Push Button Pole Base Information: Type: Cast Aluminum □ Finish: Natural Aluminum Black Dk Green Dk Bronze □ □ □ □ Push Button Pole Foundation Information: Type: Concrete □ Finish: None □ Luminaire Information: Check if Not Applicable □ Style: Cobra Residential Decorative Other_______________ □ □ □ □ Housing Manufacturer: American Electric General Electric □ □ Cooper __________________ □ □ Finish: Black Dk Green Dk Bronze Gray □ □ □ □ Mounting: Simple Arm Truss Arm Other _________________ □ □ □ Arm Length: 6ft 8ft 10ft 12ft 15ft □ □ □ □ □ Lamp Type: HPS LED □ □ Lamp Manufacturer: Sylvania General Electric □ □ Watts (LED Class Equivalent): 100 (E) 150 (D) 250 (C) □ □ □ □ 400 (A) □ Volts: 120 208 240 □ □ □ Drive Current (LED only): 700mA Other __________ □ □ □ Cobra Head LED Fixture Photo Cell Control: None 7-pin 3-pin □ □ □ Remote Monitoring Device Manufacturer: _________________ □
Push Button Pole Base Information: Type: □ Cast Aluminum Finish: □ Natural Aluminum □ Black □ Dk Green □ Dk Bronze Push Button Pole Foundation Information: Type: □ Concrete Finish: □ None Luminaire Information: □ Check if Not Applicable Style: □ Cobra □ Residential □ Decorative □ Other_______________ Housing Manufacturer: □ American Electric □ General Electric □ Cooper □ __________________ Finish: □ Black □ Dk Green □ Dk Bronze □ Gray Mounting: □ Simple Arm □ Truss Arm □ Other _________________ Arm Length: □ 6ft □ 8ft □ 10ft □ 12ft □ 15ft Lamp Type: □ HPS □ LED Lamp Manufacturer: □ Sylvania □ General Electric Watts (LED Class Equivalent): □ □ 100 (E) □ 150 (D) □ 250 (C) □ 400 (A) Volts: □ 120 □ 208 □ 240 Drive Current (LED only): □ □ 700mA □ Other __________ Cobra Head LED Fixture Photo Cell Control: □ None □ 7-pin □ 3-pin Remote Monitoring Device Manufacturer: □ _________________
V-19a.docx