Delivery Report

Blast Hole Drill (FD-2)

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

2.Furukawa Model 3.Serial Number 4.Engine Serial Number 5.Drifter Serial Number
Your language Your language Your language Your language

6.Hourmater 7.Hourmater (Drifter) 8.Delivery Date

Your language Your language Your language
Day Month Year

9.Customer Name 10.No. of Shipping Invoice (from JAPAN) 11.Date of B/L (AWB)
Your language Your language Your language
Day Month Year

12.Kind of Rock 13.Drilling Depth 14.Impact Pressure 15.Feed Pressure

Your language Your language Your language Your language

M MPa MPa
16.Rotation Pressure 17.Flashing puress 18.Dumper puress 19.Bit Gage
Your language Your language Your language Your language

MPa MPa MPa mm

20.Type of Bit 21.Type of Thread 22.Drilling Angle 23.Kind of Work
Your language Your language Your language Your language
Spherical Conical R28 T38 Horizontal ### Quarry ###
Parabolic Cross R32 T45 Vertical ### Construction ###
Ballistic 1600H T51 Fan Cut ### Other ###
24.Remark
Your language

25.Instructions for Operation and Maintenance Yes 26.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 :