2 = 3 & 5 s 4 3 8 3 2 a & INSPECTION AND TESTING JUIAM guyana ic wweton: 05/01/2028 epiy: Oh J6|/2o2Ly suo bSBCES IBC kez O99Q— Ref. No. 2 TDA ampere BOOM TRUCK - MITSUBISHI a Se -viodel S66H diesel engine opercted, hydraull, withed with bucket _ si 5) 2012 om identification: a) Maker's serial No. ‘| SLOBCEGJ2CKO20988-1024 TDA wner's distinguishing mark or No, apteiaet : b) Owner’ distinguishing WTE Type oF EquISMent an nature or POWEr Date & place of manufacture of Equipment yall adloo!! sl tomatie tafe load indicator, required | N/A ed | NA | Not Seen , of acrane with 0) (i) (iil) Proof | {iv) Safe Length | Radius | load | workingload ofjib(m) | _{m.) (TAN) (TaN) | wake kane oe efits type otderickrginerock required @) (10) Safe working load (SWL) or loads In the case of 2 variable radius (Including a crane with a derricking jib or with interchangeable jibs of different lengths) the (SWL) at various | radit of the ji. Jibs trolley or crab must be given. Test loads at various radii should be given In column (il) & in the case of a (SWL) which has been calculated without the application ofa test ioad *Nit* should be entered in thet colurnn. (ia) in the case of acrane with derrickingjib, the maximum radius | at which the jib or jibs may be worked | Date of lost previous test report seen 1.00 1.00 2.50 2.00 NIL Not seen (12) Detects noted and/or alterations or repairs required before the Equipmentis put into service Tis 1g TO CERTIFY THAT the undersigned, a competent inspector, did, attend the site for functional testing to examine and “ARTH MOVING MACHINE, its machinery, 603t2, appliances, structural supports/fixtures and associate ut injury OF Permanent deformation to the EARTH MOVING MACHINE; and EARTH MOVING MACHINE was observed. This EARTH MOVING MACHINE iding there is continuous maintenance and qualified operators employed. tain that this © apparatus have withstood the functional testing, withos 10 adverse defects that would impairthe safe use of this issafe forits intended use within the mits specified prov Gyogdall Calaall alamo ay,