MACHINERY & MECHANIZED EQUIPMENT CERTIFICATION FORM Fram rine contents Zo Cure TV connate: _N'019], -21-C -1300 - comatite ED Steal Pyojet Bua 1420 “To: Contracting Otcer ‘Sul SAFETY CERTIFICATION OF MACHINERY AND MECHANIZED EQUIPMENT Reernc: (a) US. Army Cope Enger, EM 28 ()NAVEAC F307 (Dee 2005) Per EM3R5--1, parngrph 18.A3., “Before itl ws, vehicles not thers nsec by Sate oro ‘thers, shal be inspected by quliied mechani od founda peaingconetion and in comple with ‘This sufi eulfecton form shal be rata or ispscton a. ‘Srequived polished vice sey sundaes, TH tamara > Subsequent eiespections wl be conde atleast annually therefier- Inspection and ceifetion of macbinry and mechan equipment, required by EM 3051+ nd NAVFAC 57, has bees made forthe following eupmet detention of equipment: (15 Sep 2008, Safe & Heath Reuiements Mana, (omake_Tevex. mse: TOMY Ueeneiawonter Ete guvesh SI year 100%) coe Most _ entra Nene Yew 2,The above listed equipment is CERTIFIED TO BE IN SAFE OPERATING CONDITION BY A (QUALIFIED PERSON IN ACCORDANCE WITH THE MANUFACTURE'S RECOMMENDATIONS, Evan pason operating a motor whic sal owes, atl ines wile operating sch eile, cenepemit ‘all forthe eqhpment blog opened Allmachinsy and sachaied equipment wl be opted an By designated gualied personel "cei hat all machinery aod machin equipment led above i cried tobe in sf operating codon in _vcodance with the manufca's resnimendton. ame, Tit and signature of Qualified Person making the inspection name bel Gren te: ev een ‘Signature (Qualified Person) Dae; 00 }04 71 ‘Copy to: Contac Fle