Tractor DOT Inspection Customer Name HUDSON VALLEY TRUCK CENTER CRP Inspection /5/208 Date b. Friction Parts (Shoes, Linings,Drums, etc...) c. Hoses, Tubing etc... d. Slack Adjuster & Push Rods e. Camshafts, Cam Bushings, etc... f. Valves & Fittings g. Tractor Protection Valve h. Air Compressor i. Functionality of Delivery System(Air, Hydraulic, Electrical) j. ABS System k. Low Pressure Warning 2 COUPLING DEVICES Fifth Wheel, Saddle Mounts, etc... b. Pintle Hook c. Drawbar/Towbar Eye & Tongue 3 EXHAUST SYSTEM No part of the exhaust system of anymotor vehicle shall be so located as would be likely to result in burning, charring, or damaging the electrical wiring, the fuel supply, or any combustible part of the motor vehicle FUEL SYSTEM Visible Leak Fuel Tank Filer Cap Missing Fuel Tank Securely Attached All lighting devices & reflectors required by Section 393 shall be operable b. Lights c. Wiring d. Plug box e. Reflectors, conspicuity tape 6 SAFE LOADING Part(s) of vehicle or condition of loading such that the spare tire or any part of the load or dunnage can fall onto the roadway) 9 b. c. d. 0 b. b. c. = Inspected NA = Not Applicable FRAME Frame Members Tire & Wheel Clearance Bumper, Mud Flaps & Brackets License Plate, Bracket, Permits & VIN Plate TIRES Steer Tires Drive Tires WHEELS AND RIMS Wheels & Rims Fasteners Welds b. Protection Against Shifting Cargo Any vehicle without a front-end structure or equivalent device as required Steering Wheel Free Play b. Steering Column c. Front Axle Beam & All Steering Components other than Steering Column d. Steering Gear Box 2 3 4 b. 5 g. Ball and Socket Joints h. Tie Rods and Drag Links b. Springs & Suspension Components c. U-Bolts, Saddle Mounts, Hangers, Component Movements, etc... d. Radius Rods & Bushings Front Drive 30 30 I CERTIFY I HAVE INSPECTED THE EQUIPMENT LISTED ABOVE IN ACCORDANCE WITH 49 CFR 393 APPENDIX G. Driver Print (Required) Technician Print (Required) ANTHONY MICHAEL RAYMO Driver Signature (Required) Technician Signature (Required) /2 /2 3 7 9 5 5 Left Push Rod Travel Right Short Stroke Long Stroke 8 8 Chamber: Chamber: 30 30 3/8 3/8 Brake Thickness Rear Drive This Vehicle Inspection is in accordance with, and the following list of components are to be inspected per the criteria listed in 49 CFR Part 396.7 through 396.23 Appendix G to Subchapter B, Minimum Periodic Inspection Standards. Brake Thickness i. Nuts j. Steering System 8 SUSPENSION Xmembers & Subframe (Cracks, Welds, Damage, etc...) Chamber: Chamber: e. Pitman Arm f. Power Steering = Inspected NA = Not Applicable WINDSHIELD GLAZING Requirements & exceptions as stated pertaining to any crack, discoloration or vision reducing matter (Reference Appendix G, page 2) WINDSHIELD WIPERS Any power unit that has an inoperative wiper, or missing or damaged parts that render it ineffective EMERGENCY EQUIPMENT Fire Extinguisher Triangles Left Push Rod Travel Right Short Stroke Long Stroke Steer Fail = Inspected NA = Not Applicable 5 LIGHTING DEVICES 7 STEERING MECHANISM b. Any exhaust system determined to be leaking at a point forward of or directly below the driver/sleeper compartment 4 b. c. Odometer 28324 Fail = Inspected NA = Not Applicable BRAKE SYSTEM Operation, Adjustments, Leaks (Service & Parking Brakes) Fail HUDSON VALLEY TRUCK CENTER CRP Fail Make FTL VIN FUJA6CK3ADAT9995 Pass 98650 Pass License # / State TEMP2 / NY Year 0 25 Neelytown Road, Montgomery, NY 2549 Pass Fail Pass Unit # ADAT9995 TA Maybrook Pass Site Number 20 Inspection Facility Name Inspection Facility Address Work Order Number Registered Owner Inspection Status Tractor Information Site Information Left Push Rod Travel Right Short Stroke Long Stroke 9 9 Chamber: Chamber: 30 30 7/6 7/6 Brake Thickness page of DOTTCR.
Site Information Electrical System Check Tractor Information Site Number Inspection TA Maybrook Facility Name Inspection 25 Neelytown Road, Montgomery, NY 2549 Facility Address Work Order Inspection 98650 /5/208 Number Date Technician 20 MICHAEL RAYMO Customer Name HUDSON VALLEY TRUCK CENTER CRP Unit # ADAT9995 License # / State TEMP2 / NY Year 0 00 Make FTL VIN FUJA6CK3ADAT9995 Odometer 28324 Battery Diagnostics Are the batteries and/or connections free of corrosion? Are the batteries free of physical damage? Are the batteries odorless? Are the batteries free of leaks? Are the battery hold downs in good working order? Is the battery box in good condition? Are all connections tight? Are the batteries the same type? (All AGM or all Flooded) Are the batteries AGM batteries? Yes No Battery 2 3 4 CCA Ratings. CCA Readings Open Circuit Midtronics Test Voltage 925 925 2 Good Battery 925 925 2 Good Battery 925 925 2 Good Battery 925 925 2 Good Battery ESCR.