Driver Print (Required) Technician Print (Required)

Driver Signature (Required) Technician Signature (Required)

I CERTIFY I HAVE INSPECTED THE EQUIPMENT LISTED ABOVE IN ACCORDANCE WITH 49 CFR 393 APPENDIX G.

Pass

FailInspection

Facility NameInspection

Facility Address

Site Number Customer Name

Work Order Inspection Number Date

Year Make

Unit # License # / State

RegisteredOwner

Site Information

Chamber:

Inspection StatusTractor DOT Inspection

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 396.17 through 396.23 Appendix G to Subchapter B, Minimum Periodic Inspection Standards.

Pa

ss

Fa

il

√ = Inspected

NA = Not Applicable

1 Brake System

a. Operation, Adjustments, Leaks (Service

& Parking Brakes)

b. Friction Parts (Shoes, Linings, Drums,

Rotors, etc…)

c. Hoses, Tubing, etc…

d. Low Pressure Warning Device

e. Tractor Protection Valve(s)

f. Air Compressor

g. Electric Brakes

h Hydraulic Brakes

i Vacuum System

j. Antilock Brake System

k. Automatic Brake Adjusters

2 Coupling Devices

a. Fifth Wheel, Saddle Mounts, etc…

b. Pintle Hook

c. Drawbar/Towbar Eye/Tongue

d. Safety Devices

3 Exhaust System

a. No part of the exhaust system of

required by Part 393 shall be operable

Pa

ss

Fa

il

√ = Inspected

NA = Not Applicable

6 Safe Loading

a. Part(s) of vehicle or condition of

b. Protection Against Shifting Cargo - Any

vehicle without a front-end structure

or equivalent device as required

7 Steering Mechanism

a. Steering Wheel Free Play

b. Steering Column

c. Front Axle Beam & All Steering

Components other than Steering

Column

other axle positioning part(s) cracked,

broken, loose, or missing resulting in

shifting of an axle from its normal

position

b. Spring Assembly

c. Torque Radius or Tracking Components

9 Frame

a. Frame Members

b. Tire & Wheel Clearance

c. Bumper, Mud Flaps & Brackets

d. Adjustable Axle Assemblies (Sliding

Subframe)

Pa

ss

Fa

il

√ = Inspected

NA = Not Applicable

10 Tires

a. Steer Tires

b. All other tires

c. Tires marked "Not for highway use" or

otherwise marked and having like

meaning

d. Installation of speed restricted tires

unless specifically designated by motor

carrier

11 Wheels And Rims

a. Lock or Side Ring

b Wheels and Rims

c Fasteners

d. Welds

Pa

ss

Fa

il

√ = Inspected

NA = Not Applicable

12 Windshield Glazing

a. Requirements and exceptions as stated

pertaining to any crack, discoloration

or vision reducing matter (reference

393.60 for exceptions).

loading such that the spare tire or any

part of the load or dunnage can fall

onto the roadway

4 Fuel System

a. Visible Leak

b. Fuel Tank Filler Cap Missing

c. Fuel Tank Securely Attached

5 Lighting Devices

a. All lighting devices and reflectors

14 Other

b. Any exhaust system determined to be leaking at a point forward of or directly below the driver/sleeper compartment

a. List any other condition(s) which may prevent safe operation of this vehicle

13 Windshield Wipers

Any power unit that has an inoperative

wiper, or missing or damaged parts

that render it ineffective

any motor 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

DOTTCR1.2

c. Container securement devices on

intermodal equipment

d. Steering Gear Box

e. Pitman Arm

f. Power Steering

g. Ball and Socket Joints

h. Tie Rods and Drag Links

i. Nuts

j. Steering System

8 Suspension

a. Any U-bolt(s), spring hanger(s), or

JOE ZACHARY MEECE

Ervin Equipment

TA Tonopah

225

214694 5/10/2019

TC11002

11

TEMP / AZ

Tractor Information

516H4GFD7JH226379VIN

WST

✔

✔

✔

✔

✔

✔

✔

✔

✔

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✘

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✘

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✘

✔

✔

✔

✔

✔

✘

✘

✔

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✔

✔

✔

✔

32nds32nds 32nds 32nds

Left Push Rod Travel RightShort StrokeLong Stroke

In:

