BACKHOE LOADERS

GENERAL INFORMATION DATE: INSPECTOR:

MANUFACTURER: LOCATION: City: Front BUCKET TYPE:MODEL: Region (Country): Front BUCKET C.TY: m3SERIAL NUMBER: (yy/mm) SMR reading Rear BUCKET C.TY:ENGINE MODEL: Re. BUCKET WIDTH:ENGINE Ser. No. TYRESTYPE OF USAGE: CAB:

1) EXTERIOR & CAB A B C D E Yes No1 MAIN FRAME (superstructure) CRACKED OR WELDED2 CAB / CAB DOORS & LATCHES DENTS OR DAMAGE3 WINDSHIELD & GLASS CRACKED OR BROKEN4 HOOD & GRILLS ANY DAMAGE5 FENDERS AND BUMPERS ANY DAMAGE6 PAINT CONDITION7 SEAT & CUSHIONS ALL ADJUSTMENTS FREE8 HEATER/AIR CONDITIONER ALL WORK9 TANKS (Fuel & Oils) ANY DAMAGE or LEAKS

Total:

2) TYRES A B C D E Yes No1 Right Front ANY CUTS OR DAMAGE 2 Left Front ANY CUTS OR DAMAGE 3 Right Rear ANY CUTS OR DAMAGE 4 Left Rear ANY CUTS OR DAMAGE

Total:

3) ENGINE A B C D E Yes No1 PERFORMANCE FUNCTIONAL TEST (performed)2 STARTS EASY Yes No OIL OR WATER LEAKS

Yes No UNUSUAL NOISES / SMOKECRACKED OR WELDED

3 TURBO CHARGER LEAKS OR UNUSUAL NOISES4 RADIATOR ANY DAMAGE or LEAKS

Total: BLOW BY

4) ELECTRIC SYSTEM A B C D E Yes No1 WARNING LIGHTS-GAUGES-MONITOR ALL WORK2 BATTERIES NEED CHARGING OR REPL.3 WORK LIGHTS ALL WORK

Total: ROTATING BEACON

5) DRIVE TRAIN A B C D E Yes No1 PERFORMANCE FUNCTIONAL TEST (performed)2 TRANSMISSION NOISY or LEAKS / SHIFT HARD3 TORQUE CONVERTER LEAKS4 FINAL DRIVES LEAKS / CRACKED OR WELDED5 SERVICE BRAKES ANY DAMAGE or LEAKS6 BRAKES PUMP ANY DAMAGE or LEAKS7 PARKING BRAKE WORKS8 STEERING PUMP ANY DAMAGE or LEAKS9 STEERING CYLINDER & LINKAGE ANY DAMAGE or LEAKS

Total:

6) HYDRAULICS A B C D E Yes No1 PERFORMANCE FUNCTIONAL TEST (performed)2 HOSES LEAKS3 CYLINDER ROD CONDITION DAMAGED4 CYLINDERS LEAKS or DRIFTS5 VALVES LEAKS6 PUMPS LEAKS

Total:

7) WORKING ATTACHMENTS A B C D E Yes No1 LOADING BUCKET CRACKED OR WELDED2 EXCAVATING BUCKET CRACKED OR WELDED

Total:

8) BACKHOE LOADER A B C D E Yes No1 LOADER ASSEMBLY CRACKED OR WELDED2 ARMS AND CRANKS STRAIGHT3 BUCKET PINS TIGHT4 BUCKET LEVELER & KICKOUT WORKING5 FRONT / REAR AXLES LEFT REAR - Rear or inner6 OUTRIGGER CONDITION & SHOES SHOES DAMAGED7 TELESCOPIC ARM SLIDE GUIDE ADJ. WEAR REMAINING8 BOOM / ARM CRACKED OR WELDED9 BUCKET LINKAGE WELD

10 BOOM PIN/BUSHING CLEARANCE WITHIN SPECS11 ARM PIN/BUSHING CLEARANCE WITHIN SPECS12 BOOM/ARM PIN SIDE CLEARANCE WITHIN SPECS13 BOOM - ARM ALIGNMENT STRAIGHT

