User's Manual

Geophysical Survey Systems, Inc. 2.0 GHz Antenna

Model 42600

Ground Penetrating Radar Coordination Notice And Equipment Registration

Note: This form is only for Domestic United States users. The Federal Communications

Commission (FCC) requires that all users of GPR who purchased antennas after July 15

2002 register their equipment and areas of operation. It is required that you fill out this

form and fax or mail to the FCC. Failure to do this is a violation of Federal law.

1. Date:

2. Company name:

3. Address:

4. Contact Information [contact name and phone number]:

5. Area Of Operation [state(s)]:

---Continued on next page.

6. Equipment Identification:

Brand Name: Geophysical Survey Systems, Inc.

Antenna Model No. (center frequency): List all antennas being registered.