FILL OUT FORM COMPLETELY, DO NOT LEAVE ANY QUESTIONS "BLANK" OR "UN-ANSWERED" (TAKE PICTURES IF POSSIBLE)

BOLLARD INFORMATION

  • ENTER BOLLARD MANUFACTURER AND MODEL:

  • ENTER BOLLARD ACTUATION TYPE:

  • ENTER BOLLARD SERIAL NUMBER.

Bollard

  • INSPECT BOLLARD APPEARANCE (TOUCH UP PAINT AS REQURED)

  • CLEANED AROUND BOLLARD PLATE?

  • CHECKED REFLECTIVE DECAL ON BOLLARD SLEEVE?

  • CHECKED LATCH AND LATCH MOUNT?

  • CHECKED BOLLARD LATCHES AT UP POSITION?

  • CHECKED BOLLARD LATCHES AT DOWN POSITION?

PNEUMATIC AND COUNTERWEIGHT

  • CHECKED PNEUMATIC/COUNTERWEIGHT SYSTEM BALANCE? (MUST BE ABLE TO PULL UP WITH UNDER 50LBS POWER)

  • CHECKED SYSTEM PRESSURE (RECORD PRESSURE READING) AND CYLINDER?

  • CHECKED COUNTERWEIGHT PULLEY SYSTEM (LUBRICATE AS REQUIRED)?

BOLLARD PITS

  • CHECKED DRAIN (SUSTAINING WATER)?

  • CHECKED SEDIMENT IMPEDING BOLLARD MOVEMENT?

ADDITIONAL NOTES OR COMMENTS (IF NEEDED)

  • ENTER ANY NOTES OR COMMENTS

ELECTRONIC SIGNATURE ACKNOWLEDGE

  • ELECTRONIC SIGNATURE ACKNOWLEDGE, I AGREE THAT MY ELECTRONIC SIGNATURE
    IS A LEGALLY BINDING EQUIVALENT TO MY HANDWRITTEN SIGNATURE. WHENEVER I
    EXECUTE AN ELECTRONIC SIGNATURE, IT HAS THE SAME VALIDITY AND MEANING AS
    MY HANDWRITTEN SIGNATURE. I WILL NOT AT ANY TIME IN THE FUTURE, REPUDIATE
    THE MEANING OF MY ELECTRONIC SIGNATURE OR CLAIM THAT MY ELECTRONIC SIGNATURE
    IS NOT LEGALLY BINDING.

  • NASATKA REPRESENTATIVE SIGNATURE

  • CUSTOMER REPRESENTATIVE OR AUTHORIZED REPRESENTATIVE

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