CERTIFICATE FOR EXAMINATION OF BACKHOE LOADER

SQS-T-CR-006 Rev00 (08/01/2020)

Job Order No.: WO-SQS-20-
Certificate Number: SQS-20-14063-01 Inspection Standard: BS EN 474-1, BS EN 474-3
14063

Client Name : SAIFULLAH TRANSPORT AND HEAVY EQUIPMENT RENTAL LLC

Time sheet number : 1261 Location: DUBAI, U.A.E.

Inspection Type: Initial Periodic Major

Description of equipment DIESEL POWERED HYDRAULICALLY OPERATED BACKHOE LOADER
Manufacturer JCB Manufacturing year 2010
Attachment details BUCKET Traffic plate no. C/22947 RAK
Model 3CX Engine serial no. NIL
Bucket Capacity 1m³ Chassis no. JCB3CX4TAA1618198
Date of Inspection: 07/09/2021 Date of Next Inspection: 06/09/2022
Date of Previous Inspection: NIL

A. Within a 6 Month Interval

B. Within a 12 Months Interval
The Examination Was Carried Out
C. In Accordance of Examination Scheme √
D. After Occurrence of Exceptional Circumstances
Test Procedure Number: SQS-SOP-T-006
Equipment Status: “SAFE TO USE AT THE TIME OF INSPECTION”
Date of Issue: 07/09/2021
Note: This certificate will become invalid, if any alteration / repair or modification is made.

This is to inform that the undersigned inspector or representative attended to examine this machine (equipment) to assure that it is in safe working
condition. Examination indicate that this equipment has no indigenous defects or sighted deformation and is in safe working condition. The said
equipment is found to be satisfactory for further use, provided there is continuous maintenance applied and qualified operators employed. This
certificate is granted subject to the condition that is agreed & understood. SQS Safety Consultancies liability shall be limited to the act or premises
of its employees, subcontractors. Under no circumstances whatsoever shall SQS Safety Consultancies be liable for any injury or damage to any
person or occurring by reason of negligent operation or any defect in materials, machinery, equipment or other items other than such defects
ascertainable normally. We hereby report that all particulars in this report are correct at the time of test/inspection. Daily inspection & operational
maintenance is the sole responsibility of the users. This certificate shall not be reproduced except in full without written approval of SQS Safety
Consultancies and Client.
 INSPECTION DETAILS

DESCRIPTION STATUS/CONDITION DESCRIPTION STATUS/CONDITION

DOCUMENT VERIFICATION HYDRAULIC SYSTEM
Manufacturer/Previous Hydraulic Hoses / tubes /
inspection Certificates C Fittings A
Maintenance Records A Steering Cylinder A
Repair / Modification Records A Boom Lift Cylinder A
GENERAL CONDITION Bucket/Fork Tilt Cylinder A
Guards / Covers A Hydraulic Fluid Level A
External Lights A OTHERS
Housekeeping A Parking Brake A
Safety / Warning Decals &
A Brake A
Labels
Steering A Engine Condition A
Paint Condition / Corrosion Tyre / Wheels/ Air
Control A Pressure/Crawler A
Access – Grab Rails / Steps A Lakes or Loose Materials A
Glass A Attachments(Bucket/Fork) A
Windshield Wiper A Warning Signs & Labeling A
Door Restraint A Lifting and lowering Motion A
Mirrors A Accelerator A
Reverse Alarm A Vehicle Structure A
Seat Belt A Electrical Switches / Functions A
Horn A Others (If any) C
Light (Head Light, Brake Light,
Indicator & Warning Beacon A Fire Extinguisher A

Note: A =Satisfactory, B =Unsatisfactory, C =Not Applicable

Remarks & Recommendations:

Fit For Further Use At The Time Of Inspection

Critical Findings: NIL

Non-Critical Findings: NIL

Equipment Utilized For Test: VC-01 , MT-01, TPG-01