Delivery Report

Demolition Equipment (FD-1)

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1.Distributor reference No. 1.Distributor reference No.

2.Furukawa Model 3.Serial Number 4.Kind of flame

Your language Your language Your language
T-BOX Bracket S-BOX B.H.Bracket
NT-BOX side-Plate side-bracket Other
5.Number of frame 6.Base Machine Manufacturer 7.B. M. Model Name
Your language Your language Your language

8.B. M. Serial Number 9.B. M. Hourmater 10.Delivery Date

Your language Your language Your language
Day Month Year

11.Customer Name 12.No. of Shipping Invoice (from JAPAN) 13.Date of B/L (AWB)
Your language Your language Your language
Day Month Year

14.Operating Pressure 15.Oil Flow Rate 16.Type of Rod 17.Kind of Work

Your language Your language Your language Your language
Wedge Flat Ball point Quarry Rental

Moil Cone Construction Other

18.Remark
Your language

19.Instructions for Operation and Maintenance Yes 20.Instruction of Parts List, Parts Order Yes
Your language No Your language No

INSTRUCTED IN PROPER USE AND MAINTENANCE PROCEDURES

The owner's signature below acknowledges that the breaker above mentioned was delivered to him in a
satisfactory condition and that he has received proper instruction as to the operation and maintenance.

Purchaser signature : Date :

Distributor :
Dealer : Seviceman :