GroundBed Case Form

Rectifier Directory

Date *

Case Number (to be entered by CRCCC) *

Location Map Attached *
YesNo

General Data

Company *

Contact *

Address *

Office Phone *

Cell Phone *

Email *

Rectifier/Groundbed Location *

Directions *

Latitude & Longitude *

County *
Adair CountyAlfalfa CountyAtoka CountyBeaver CountyBeckham CountyBlaine CountyBryan CountyCaddo CountyCanadian CountyCarter CountyCherokee CountyChoctaw CountyCimarron CountyCleveland CountyCoal CountyComanche CountyCotton CountyCraig CountyCreek CountyCuster CountyDelaware CountyDewey CountyEllis CountyGarfield CountyGarvin CountyGrady CountyGrant CountyGreer CountyHarmon CountyHarper CountyHaskell CountyHughes CountyJackson CountyJefferson CountyJohnston CountyKay CountyKingfisher CountyKiowa CountyLatimer CountyLe Flore CountyLincoln CountyLogan CountyLove CountyMajor CountyMarshall CountyMayes CountyMcClain CountyMcCurtain CountyMcIntosh CountyMurray CountyMuskogee CountyNoble CountyNowata CountyOkfuskee CountyOklahoma CountyOkmulgee CountyOsage CountyOttawa CountyPawnee CountyPayne CountyPittsburg CountyPontotoc CountyPottawatomie CountyPushmataha CountyRoger Mills CountyRogers CountySeminole CountySequoyah CountyStephens CountyTexas CountyTillman CountyTulsa CountyWagoner CountyWashington CountyWashita CountyWoods CountyWoodward County

Nearest Town or Municipality *

Rectifier Data

Rectifier Designation/Description *

Rated Output *

Operating Output *

Date Output Taken *

Groundbed Description

Location from Rectifier *

Pole *
NorthNortheastEastSoutheastSouthSouthwestWestNorthwest

Type of Groundbed *

Number of Anodes *

Type of Anodes *

Anode Spacing (ft) *

Structure Protected

Type of Structure *

Size *

Length *

Coating Type *

Remarks *

Other Structures

Companies that may be affected