Ground Station Interference Report

Submitter's Information

Submitter's Name *

Submitter's Phone *

Submitter's Email *

Licensee Name *

Licensee Contact *

Address *

City *

State *

Zip Code *

Telephone *

Fax

Email *

FCC Call Sign *

Frequency *

Transmitter Address *

City *

Transmitter State *

Coordinates

Physical location of radio *

(Bldg#, Room #, etc.)

Physical location of antenna

(i.e., "On roof above gate C10)

Approximate Duration of Interference *

(Constant, Intermittent, Sporadic, etc.)

Type of interference being received: *

(Voice, Data Bursts, Squeals, etc.)

How long has the interference been going on?

Remarks