CERTIFICATE OF PROOF TEST
(1)
Distinguishing
Mark
(2)
Description of
Item Tested
(3)
Quantity
Tested
(4)
Date
Tested
(5)
Load
Applied
(6)
Rated
Load
AX
23408
HOIST RING
1 1/1/2016 2,000 LBS 1,000 LBS
(7) Name and Address of Supplier: Jergens Inc., 15700 Waterloo Rd., Cleveland, OH 44110
(8) Name and Address of Company performing test: Jergens Inc., 15700 Waterloo Rd., Cleveland, OH 44110
(9) Position of Signatory in Company Quality Assurance Manager
Jergens Inc. certifies that all hoist rings have been proof tested and examined in accordance with Jergens QSWI 3.10
and that this test completes all procedures as required.
(Signature)
In substantial agreement with (OSHA) 29 CFR 1918, ANSI/ASME B30-26, MIL-STD-1365C, MIL-STD-209K
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