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Your signature on this form will verify that you have performed the indicated modifications on
the serial numbers listed below. List the complete serial number of the machine (ex. GS6911-
136 or GS6912-364). Please check all that apply.
Model: __________________________
Serial Number :____________________
Oscillate System:
rewired the ground control box
rewired the limit switches
rerouted oscillate hoses
Axle Pivot Pins
replaced 1 non-steer end pin
replaced 2 non-steer end pins
replaced steer-end pin
Model: __________________________
Serial Number :____________________
Oscillate System:
rewired the ground control box
rewired the limit switches
rerouted oscillate hoses
Axle Pivot Pins
replaced 1 non-steer end pin
replaced 2 non-steer end pins
replaced steer-end pin
Date:
Company Name:
Account #:
Address:
(street)
(city)
State, zip code
Phone #:
Fax to:
Signature (Service Manager)
Terex Aerial Work Platform, 18340 NE 76th Street Redmond WA 98052, Ph: 800-536-1800, 425-881-
Safety Notice 110008
Completion Form
United States
Canada
All other locations
1800
Model: ____________________________
Serial Number: _____________________
Oscillate System:
rewired ground control box
rewired the limit switches
rerouted oscillate hoses
Axle Pivot Pins
replaced 1 non-steer end pin
replaced 2 non-steer end pins
replaced steer-end pin
Model: ____________________________
Serial Number: _____________________
Oscillate System:
rewired ground control box
rewired the limit switches
rerouted oscillate hoses
Axle Pivot Pins
replaced 1 non-steer end pin
replaced 2 non-steer end pins
replaced steer-end pin
877-738-7530
425-498-7530
001-425-498-7530
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