One Stop Shopping for Loading Dock Equipment
N90 W14507 Commerce Drive
Menomonee Falls, WI 53051
Phone: 262-502-1707
Fax: 262-502-1762 .
e-mail:info@multi-fab.com
www.multi-fab.com
Your Quickest Source for Dockboard Equipment
HYDRAULIC CONVERSION KIT SURVEY SHEET
Please fill in the blanks or circle the appropriate answers below.
Warning:
The installer must thoroughly inspect the structural integrity of the dockleveler. Being certain that the dockleveler being converted is mechanically sound and will have a minimum of 5 years more of service before attempting the conversion.
If in doubt, rip it out!
Date:
Company Name:
Salesman's Name:
Email Address:
Phone Number:
Fax Number:
End User's Name:
Street Address:
City:
State:
Zip:
Signature of Installing Company's Representative:
I
n signing the survey the installing company is acknowledging that they are responsible for the structural integrity of the dockleveler and all installation workmanship. Multi-Fab Products, LLC is not responsible nor liable for any loss of equipment or any incidental or consequential damage of any kind due to installation of this kit on a docklever.
SHEETS MUST BE FILLED OUT COMPLETELY TO ENSURE PROPER KIT!
Model and Brand of Dockleveler:
.
Size of Dockleveler:
.
Size of Lip:
Pit Depth:
Height from Approach to Dock Edge:
Type of Dockleveler:
Please Select One:
Air
Hydraulic
Mechanical
.
Dimension 'A'
(from survey drawing)
Deck Reinforcing Member Dimensions from Survey Drawing:
Size & Style (if any):
Does this unit have fully functional full range toe guards?
Yes
No
Is this unit equipped with Maintenance Strut?
Yes
No
What Type of equipment travels over this unit?
(Forktrucks, Palletjacks, etc.):
Additional Information to assist us :
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Web Centers of America, Inc.