Total: STD ADDITIONAL

9) OPTIONS A B C D E OPTIONS A B C D E1 42 53 6

10) SAFETY ITEMS & COMPLIANCE Yes Yes Yes1 MOTION/BACK-UP ALARM 8 POWER CUT OFF DEVICE 15 DOORS - CATWALKS ANTISLIP2 HORN 9 SAFETY LEVER LOCK 16 STEPS & HANDRAILS3 MODIFICATIONS TO OPERATOR SEAT 10 CONTROL PATERN DECALS ETC. 17 KEEP CLEAR DECALS4 SEAT BELT 11 CHECK LEVER FOR CORRECT PATTERN 18 CRUSH HAZARD5 MODIFICATIONS TO CONTROL LEVERS 12 WARNING DECALS (Read O&M manual) 19 FAN FINGER GUARDS6 NEUTRAL START SWITCH 13 MIRRORS 20 NOISE DECAL INSIDE CAB (LpA)7 CONTROLS RETURN TO NEUTRAL 14 FOPS 21 NOISE DECAL OUTSIDE CAB (LwA)

A B C D E O & M MANUAL CE PLATE CE Certific. EU EMISSION PLATE

Others ROAD CIRC PLATE

A B C D E PHOTOS Right Rear DEALER QUALIFIED SERVICE

SUMMARY OF COMPONENTS RATINGS Right Front Left Rear KOWA Mach. History

Left Front Controls PM CLINIC Maint. Contract

MACHINE RATING Tyres Complete KUC R & M Contract Signature:

YEAR OF SALE

TRADE IN DATEYEAR OF MFG

% of new

ESTIMATEDACTUAL reading

AT TRADE IN AC

Remarks Remarks

Remarks

m3

Remarks

Type

SizeEROPS

Remarks

OROPS

% of new

% of new

% of new

% of new

Remarks

% of new

% of new

mmmmmm

OWNER NAME

Remarks

Remarks

Remarks

Remarks

OVERALL RATING

COUNTERWEIGHT

Remarks

Remarks

NOISE PL.

COMPLIANCES:

RETAIL VALUE AS INSPECTED:

Remarks

BRAND

Key set

% of new

07/13/2009Komatsu

WB140-2NA22239

S4D106-2XFHV09515

-

291658

06/061096

Edwin Chamorro 291658

STANDARD

609mm

X XN/AN/A

X XXXX

N/AX

0 6 0 0 0

X 50% X FIRESTONE 14-17.5X 50% X FIRESTONE 14-17.5X 50% X FIRESTONE 19.5L-24X 50% X FIRESTONE 19.5L-24

0 4 0 0 0

X XXX

XXXX

X XX X

X0 4 0 0 0

X XX XX X

0 3 0 0 0

X XX XX XX XX XX XX XX XX X

0 9 0 0 0

X XX XX XX XX XX X

0 6 0 0 0

X X Cutting edge can be turnedX X

0 2 0 0 0

X XX XX XX X needs to be adjusted

XX X Both outrigger shoes need to be replaced.

N/AX XX XXX XX XX X

0 10 0 1 0

X

X

XX XX

X XX XXX

0 44 1 1 0 X

X

X

X

X

X

X

X

-

Remarks & Photo

GENERAL REMARKS

25MODEL S/N0 (FRONT) MODEL S/N0 PLATE (CE) EPA PLATE ROPS PLATE

BOOM / ARM / EXT REAR BH BUCKET FRONT BH BUCKET REAR12 13 14

51 2 3 TIRE FRONT RIGHT

6 7 8 9 10

21 22 23 24 -

4FRONT RIGHT FRONT LEFT REAR RIGHT REAR LEFT

1 2 3 4

7 8TIRE REAR RIGHT TIRE REAR LEFT6

11

TIRE FRONT LEFT

BUCKET REAR

16 17CONSOLE MONITOR FRONT CONSOLE MONITOR REAR 18 ENGINE

9

19 HYD. PUMP

LOADER ARM FRONT

SEAT

MAIN VALVE

15

10

20

BUCKET FRONT

5

Record of Photos

Photos for Special Remarks

OUTRIGGER PADS NEEDREPLACING.

HOUR METER PLASTIC ISOPAQUE.

Unit is in good condition. Some things to note at are, cutting edge needs to be turned, outrigger pads need replacing, hour meter plastic opaque, kick out needs adjustment. Unitis a D.