In:

In:

Brake Thickness

Chamber: Chamber:

In:

✔

24 24

1 1/41 1/4

15/1615/16

23 15

Steer✔

32nds32nds 32nds 32nds

Left Push Rod Travel RightShort StrokeLong Stroke

In:

In:

In:

Brake Thickness

Chamber: Chamber:

In:

✔

30 30

11

15/1615/16

23 23 23 23

Front Drive✔

page 1 of 2

Odometer 19582

This Vehicle Inspection is in accordance with, and the following list of components are to be inspected per the criteria listed in 49 CRF Part 396.17 through 396.23 Appendix G to Subpart B, Minimum Periodic Inspection Standards.

This Vehicle Inspection is in accordance with, and the following list of components are to be inspected per the criteria listed in 49 CRF Part 396.17 through 396.23 Appendix G to Subpart B, Minimum Periodic Inspection Standards.

Pass

FailInspection

Facility NameInspection

Facility Address

Site Number Customer Name

Work Order Inspection Number Date

Year Make

Unit # License # / State

RegisteredOwner

Site Information Inspection Status

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 396.17 through 396.23 Appendix G to Subchapter B, Minimum Periodic Inspection Standards.

Tractor DOT Inspection

Ervin Equipment

TA Tonopah

225

214694 5/10/2019

TC11002

11

TEMP / AZ

Tractor Information

516H4GFD7JH226379VIN

WST

Section Comment

5. LIGHTING DEVICES a. All lighting devices & reflectorsrequired by Section 393 shall be operable

turn signals and high beams do not work

7. STEERING MECHANISM f. Power Steering leaking power steering fluid

10. TIRES a. Steer Tires recap tires on steer axle

13. WINDSHIELD WIPERS a. Any power unit that has aninoperative wiper, or missing or damaged parts that render itineffective

no washer fluid

14. OTHER a. Any power unit that has an inoperative wiper,or missing or damaged parts that render it ineffective

no extinguisher in cab

page 2 of 2

Odometer 19582

5 1 6 H 4 G F D 7 J H 2 2 6 3 7 9

OKSee

Notes

a

b

c

X d

X eX fX gX h

iX jX k

l

m

n

o

p

q

r

s

t

1 2 3 4 5 6

Xa

Xb

Xc

Xd

X e

X f

Xg

X h Photo of the right side of the vehicle from front to rear

Door tag that clearly shows the manufacturer / build date (month /

year)

Dash photo from driver’s door with steering wheel at center

Photo of the left side of the vehicle from front to rear (Try to show DPF

& Tank Configuration)

ECU Mileage

2. Minimum Required Pictures

Engine tag that clearly shows the Engine Model & Serial # of the truck

being inspected

Door tag that clearly shows the Transmission and Front Axle Model &

Serial #’s ( If Applicable)

Unit VIN (17 digits)

Perform electronic cylinder cut-out or contribution test. If test is not available use infrared thermometer to

measure exhaust temperature at each cylinder. Record results, and note any observations.

1. Jpro Hook Up

Make

Notes

N/A

ALEXL049AAC

SCR equipped NONE

DPF equipped NONE

173Engine HP Rating

Connect JPRO. Print diagnostics report.

USED TRUCK INSPECTION FORM

Engine Make

QSR6.7

Engine Serial No.

CUMMINS

Engine Brake (Jake, None, Driveline, Exhaust) NONE

Engine Family Code

Hours

Year 2011

Full VIN

73149951

516H4GFD7JH226379

Engine Model

Model

19582

Odometer Mileage

Engine CPL No.

Photo of front of vehicle (Stright on hood closed)

Transmission (if electronic Automated)

Active Fault Codes

Inactive Fault Codes

Door tag that clearly shows the Rear Axle Model & Serial #’s (If

Applicable)

Inspections of used trucks (TA service code TIUT) are performed by TA Truck Service (a dba of TA Operating LLC) ASE Certified

technicians. Inspections are performed solely to report information about a truck at the time of inspection. A “Certified Used” emblem

adhered to a truck means only that the inspection reflected in this packet was conducted. This inspection, while thorough, does not and

cannot address every item on a truck, and serves only as a guide and aid in the inspection process. TA does not provide implied or

express warranties of any kind in connection with this inspection or the use of the “Certified Used” emblem. TA Operating LLC

specifically disclaims any liability for any loss or damage arising in connection with ownership or operation of the inspected truck, and

further disclaims any liability for any damage or defects not found during this inspection.

