ITS Facility Management System Gantry Attribute Form

STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION
ITS Facility Management System
Gantry Attribute Form
ITSFM060
Page 1 of 5
Rev. 01/14
Date:
Inspector:
Site Identification Name:
Gantry Information
Site Identification Name (SIN)
District:
Route
Street Address:
Latitude/Longitude (N/W) or
State Plane Coordinate (N/E)
County:
Mile Marker Lane Letter
-
-
=
City:
-
=
Gantry Name:
Gantry Type:
Year Installed:
Mainline
Ramp
Electric Circuit Name:
Automatic Vehicle Identification Transceiver Information
AVI Controller (Transceiver) #1
Comments:
Year Installed:
Manufacturer:
Transmit Frequency:
Model:
Transmit Channel: Not Applicable
Serial Number:
Receive Frequency:
IP Address:
Receive Channel: Not Applicable
MAC Address:
FCC Call Sign:
Firmware Version:
FCC Station Class:
Output Ports:
FCC License Expiration Date:
Connector Type:
Fiber:
ST
Copper:
FC
SC
Other
Antenna Connected to AVI #1
Travel Lane Coverage:
Antenna Type:
Lane 1
Lane 2
Lane 3
Lane 4
Lane 6
On Ramp
Travel Lane Direction:
NB
Lane 4
SB
Lane 5
Exit Ramp
EB
WB
Dish
Panel
Yagi
Omni
Folded Dipole
Manufacturer:
Model:
Page ____ of ____
Site Identification Name:
Route Mile Marker Lane Letter
-
Gantry Attribute Form
Page 2 of 5
AVI Controller (Transceiver) #2
Comments:
Year Installed:
Manufacturer:
Transmit Frequency:
Model:
Transmit Channel: Not Applicable
Serial Number:
Receive Frequency:
IP Address:
Receive Channel: Not Applicable
MAC Address:
FCC Call Sign:
Firmware Version:
FCC Station Class:
Output Ports:
FCC License Expiration Date:
Connector Type:
Fiber:
ST
Copper:
FC
SC
Other
Antenna Connected to AVI #2
Travel Lane Coverage:
Antenna Type:
Lane 1
Lane 2
Lane 3
Lane 4
Lane 6
On Ramp
Travel Lane Direction:
NB
Lane 4
Lane 5
Exit Ramp
SB
EB
WB
Dish
Panel
Yagi
Omni
Folded Dipole
Manufacturer:
Model:
AVI Controller (Transceiver) #3
Comments:
Year Installed:
Manufacturer:
Transmit Frequency:
Model:
Transmit Channel: Not Applicable
Serial Number:
Receive Frequency:
IP Address:
Receive Channel: Not Applicable
MAC Address:
FCC Call Sign:
Firmware Version:
FCC Station Class:
Output Ports:
FCC License Expiration Date:
Connector Type:
Fiber:
ST
Copper:
FC
SC
Other
Antenna Connected to AVI #3
Travel Lane Coverage:
Antenna Type:
Lane 1
Lane 2
Lane 3
Lane 4
Lane 6
On Ramp
Travel Lane Direction:
NB
Lane 4
SB
Lane 5
Exit Ramp
EB
WB
Dish
Panel
Yagi
Omni
Folded Dipole
Manufacturer:
Model:
Page ____ of ____
Site Identification Name:
Route Mile Marker Lane Letter
-
Gantry Attribute Form
Page 3 of 5
AVI Controller (Transceiver) #4
Comments:
Year Installed:
Manufacturer:
Transmit Frequency:
Model:
Transmit Channel: Not Applicable
Serial Number:
Receive Frequency:
IP Address:
Receive Channel: Not Applicable
MAC Address:
FCC Call Sign:
Firmware Version:
FCC Station Class:
Output Ports:
FCC License Expiration Date:
