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SOUTHERN CALIFORNIA EDISON STREETLIGHT AUTHORIZATION <br />DEVELOPER/APPLICANTMUST PROVIDE THIS FORM <br />COMPLETED BY THE PUBLICAUTHORITY <br />FOR ANY SCE -OWNED STREETLIGHT INSTALLATION, REMOVAL OR CHANGE REQUESTS <br />Incomplete forms will be returned and notprocessed <br />r'ifi, of ConM A.,., <br />PUBLIC AUTHORITY NAME: <br />Builder/Developer Name: Phone d: <br />Tract/Ref d Streetlight Location See Attached SCE Maps <br />Please Check one., ❑ Installation ❑ Removal X Change <br />Number of Lamp(s) Lamp Size Lamp Type <br />—22_ 82 watt LED <br />New Installations <br />Public Authority Responsibility for Streetlight Monthly Billing <br />Please Check one and fill out applicable dates. <br />X <br />_Upon Energizing <br />❑if Public Authority Is collecting Bullder/Developer Advanced Energy Payment, <br />Indicate date collected. ( I <br />Monthly Billing: _Establish new Service Account (SA) Use existing SA # 1327055 <br />Commitment Date. <br />Date Agreed upon by SCE and Public Authority (_) or no later than 36 months from first <br />streeUlght energized whichever Is earlier. <br />Monthly Billing: _Establish new Service Account (SA) Use existing SA d <br />_Public Authority Is not responsible <br />QHOAArea Name Other Entity (please detine) <br />Public Authority Notes: <br />wumonzea ruolle Aumonty Agent <br />Tyrone Chesanek 8/30/18 <br />Print name Date Signature <br />Phone 714.647.5045 Principal CE <br />TO BE COMPLETED BYSCE <br />ACTION: ENTER TRACT/REF(1 ON OM PROGRAM NAME FIELD. <br />Planning AOR <br />DM SR 9 Product d (one mer SLAI <br />PLANNER NAME (PRINT) <br />FORWARD COMPLETED te i a oia THE <br />E SLAght! rganlzatlan Santa CONTRACT. <br />n B dg .I APPLICABLE To: <br />SCE: SOLO-= Rev 04-20-15 CY411RIT 4 <br />