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SCHEDULE 3—INTERCONNECTION PROCESS,TECHNICAL REQUIREMENTS,AND OPERATING PROCEDURES <br /> State of Minnesota <br /> Generation Interconnection Application Page 1 <br /> WHO SHOULD FILE THIS APPLICATION: Anyone expressing interest to install generation which will interconnec <br /> with (the Utility). This application should be completed and returned <br /> to the Utility'sGeneration Interconnection Coordinator,in order to begin processing the request. <br /> INFORMATION: This application is used by the Utility to perform a preliminary interconnection review. <br /> The Applicant shall complete as much of the form as possible. The fields in BOLD are required to be completed <br /> to the best of the Applicants ability.The Applicant will be contacted if additional information is required. The <br /> response may take up to 15 business days after receipt of all the required information. <br /> COST: A payment to cover the application fee shall be included with this application. The application fee amount is <br /> outlined in the`State of Minnesota Interconnection Process for Distributed Generation Systems'. <br /> OWNER/APPLICANT <br /> Company!Applicant's Name: <br /> Representative: Phone Number: FAX Number: <br /> Title: <br /> Mailing Address: <br /> Email Address: <br /> LOCATION OF GENERATION SYSTEM INTERCONNECTION <br /> Street Address,legal description or GPS coordinates: <br /> PROJECT DESIGN I ENGINEERING (if applicable) <br /> Company: <br /> Representative: Phone: FAX Number: <br /> Mailing Address: <br /> Email Address: <br /> ELECTRICAL CONTRACTOR(if applicable) <br /> Company: <br /> Representative: Phone: FAX Number: <br /> Mailing Address: <br /> Email Address: <br /> GENERATOR <br /> Manufacturer: Mod et: <br /> Type(Synchronous Induction.Inverter,etc): Phases: 1 or 3 <br /> Rated Output(Prime kW): (Standby kW): Frequency: <br /> Rated Power Factor(%): Rated Voltage(Volts): Rated Current(Amperes): <br /> Energy Source(gas,steam,hydro,wind,etc.) <br /> TYPE OF INTERCONNECTED OPERATION <br /> Interconnection,'Transfer method: <br /> Open Quick Open Closed Soft Loading Inverter <br /> Proposed use of generation:(Check all that may apply) Duration Parallel: <br /> Peak Reduction Standby Energy Sales None Limited Continuous <br /> Cover Load <br /> Pre-Certified System: Yes!No (Circle one) Exporting Energy Yes i No (Circle one) <br /> Interconnection Process for Distributed Generate Systems <br />