Connector Type:
Fiber:
ST
Copper:
FC
SC
Other
Antenna Connected to AVI #4
Travel Lane Coverage:
Antenna Type:
Lane 1
Lane 2
Lane 3
Lane 4
Lane 6
On Ramp
Travel Lane Direction:
NB
Lane 4
Lane 5
Exit Ramp
SB
EB
WB
Dish
Panel
Yagi
Omni
Folded Dipole
Manufacturer:
Model:
AVI Controller (Transceiver) #5
Comments:
Year Installed:
Manufacturer:
Transmit Frequency:
Model:
Transmit Channel: Not Applicable
Serial Number:
Receive Frequency:
IP Address:
Receive Channel: Not Applicable
MAC Address:
FCC Call Sign:
Firmware Version:
FCC Station Class:
Output Ports:
FCC License Expiration Date:
Connector Type:
Fiber:
ST
Copper:
FC
SC
Other
Antenna Connected to AVI #5
Travel Lane Coverage:
Antenna Type:
Lane 1
Lane 2
Lane 3
Lane 4
Lane 6
On Ramp
Travel Lane Direction:
NB
Lane 4
SB
Lane 5
Exit Ramp
EB
WB
Dish
Panel
Yagi
Omni
Folded Dipole
Manufacturer:
Model:
Page ____ of ____
Site Identification Name:
Route Mile Marker Lane Letter
-
Gantry Attribute Form
Page 4 of 5
AVI Controller (Transceiver) #6
Comments:
Year Installed:
Manufacturer:
Transmit Frequency:
Model:
Transmit Channel: Not Applicable
Serial Number:
Receive Frequency:
IP Address:
Receive Channel: Not Applicable
MAC Address:
FCC Call Sign:
Firmware Version:
FCC Station Class:
Output Ports:
FCC License Expiration Date:
Connector Type:
Fiber:
ST
Copper:
FC
SC
Other
Antenna Connected to AVI #6
Travel Lane Coverage:
Antenna Type:
Lane 1
Lane 2
Lane 3
Lane 4
Lane 6
On Ramp
Travel Lane Direction:
NB
Lane 4
Lane 5
Exit Ramp
SB
EB
WB
Dish
Panel
Yagi
Omni
Folded Dipole
Manufacturer:
Model:
AVI Controller (Transceiver) #7
Comments:
Year Installed:
Manufacturer:
Transmit Frequency:
Model:
Transmit Channel: Not Applicable
Serial Number:
Receive Frequency:
IP Address:
Receive Channel: Not Applicable
MAC Address:
FCC Call Sign:
Firmware Version:
FCC Station Class:
Output Ports:
FCC License Expiration Date:
Connector Type:
Fiber:
ST
Copper:
FC
SC
Other
Antenna Connected to AVI #7
Travel Lane Coverage:
Antenna Type:
Lane 1
Lane 2
Lane 3
Lane 4
Lane 6
On Ramp
Travel Lane Direction:
NB
Lane 4
SB
Lane 5
Exit Ramp
EB
WB
Dish
Panel
Yagi
Omni
Folded Dipole
Manufacturer:
Model:
Page ____ of ____
Site Identification Name:
Route Mile Marker Lane Letter
-
Gantry Attribute Form
Page 5 of 5
AVI Controller (Transceiver) #8
Comments:
Year Installed:
Manufacturer:
Transmit Frequency:
Model:
Transmit Channel: Not Applicable
Serial Number:
Receive Frequency:
IP Address:
Receive Channel: Not Applicable
MAC Address:
FCC Call Sign:
Firmware Version:
FCC Station Class:
Output Ports:
FCC License Expiration Date:
Connector Type:
Fiber:
ST
Copper:
FC
SC
Other
Antenna Connected to AVI #8
Travel Lane Coverage:
Antenna Type:
Lane 1
Lane 2
Lane 3
Lane 4
Lane 6
On Ramp
Travel Lane Direction:
NB
Lane 4
SB
Lane 5
Exit Ramp
EB
WB
Dish
Panel
Yagi
Omni
Folded Dipole
Manufacturer:
Model:
Page ____ of ____