PLOT NO.: 5215, GIDC, NR.

7 WATER TANKS, ANKLESHWAR-393002

MAIL ID : krishnaengineers93@gmail.com, M. No.: 0-9426858180

Certi No.: 22-09/Arif-Mukaddar/Pick & Carry/PC46

FORM NO : 10
(Prescribed under Section 29/ Rule 60-GFR)
Report of Examination of the Lifting Machines, Ropes and Lifting Tackles

PARTICULARS

1 Name of Occupier of Factory : M/S Arif Jummakhan Khokhar

2 Address of Factory : M/S Mukaddar Crane

: 81/336, Gujarat Housing Board, Old Bapunagar,
: Ahmedabad - 380024, Gujarat
: Inspection at.: GIDC, Ankleshwar

20/09/2022
3 Distinguishing number or mark and description sufficient
to identify the lifting machine, chain, rope or the lifting
tackle.
: Tyre mounted Hydraulic Mobile Crane, Make: Escorts Ltd.,
: Model: F 15, Reg. No.: GJ-27-CQ-0883, Rope: Ø13 mm, Falls:
: 04 Nos, SWL: 14 T, Engine no.: E413CDJL2509151E, Chassis
: No.: ECE02169 LK0206520, Telescopic Boom L Min/Max:
5.93/17.75 M, Ht. 17.6 M

4 Date when the lifting machine, chain, rope or lifting tackle : January, 2019

20/09/2022
was first used in the factory.

5 Date of each examination made under section 29(1)(a)(iii) : Through visual inspection & Functional load test as per Load
and by whom it was carried out. : Chart was carried out by Mr. Rakesh M. Shah on Date:
: 20/09/2022

6 Date and number of the certificate relating to any test and : Not Known
examination made under sub-rule (1) of Rule 60 together :
with the name of the person who issued the certificate

7 Date of annealing or other heat treatment of the chain and : Not Applicable
lifting tackle carried out under sub-rule (5) of Rule 60 and :
by whom it was carried out

8 Particulars of any defect found at any such examination or : No defects noticed. Safe to use as per LOAD CHART of Escort F
after annealing and affecting the safe working load and the : 15 Crane. Prior to every use damage free condition of Wire
steps taken to remedy such defect. : Rope and its end joint are to be ensured by operator.

I certify that on 20/09/2022, I have thoroughly examined the above mentioned Lifting Machine/ Chain/ Rope/
Lifting Tackle and that the above is correct report of the result.

Signature:
Name: Shri Rakesh M. Shah
Address: 14, Shubham Society,
Link Road, Bharuch – 392001
Mobile No.: 9426858180

Competency Certificate No: GUJ/DISH/CPT/A/0243/2014 Valid From 13/06/2022 to 12/06/2023

Ref: Arif Khokhar/Mukaddar Crane/Ankleshwar/7016789268

Next Inspection Recommended: 19/09/2023