Free Notice of Proposed Outdoor Laser Operations and Laser Configuration Worksheet. - Federal

Please Type or Print on This Form
Failure To Provide All Requested Information May Delay Processing of Your Notice
U.S. Department of Transportation Federal Aviation Administration

Form Approved OMB No. 2120-0662

FOR FAA USE ONLY

NOTICE OF PROPOSED OUTDOOR LASER OPERATION(S)
(b) From: (Proponent)

1. GENERAL INFORMATION
(a) To: (FAA Regional Office)

(c) Event or Facility (e) Customer

(d) Report Date: (f) Site address

2. DATE(S) AND TIME(S) OF LASER OPERATION
(a) Testing and alignment (b) Operation

3. BRIEF DESCRIPTION OF OPERATION

4. ON-SITE OPERATION INFORMATION
(a) Operator(s) (b) On-site phone #1 (c) On-site phone #2

5. FDS CDRH LASER LIGHT SHOW VARIANCE (if applicable)
(a) Variance # (b) Accession # (c) Expiration date

6. BRIEF DESCRIPTION OF CONTROL MEASURES

7. ATTACHMENTS
(a) Number of laser configurations [fill out one copy of page 2 of this notice ("Laser Configurations Worksheet") for each configuration] (b) List Additional attachments (including maps, diagrams, and details of control measures)

8. DESIGNATED CONTACT PERSON (if further information is needed)
(a) Name (c) Phone (d) Fax (b) Position (e) E-mail

9. STATEMENT OF ACCURACY
To the best of my knowledge, the information provided in this Notice and attached worksheet(s) is accurate and correct. (a) Name (if different from contact person) (c) Signature FAA Form 7140-1 (4-01) (b) Position (d) Date Local Reproduction Authorized
032500.111

Please Type or Print on This Form
Failure To Provide All Requested Information May Delay Processing of Your Notice
U.S. Department of Transportation Federal Aviation Administration

Form Approved OMB No. 2120-0662

FOR FAA USE ONLY

LASER CONFIGURATION WORKSHEET
(b) Name of event/facility (c) Report date: of

1. CONFIGURATION INFORMATION
(a) Configuration number (d) Brief Description of Configuration

2. GEOGRAPHIC LOCATION
(a) Site Elevation (ft. above Mean Sea Level) (b) Laser Height Above Site Elevation (ft.) (c) Overall Laser Elevation (a + b)

(d) Latitude (e) Longitude (f) Determined by: (g) Horizontal Datum: (h) Vertical Datum: GPS

º (deg.)

` (min.) ` (min.)
Other NAD 88 NAVD 88

" (sec.) " (sec.)

º (deg.)
Map (Quad) NAD 27 NGVD 29

3. BEAM CHARACTERISTICS AND CALCULATIONS (check one Mode of Operation only, and fill in only that column)
Mode of Operation Laser Type (lasing medium) Power Watts (W) Pulse Energy Joules (J) Pulse Width Seconds (s) Pulse Repetition Frequency Hertz (Hz) Beam Diameter @ 1/e points Centimeters (cm) Beam Divergency 1/e @ full Angle Milliradians (mrad) Wavelength(s) Nanometers (nm) MPE W/cm² MPE per pulse J/cm² Pre-Corrected Power (PCP) Watts (W) Visual Correction Factor (VCF) (Enter "1.0" or use Table 5) Visually corrected Power PCP x VCF 4. BEAM DIRECTION(S) Maximum elevation angle (degrees) Minimum elevation angle (degrees, where horizontal = 0º) 5. CALCULATED DISTANCES (fill in all three columns) NOHD (based on MPE) *SZED (for 100 µ W/cm² level) *CZED (for 5 µ W/cm² level) *LFED (for 50 n W/cm² level)
*If the laser has no wavelengths in the visible range (400-700 nm), enter "N/A (non-visible laser)" in all blocks. For visible lasers, if the calculated SZED, CZED, and/or LFED is less than the NOHD, enter "less than NOHD." than "NOHD."
Pulse Energy (J) x 4

SINGLE PULSE (not applicable)

CONTINUOUS WAVE

REPETIVELY PULSED

maximum power (not applicable) (not applicable) (not applicable) (not applicable)

average power

(a) MAXIMUM PERMISSIBLE EXPOSURE (MPE) CALCULATIONS (will be used to calculate NOHD)
(not applicable) (not applicable)

(b) VISUAL EFFECT CALCULATIONS (will be used only for visible lasers [400-700 nm] to calculate SZED, CZED, and LFED)
Maximum Power (from above) Pulse Energy (J) x PRF (Hz) OR Average Power

Magnetic variation (degrees) Azimuth (degrees) HORIZONTAL DISTANCE (ft.) VERTICAL DISTANCE (ft.) True Magnetic

SLANT RANGE (ft.)

6. CALCULATION METHOD Commercial software (print product name) Other [describe method (spreadsheet, calculator, etc.)] FAA Form 7140-1 (4-01) Local Reproduction Authorized
032500.111