See bit.ly/UsedTruckInspections for details.

Inspector's Name: Zach Meece

u

Xi

Xj

X k

X l

X m

X n

X o

X p

X q

Xr

Xs

X t

X u

X v

X w

Xx

X y

X z

X a

X b

X c

X d

X e

X f

X g

X h

X i

j

k

X l

X m

X n

X o

X p

X q

X r

X s

X t

Xu

v

w

x

X y

X z

X aa

X bb

X cc

Radio (None, AM/FM, Cassette, CD, MP3, Satelite, Weather Band) NONE

Power Steering ( Y or N ) Y

Air Conditioning ( Y or N ) Y

Interior Type ( Basic or Premium) BASIC

Body Type (Tractor, Truck, Cab and Chassis) TRACTOR

N/A

DIESEL

Fuel Tank 1 Capacity

STATIONARY

Fuel Type - ( Diesel, Gasoline, CNG, LNG )

Wheel Mounting - ( Stud Pilot, Hub Pilot, or Spoke)

Roof Fairing ( Y or N )

Side Extenders ( Y or N )

Cab Type ( Conventional or Cabover)

Front Wheels (Aluminum, Steel, Spoke )

STEEL

45° exterior photo from front right corner (should show front of truck +

entire left side)

Interior photo from driver’s door

Photo of oil pan

Photo of DPF system

Photos of any defects in order they were listed on the report.

Exterior Visor (Fiberglass, Steel/ Aluminum, None) NONE

Chassis Fairings ( None, Full, Partial ) NONE

Photo of Left side of engine

45° exterior photo from front left corner (should show front of truck +

entire right side)

NONE

Photo of Right side of engine

Photo of differential(s) from bottom (back from check plug to bottom of

differential)

Left side drive tires

Sleeper Size in Inches - Back wall of Sleeper to Curtain

Fuel Tanks - (Steel or Aluminum )

SINGLE

VERTICAL

5th Wheel (Air, Stationary, None )

Frame - ( Steel or Aluminum )

Frame - (Double or Single )

Exhaust - ( Single or Dual )

Exhaust - ( Vertical or Horizontal )

3. Specifications

45° exterior photo from left rear corner

45° interior photo of right side of sleeper area (showing cabinetry & back

wall) If Applicable

45° interior photo of left side of sleeper area (showing cabinetry & back

wall) If Applicable

Photo of Odometer (clearly showing current miles/kilometers)

STEEL

SINGLE

Fuel Tank 2 Capacity

Fuel Tank 3 Capacity

Photo of rear of vehicle

HUBPILOT

N

N

CABOVER

STEEL

STEEL

Interior photo from passenger’s door

45° exterior photo from right rear corner

Right side drive tires

Wheelbase (Distance from steer axle to center of drive axle)

Rear Wheels (Aluminum, Aluminum Outside, Steel, Spoke )

Dual Beds - Y or N

Sleeper Type - (Integral Raised, Mid, Flat) (Boxed Raised, Mid, Flat)

(None)

Upholstery (Cloth, Vinyl/Cloth, Leather, Vinyl, Button-Tuck) VINYL

Interior Level (Mid, Low, High) LOW

X dd

X ee

X ff

X gg

X hh

X ii

X jj

kk

ll

X mm

X nn

X oo

X pp

qq

X rr

ss

X tt

X uu

vv

X ww

xx

X yy

X a

b

X c

X d

X e

X f

X g

X h

X i

X j

X k

l

X m

X n

X o

p

X q

r

X s

t

u

X v

X w

X x

X y

X z

aa

X bb

a

b

Exterior Paint Color WHITE

Mirrors - Heated ( Y or N ) N

Mirrors - Power ( No, RH, Dual) N

Axle Ratio

Charging System- Record Voltage Reading:

