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QPS EVALUATION SERVICES INC. <br /> PS US FIELD EVALUATION REPORT <br /> a0 <br /> Page 2 of 19 <br /> File Number: QFEN 85055-3 Model Number: Ground Control Panel Date: October 26, 2023 <br /> CUSTOMER INFORMATION <br /> Company Name: Deshazo Crane PO Number: [513634-401185-Ml <br /> Company Contact: Daniel Porter <br /> Company Location: 200 Kilsby Cir. Location of Inspection: Boeing Building 40-58 <br /> Bessemer, AL 35022 ❑ Same as Customer 3003 W. Casino Rd. <br /> Everett, WA 98203 <br /> Date of Inspection: October 26, 2023 Service Agreement: ® On File <br /> ® <br /> Signed <br /> Time of Arrival: 8:00am Time of Departure: 5:00pm <br /> EQUIPMENT INFORMATION <br /> Equipment Type: Main Ground Control Panel and 10 Sub Panels <br /> Model Number: Ground Control Panel <br /> Installation Destination Boeing Building 40-58 <br /> (If known) 3003 W. Casino Rd. Everett, WA 98203 <br /> UL Standards: UL 508A: Standard for Safety: Industrial Control Panels; <br /> (Referenced as a guide) <br /> NEC (current edition) 2020 & NFPA 79 <br /> Electrical Rating 460V ®AC ❑DC 60 Hz 108 ®A 3 Ph 10HP <br /> SCCR 200KA RMS ❑ Cord <br /> at 460 Volts ❑ Cord Set Connected 3+GND Conductors <br /> ® Permanently Connected <br /> ❑ Battery Operated <br /> Inspector Name: Thai Piotrowski Inspector Signature: <br /> (Report Prepared By) <br /> Report Reviewed By: Tom Buchal Reviewer Signature: <br /> Engineering V i, <br /> Reviewer <br /> QSD 122 Rev 06 <br /> The inspection report shall only be reproduced in full with the approval of the inspection body and the client. <br />