Form 399b Telecommunications Equipment Field Trial

This form is required by RUS to obtain and review information on equipment operating under actual field conditions.
USDA - RUS
FIELD TRIAL NUMBER
DATE

TELECOMMUNICATIONS EQUIPMENT
FIELD TRIAL
A. GENERAL
la. BORROWER NAME AND ADDRESS (Number, Street, City, State, Zip)

FORM APPROVED
OMB No. 0572-0133

lb. RUS PROJECTNUMBER

2a. DESCRIPTION, QUANTITY, AND COST OF ITEMS UNDERGOING FIELD TRIAL (Include catalog numbers and estimated total installed cost.)

3a. RUS CONTRACT NUMBER

2b. SUPPLIER NAME AND ADDRESS (Number, Street, City, State, Zip)

4. SPECIFIC FIELD TRIAL LOCATION(S) (CDO, trunk route, etc.)

5. FIELD TRIAL PURPOSE (Specify in detail what aspect of performance is to be evaluated.)

7. INSTALLATION TO BE MADE BY (Name andAddress IF OTHER
THAN 2b ABOVE)

6a. STARTING DATE (Month, Day, Year)

6b. DURATION

8. INSTALLATION COST TO BE BORNE BY (Name andAddress IF
OTHER THAN la ABOVE)

1. INITIAL TESTS TO BE PERFORMED BY
Comments:

9. OWNERSHIP OF ITEMS DURING FIELD TRIAL (Name andAddress
IF OTHER THAN la ABOVE)

B. ASSIGNMENT OF RESPONSIBILITIES
[] Supplier
[] Borrov,~r

[] RUS

[] Supplier

[] Borrower

[] RUS

2b. SUBSEQUENTLY, TEST EQUIPMENT WILL BE PROVIDED BY [] Supplier
Comments:

[] Borrower

[] RUS

2a. INITIALLY, TEST EQUIPMENT WILL BE PROVIDED BY
Comtnents:

RUS Form 399b (8-82)

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