New Charging Location Information Submission Checklist
      ----------------------------------------------------
       Please copy the checklist below into a new email
               and fill in whatever you can. 

Your name: 

Your e-mail address:

Date: 

Site name:

Address/City/Zip:

Numbers of chargers-- SPI:   LPI:   Avcon:

Voltage, if known:
(208V or 240V)

Other power outlets apparently for charging:
(Number and description -- 5-15, 5-20, 14-50, etc.)

Did you charge here?     
If so, vehicle type:

Do EV drivers have to pay for Parking?
(If so, what are the rates?)

Is the location available 24x7?
(If not, what are the available hours?)

Thomas Bros. Maps page & grid:
(e.g., "638-J2")

Latitude/Longitude:
Source:
(GPS (brand/model), Google Maps, ...)

Elevation:
(Altitude, in feet)

Driving directions (to the facility):

Charger Location (within the facility):

Site contact & phone#:

Nearby shops, entertainment, restaurants:

Rate this site (1=boring  to  5=plenty to do)
(Also consider closeness to traveled routes,
ease of locating, availability, parking fees if any):

Are there any problems or malfunctions to report?
(If so, please describe.)

Is there a potential rollaway problem* here?
(a downslope backing away from the chargers) 

Is signage adequate?
   "Electric Vehicles Only" sign:
   "Rollaway Hazard" sign if applicable*:
   Indicative floor striping:

Is blocking by non-electric vehicles (ICEing) 
likely to be a problem here?

Serial numbers of the chargers:
(starting with the left-most charger)

Any other comments:

Please email your completed checklist to

         Updates at EVChargerNews dot com

Please attach any photos to your email.
(We prefer medium-sized (640 x 480 pixel) .jpg files,
but give us what you have and we'll make it work.)

* - A potential rollaway problem exists if the floor slopes AWAY
from the chargers, allowing for the possibility that the car 
might roll back while plugged in.

Form by Gil Dawson.  Revised 12/11/06 by Tom Dowling.