TECHNICAL EXHIBIT _ Aerial Work Platform Certification Form.doc

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USNS WASHINGTON CHAMBERS MHE RECERT
Solicitation number
N3220520Q0164
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SAFETY INSPECTION AND WEIGHT TEST CERTIFICATION

OF AERIAL MAINTENANCE PLATFORM

USN NO.

COMMAND:

MANUFACTURER:

EQUIPMENT TYPE:

AERIAL MAINTENANCE PLATFORM

SERIAL NUMBER:

BASKET #

MODEL:

MODEL YEAR:

HOUR METER:

CAPACITY:

500 Lbs. Unrestricted

CERTIFICATION:

This is to certify that inspections and tests have been conducted in accordance with procedures set forth in the current NAVFAC P-300 and applicable manufactures technical manual. It is further certified that the above Aerial Maintenance Platform is satisfactory to lift its rated capacity and is fully operational.

· Certified for 500 Lbs., (500 lb. un-restricted). Percent testing 100% .

· Not certified for electrical or hot work

X Annual Certification Special Certification

Certification Date:

Expiration Date:

Inspector (printed name)

Inspector (signature)
Date

MHE-11-2010

REVISED 07/19/10

File details come from the government source that posted it. Updated .