Bumper ( Aero, Chrome, Steel/Aluminum) STEEL

OK

HVAC - Check refrigerant compressor for secure mounting, noticeable

Turbo - Check for any abnormal noises and vibrations. If any are found,

Turbo - Check for external oil leaks

OK

OK

OK

5. Interior

OK

OIL LEAK ON OIL PAN

SMALL LEAK AT POWER STEERING

Engine Oil - Condition

OK

Exhaust system - manifold, turbo & piping OK

Engine Fuel Leaks

Starter & solenoid - Proper mounting / Damage

Fan hub, clutch, blade, shroud

OK

OIL LEAKING AT PLUG

NONE

Coolant - Condition

Air intake - manifold, air-to-air & piping

ALISON

Gauge reading: OK

Front Axle Make

Engine oil leaks, seeps, or build up indicating a leak

Steering System - Steering gear, draglink, pump & hoses

Check air filter &/or restriction gauge

HVAC - Check main HVAC boxes for any abnormal drainage

Check engine Oil Pan. Note any leaks or any seeps with build-up,

Air System - compressor, governor & hoses

Start engine - Listen for unusual noises

OK

Clutch pedal free stroke

Emission Snap Test Performance

Transmission - Make

Belt - Alignmrent , Condition & Adjustment

OK

A/C compressor, clutch & brackets

Protection:

Radiator, reservoir, hoses PK

Measure engine blow-by with manometer no engine load). If condition

Check engine for irregular noies, vibrations, misses, etc

OK

OVER FULL

OK

Engine Oil - Level

Coolant - Level

Turbo - Remove intake and visually inspect the turbine, the shaft, and

Exhaust system - manifold, turbo & piping

03/2011

Front Axle Position - ( Set Back or Set Forward )

Rear Axle Make MERITOR

Rear Axle Load Capacity

Auxiliary Axle - ( None, Tag, Pusher, or Liftable)

SINGLE

Transmission Model

Transmission Speeds

Transmission Type - ( Automated or Manual )

4. Engine Compartment

Record coolant protection level - Temp and SCA

PTO ( Y or N) Y

Rear Axle Type (Single, Tandem, Triaxle, Quad)

Wet Line Kit - ( Y or N )

Build Date (month/year)

AUTO

Suspension (Air Ride, Heavy Duty, Spring) HEAVY DUTY

MERITOR

Front Axle -Load Capacity 12,000

NONE

Seat Suspension (Dual Air, LH Air, None) AIR

Interior Color GREY

-20

14

c

X d

e

f

X g

X h

X i

X j

k

l

m

n

X o

p

q

r

X s

X t

X u

Xv

X w

X x

X y

X a

X b

X c

d

e

f

X g

X h

X i

X j

X k

X l

X m

X n

X o

X p

X q

r

X s

X t

X u

X v

X w

X x

X y

z

a

OK

Mud flaps, 1/4 fenders, brackets OK

Engine monitor display & LCD readout

OK

Lights & reflectors

Trailer cord, air lines, glad-hands, hangers NO CHORD

Fuel tanks & mounting OK

Batteries, cables & terminals OK

Mirrors & mounting brackets OK

Suspension- springs,pins, hangers, etc. OK

Frame & Crossmembers OK

OK

Air dryer

Check heater core for operation and leaks OK

Engine brake

Check operation of all HVAC control on each control unit OK

Air leaks on outside of truck

Drain wet tank - oil in air system?

Front axle, king pins, tie rods & ends

Engine/transmission mounts: Visual Inspection Loose or Broken

Reading:

OK

OK

OK

OK

Glass - windshields, doors & mirrors

Air leaks - dash, foot valve, shift knob, etc...

OK

Check front and rear blower motors for abnormal noises and operation

at all speeds

OK

Perform basic air-conditioning performance test: run AC on high with

40 1200 RPM:

OK

Idle:

OK

Windshield wipers & washers condition

Door hinges, latches, regulators & knobs

Seats - air operation & condition OK

Upholstery, carpet, mats, etc..

