Assembly Instructions

Order #:
Surveyed By:
Date:
Quantity:
# of Pictures*:
Customer:
Job:
Address:
City:
State & Zip:
* Note pictures are useful in seeing what might be missing from this survey. If at all possible please include with this survey
BUILDING AND DOCK PIT DATA
1. Dock/Door #’s:
2. Centerline Dimension between Doors: Inches
*Note adequate space is required for mounting signs and lights.
3. Dock Face/TPR Mounting Surface:
4. Is the pit oor material concrete:
5. If pit does not exist, is the dock oor concrete:
6. Is there an existing pit oor plate bracket:
7. Is there an existing wall imbed plate:
8. Lower Front Pit Curb Angle
9. Drive/Approach Material at Dock Face
10. Leveler Sub-Frame Position to Dock Face:
11. Leveler Sub-frame Set back or Protrusion: Inches
12. Will this application incorporate Trailer Lifts, Wheel Risers, Existing
Brackets (Aftermarket Upgrade) or obstructions on the dock face?
Yes No
Concrete, solid tilt-up precast, min 6” thick Embed mounting plate, minimum 6” thick concrete
Brick/cinder block, hollow tilt-up/precast Stub wall (partial wall w/open pit)
Legs/Self Stand Frames - (Consult Factory) Other
Yes No
Yes No
3 x 3 4 x 4 None Pan Material Other
Concrete Asphalt Gravel/Dirt Other
Flush Protruding Set Back Not Applicable
No Existing Brackets (Upgrade) Trailer Lift Wheel Risers
Dock Face Obstructions - Explain:
Yes No
RESTRAINT TYPE
TPR Vehicle Restraint
UniLock Vehicle Restraint
PowerHold Vehicle Restraint
PowerStop Hydraulic Vehicle Restraint
PowerStop Manual Vehicle Restraint
Low Prole Hook
Low Prole Tall Hook
24” Tall Back Plate in Lieu of 27”
All LEDs