W M. D. A sw in K um af 9 u.u,,un.,,,.1.E, D.r. F.s, NDr.LrL s.
L c Ens(t)
Competent Person / Chartered Engineer
FIRE SAFETY AND TRAINING FOR OPERAIORS"
TC.No. : MDA-CP/1 176712023 TEST CERTIFICATE Date : 09.10.2023
(Approval No. H1/1042012021 (valid ltom 22.10.2021 lo 21.102024)
Rule No. 55 A (4) Under Clause (a) (iii) of Sub-section (i) of Section 29 of Factory Act
Prescribed for report of examination for Lifting Machines , Chains, ropes and lifting tackles
Name of the Occupier of factory M/s. MAS CRANE SERVICE
) qddress of the factory No. 90/A, JJ Nagar, 3d Street,
Thenkulapakkam, Villupuram,
Tamil Nadu : 604304
)istinguished number or mark if any and description "BOOM LIFT"
sufficient to identify the lifting machine, chain, rope Type : Diesel / Hydraulically Operator
lr the lifting tackle Max Platform Height : 60 feet
Make : Genie
Model : 560
Year of Manufacture : 2004
Sr.No. : S6004-9511
SWL : 227 KG
4. Date when the lifting machine, chain, rope or lifting tackle was :2004
first taken into use in the factory
5. Date and number of the certificate relating to any test who : First time inspection
issued the certificate together with the name and the address oi
the person and examination made under sub-rules (1) and (8)
6. Date of each periodical thorough examination made under : Examination
clause (a) (iii) of sub-section(1) of sectlon 29 of the act and (Visual / Dimensional / performance)
sub-rule(7)and by whom it was carried out done by me on 09.10.2023
7. Date of annealing or other heat treatment of the chain and : Not applicable
other lifting tackle made under sub-rule(6) and by whom it was
carried out
8. Particulars of any defects found at any such thorough :NlL
examination or after annealing and affecting the safe working
load, and of the steps taken to remedy such defects
9. Remarks : All parts of the machine of good mechanical
construction, sound material, adequate
strength and examination found satisfactory.
certify that on 09.10.2023, the machinery and gear shown in column 3 were thoroughly examined and no defects
affecting its safe working conditions were found. The above certificate is a correct report of the result.
Date of next examination : 08.,10.2024
Signature
(M. D. ASW|N KUMAR)
B.E. (Mech.), M.l.E, D.l,F.S, NDT-LIl, S.l, C.Eng(l))
coMPETENT PERSol{ / cHARTERED ENGINEER
Note: This certificate is issued based on tests & inspection conducted, our observations and information provided.
Our responsibility is restricted to proper inspection and the exercise of reasonable care. The user is responsible for
periodic maintenance, checks and inspections as per lS 14473 & 14475 arc to be conducted of all equipment. Safe
operation & Safety guidelines as per IS '13367 are to be followed.
No. 153, Kamakoti Street, Lake View Road, W.Mambalam, Chennai : 600033.
Email : ai l.com. Mob. No. : 87 7 8421 017 . 9840242007 . 9841 0377 32
