LIGHTING PROJECT RETROFIT ASSESSMENT FORM

1 LIGHTING PROJECTRETROFIT ASSESSMENT FORMP roject Name:Date: PROJECT Address:City/Prov:Zip Code: PROJECT Contact :Title: Existing Fixture InformationHigh Bay/ Low BayStreet LightAcorn/ DecorWall PackParking GarageParking LotFloodSurface MountFixture Type:Acrylic Metal Acrylic / MetalGlassFixture Color:ClearWhiteBlackSilverBrownFixture Wattage:1000W400W250W200W175W100W85 WOther:Fixture Light Source:Metal HalideMetal Halide Pulse StartHigh Press SodiumMercury VaporFluore -scentFixture Color Temperature:5000 K4200 K4100 K3800 K3500 KNumber of Fixtures:Fixture Manufacturer:Fixture Make/Model Number:Fixture Height (off the floor/ road):Fixture Spacing (center to center):Supply Voltage:120V240V277V480 VFixture Mounting Configuration:WALL MOUNTHANGER / HOOK MTHARD PIPE MTSURFACE MOUNTGROUND MOUNTPOLE MOUNTPENDANT MOUNTOTHER:Fixture Wiring / Electrical hook up:Yearly Burn / Operating Hours:Utility / Energy Provider:Energy Provider Rate (kwh): Ambient Temperature:Size of Location (Square Feet):(PLEASE CHECK APPLICABLE / FILL IN OTHER DATA)Other:Other:3 WIRE CORD LENTH IN INCHES: 277V TWIST LOCK PLUG6" WIRES IN CONNECTION BOXNOTES.

2 WORK ORDER NUMBER # Fixture Configuration:Other: Other:Other:** PLEASE COMPLETE ONE form FOR EACH FIXTURE TYPE/CONFIGURATION ** PLEASE MAKE CERTAIN form IS COMPLETED FOR EACH QUOTED OPPORTUNITY/ORDER ** 960 NORTH SHORE DRIVE, LAKE BLUFF, IL 60044 PH: 847-735-8330 FAX: 847-735-8004 Temperature of fixture locationSPACING IN FEETSPACING IN FEET120V TWIST LOCK PLUG