3b10e091

Brookhaven National Laboratory MOBILE CRANE AND BOOM TRUCK PERIODIC INSPECTION REPORT Manuf. Bldg. #

Sn. # Equip. #: Item

NDF*

SR*

GENERAL Appearance Paint Cab Fire Extinguisher (5 BC min.) Glass Safety Glass Used Boom Angle indicator Load Indicator Load Charts Grease/Oil Leaks Bolts SCI (see exhibit DOE Headmark List) CARRIER & CRANE ENGINE Oil Level & Condition Hour Meter Operating Conditions Cooling System Anti-Freeze Battery Condition Air System Pressure Engine Instruments All Guards in Position DRAW WORK Boom Hoist Clutch Brake Pawl Swingshaft Clutches Brake Drum Shaft Flanges - Left Hand Flanges - Right Hand Brakes - Left Hand Brakes - Right Hand Third Drum Clutch Brake Control Operation

Capacity Tag # Item

NDF*

SR*

CARRIER Tire Condition Brakes Steering Outriggers Glass Controls Fire Extinguisher (5 BC min.) Serial No. BOOM Number or Type Length

Tagline Sections Damage Boom Stops Auto Boom Stops Auto Mast Stop GANTRY SHEAVES Condition Pendants Lubed Condition Load Block Capacity Condition Hook Safety Latch Jib Length Condition WIRE ROPE Kinks, Broken Strands, Abuse Jib Pendants Load Line Whip Line Anti-two Block System

Load Indicator System BOOM TRUCK CARGO BODY

Body Condition - Stakes Cargo Tie-Down Straps

* NDF = No Defects Found; SR = Service Required COMMENTS: (continue comments on back if necessary) Inspected by (Print Name): Inspected by (Signature):

6.0/3b10e091.pdf

Date:

1

(07/2007)