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2. Request to MODIFY a streetlight
   To be completed by the city
4. Your request to MODIFY a streetlight on:
5. located on National Grid Co. Pole No:
7. has been evaluated according to the City of Northampton's established criteria. A copy of the field evaluation form for this location is attached.
9. Field Evaluation
11. Request is:*

    1. Approved
    2. Denied
13. If approved, the recommended action is (check all that might apply)

    1. Attempt to adjust the position of the luminaire of the arm
    2. Install a house-side shield
    3. Install a street-side shield
    4. Install a cul-de-sac shield
15. - If the request is approved, and assuming that funding is available in the current fiscal year, Central Services will place a service request for the approved task.
17. - If the request is denied, such denial may be appealed to the Mayor.
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19. 1. Receive an email copy of this form.
20. Email address

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