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SITE SURVEY

FORM

SITE SURVEY

FORM

Thank you for thoroughly completing the site survey form!

SECTION 1

FACILITY INFORMATION

All fields marked * are required.

Company Name *

Facility Address *

Facility City *

Facility Zip Code *

Facility Type *

Select Facility Type

Building Square Footage *

Number of Buildings *

Additional Facility Notes

SECTION 2

SITE CONTACT

All fields marked * are required.

First Name *

Last Name *

Job Title

Phone *

Email *

On-Site Contact Day of Visit

SECTION 3

PG&E ACCOUNT & RATE INFORMATION

All fields marked * are required.

Utility Provider *

Select Utility Provider

Utility Account Number

PG&E Rate Schedule

Select Rate Schedule

Average Monthly Bill

$

SECTION 4

ELECTRICAL SERVICE

All fields marked * are required.

Main Service Size (Amps) *

Service Type *

Select Service Type

Service Voltage *

Select Service Voltage

Utility Transformer Location *

Main Panel / Switchgear Location *

Available Panel Capacity *

3Phase Power Balance Check *

Select 3Phase Power Balance

Voltage Readings (L1/L2/L3) - If Unbalanced

SECTION 5

PRINCIPAL ELECTRICAL LOADS

All fields marked * are required.

List Major Equipment (Compressors, Evaporators, Fans, Pumps) *

SECTION 6

REFRIGERATION SYSTEM DETAIL

All fields marked * are required.

Refrigerant Type

Existing VFDS on Compressors / Fans? *

Yes

No

Number of Compressors

Compressor Type

Select Compressor Type

Number of Evaporators

Defrost Type

Select Defrost Type

Defrost Schedule (Times / Day)

Refrigeration Controls Contractor

Controls Contractor Phone

SECTION 7

ROOF & SOLAR ASSESSMENT

All fields marked * are required.

Roof Type *

Select Roof Type

Roof Condition *

Select Roof Condition

Roof Age (Years)

Estimated Usable Roof Sq Ft *

Roof Structural Assessment

Select Roof Structural Assessment

Roof Pitch *

Shading Obstructions *

Roof Access *

Select Roof Access

Parking / Land Available for Solar *

Select Parking / Land Available for Solar

Estimated Parking / Land Sq Ft

Existing Solar on Site

Yes

No

Existing Solar Size (kW)

Existing Battery Storage

Yes

No

Existing Battery Size (kW)

Existing EV Charging

Yes

No

Existing Generator

Yes

No

SECTION 8

BESS & EQUIPMENT PLACEMENT

All fields marked * are required.

Proposed BESS Location

Distance from Main Panel (ft)

Clearance / Setback Constraints

Fire Department Access Path

Ambient Temp Range at Location

SECTION 9

SITE & OPERATIONAL NOTES

All fields marked * are required.

Operating Hours / Shift Patterns / Planned Expansions / Special Consideration

SECTION 10

PHOTO & SKETCH LOG

All fields marked * are required.

Site Photos *

Please add all site survey photos here. If you're able to label them before uploading, that's very helpful.

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF ( max 100 Files )

Photo Notes

SECTION 11

SURVEY COMPLETED BY

All fields marked * are required.

Site Surveyor Name *

Date of Visit *

Time on Site *

Follow-Up Items / Next Steps

CONTACT INFORMATION

PHONE

EMAIL

SEND US A MESSAGE

FIRST NAME *

LAST NAME *

Company Name *

EMAIL ADDRESS *

PHONE NUMBER *

MESSAGE (optional)

VoltBlock Infrastructure

Demand Shield Systems for Cold Storage, Food Distribution & Industrial Facilities — Northern California

+1 650-706-7997

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