Sleeper / cab privacy curtains & tracks

Cabinets, doors & hinges

Mufflers, stanchion mounts, guards

Hydraulic brake lines & components

Air Pressure Build Up- Governed Psi

Cab/sleeper air ride & mounting

5th wheel- plate, bushings, cylinder, etc.

OK

Mirrors- heated & power operation & condition

Parking brake

Radio & speakers

Horn - City/ Air

Dash, gauges, switches & interior lights

65

OK

Steering wheel, tilt column, shafts & u-joints condition

Check engine oil pressure

OK

Driveshafts, u-joints, yokes, carrier bearing OK

Transmission & rear axle - condition & leaks

Rear axle & suspension alignment OK

7. Powertrain: Ride Along With Driver

Check transmission for abnormal, shifting, grinding, noises, vibrations

NONE

Shocks, bushings & mount brackets

Wheel seals - leaks with build up

Seat Belts & Bunk Restraints OK

6. Exterior

Brake hoses- cracking & chafing OK

OK

Clean Idle Decal

Paint Defects NONE

Paint Defects

OK

120

b

X c

X d

Xe

f

Xg

h

a

b

c

BackingBFGD H Plates R C

BRST L YES V D

CONT NO F

DUNP M

FIRE R

GDYR W

GENR X2HANK X3

KUMH

MICH

TOYO

YOKOOTHR

Make

Model

Size

Date

Type

Tread

32ndsFaults

Make

Model

Size

Date

Type

Tread

32ndsFaults

Perform electrical systems diagnostics. Keep report for inspection

Check drive-line for any loose/worn components prior to any lubrication

Check transmission seals for any leaks or any seeps with build-up

NONE

OK

OK

OK

OK

8.Charging and starting system: Perform ESCR (Powernet test with Autometer)

Check rear axle(s) and hubs for abnormal noises or vibrations

Check transmission lubricant for operating levels and metal shavings

Check rear axle(s) and hubs lubricant for operating levels and metal

shavings

Fireston

Goodyear

General

Hankook

Kuhmo

Tread

Left Steer

Make OTHR

Model K211

Michelin

Toyo L

Yokohama

Make

Check batteries for secure mounting, performance, and for any corrosion

Check alternator for secure mounting, operation, and wire corrosion

Check ride-height and airbags.

Check rear axle(s) and hubs for any leaks or any seeps with build-up

9. Tires

Other

Make Codes

BF Goodrich

Bridgestone

Continental

Dunlop

BRST Make MICH

40/13

RECAP

L

Left Front Outside

Faults Faults D

Faults

Right Steer

Make HANK

Model AH12

32nds 24 32nds

Date 15/18 Date

Type RECAP Type

Tread

15

Tread L Tread L

32nds 23 32nds 23

Faults Faults

Left Rear Outside Left Rear Inside Right Rear Inside Right Rear Outside

Model Model

Date

Date

Type

Tread

32nds

Faults

GENR

S371

2318

R

L

23

Right Front Outside

GDYR

G661

RECAP

L

23

Date

Model M843 Model MULTI X

Date

Type RECAP Type RECAP

Left Front Inside Right Front Inside

Make

Model

Date Date

Type Type Type

Tread Tread Tread

32nds 32nds 32nds

Faults Faults Faults

Tread Type

Recap

Virgin

Highway

Lug

Size 11R22.5 Size 11R22.5

11R22.5 Size 11R22.5 Size 11R22.5 Size 11R22.5

Size Size Size

Cut

Dry rot

Flat

Mismatch Tread/Casings

Wheel Damage

Irregular Wear

Recapped twice

Recapped three times

Make Make Make

Model

Inspection completed by:

(PRINT NAME) (SIGNATURE) (Date)

Additional Notes

TC11002

Cab right side Cab left side

TC11002

Cab front right 45 Cab front left 45

TC11002

Cab front Cab rear

TC11002

Cab right rear 45 Cab left rear 45

TC11002

Tires left Tires RIGHT

TC11002

Door vin Door vin

TC11002

Gauge cluster Mileage information

TC11002

Driver door view Passenger door view

TC11002

Engine left Engine right

TC11002

Front differential Rear differential

TC11002

Oil pan VIN TAG