | ass** |         |           |        |
| elephone** |        |      |       |         |           |        |
|            |        |      | **8'x |         |           |        |
|            |        |      | 12'   |         |           |        |
|            |        |      | open  |         |           |        |
|            |        |      | c     |         |           |        |
|            |        |      | anopy |         |           |        |
|            |        |      | over  |         |           |        |
|            |        |      | g     |         |           |        |
|            |        |      | enera |         |           |        |
|            |        |      | tor** |         |           |        |
+------------+--------+------+-------+---------+-----------+--------+
|            |        |      |       |         |           |        |
+------------+--------+------+-------+---------+-----------+--------+

**APPENDIX C**

**SITE PHOTOGRAPHS**

**SOUTH RIM**

**FACILITY #1**

**GoComm Communications**

**WYW-079464**

![](media/image4.jpeg){width="3.5208333333333335in" height="4.6875in"}

**SOUTH RIM**

**FACILITY #2**

**Union Telephone**

**WYW-116028**

![](media/image5.jpeg){width="3.5208333333333335in" height="4.6875in"}

**APPENDIX D**

"South Rim Annual Technical Inspection"

Date Inspected:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Time
Inspection:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Permit Holder:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Authorization \#
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Site Technician :
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Phone \#
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Number of Transmitters \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
License Posted
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

*Please mark the following Items as Acceptable (A) or Unacceptable (U).*

Electrical Wiring \-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-- (A) (U)
Grounding \-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-- (A) (U)

Equipment Installation \-\-\-\-\-\-\-\-\-\-\-- (A) (U) Housekeeping
\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-- (A) (U)

Building Repair \-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-- (A) (U) Tower
Repair \-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-- (A) (U)

*Please mark the following Items as Yes (Y) or NO (N) or (NA)*

Isolators \-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-- (Y)
(N) (NA) Circulators \-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-- (Y) (N)
(NA)

Cavities \-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-- (Y)
(N) (NA) Terminators \-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-- (Y) (N)
(NA)

Filters \-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\--
(Y) (N) (NA) Lightning Protection \-\-\-\-\-\-\-\-\-- (Y) (N) (NA)

Comments:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Recommended Corrective Action:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Required Corrective Action To Be Taken:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

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Committee Representatives:
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Bureau of Land Management Representatives:
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*Please make the required corrective action within the next 120 days.*