Walinga AGRI-VAC 5614 Operator's Manual And Parts Book page 3

This form must be filled out by the sales representative and/or dealer; and signed by both the sales
representative and/or dealer and the customer at the time of delivery.
Delivery date: MM/DD/YYYY
Owner Operator Name
Phone
Email
Address
City
Postal Code/ZIP
Unit Serial Number
Blower Serial Number
CONFIRMATION OF ACTIONS COMPLETED
All items and features accounted for
Pre-delivery inspection
Review of warranty terms
Review of standard notes and terms
Review operating and safety instructions
Operator manual supplied
Supplemental documents supplied
Guards installed and secured
All safety signs identified and reviewed
Discussion regarding applicable standards (see statement on reverse)
Effective: September 10, 2020
Version 1
WALINGA
Start-up/Commissioning Form
Sales Representative / Dealer Name
Phone
Email
Address
Prov/State City
Country Postal Code/ZIP
Airlock Serial Number
Prov/State
Country