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

EDWARD POOLEY LUIS HERRERARODRIGUEZ

✔TRUCK TRACTOR TRAILER

TA Atlanta Onsite

3181 Donald Lee Hollowell Parkway, Atlanta, GA 30318

406

3313 5/13/2019

GE1824

15

222362Odometer

TEMP / FL

Tractor Information

3AKBCYCY6FDGE1824VIN

FTL

TRUCK TRACTOR TRAILER

✔

✔

✔

✔

N A

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N A

N A

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✔

N A

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N A

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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

1/21/2

17 17

Steer✔

32nds32nds 32nds 32nds

Left Push Rod Travel RightShort StrokeLong Stroke

In:

In:

In:

Brake Thickness

Chamber: Chamber:

In:

✔

30 30

1 1/41 1/4

1/21/2

15 16 15 17

Front Drive✔

page 1 of 1

FD 00204 Revised 7/19/10

US DOT/FMCSA FEDERAL MOTOR CARRIER SAFETY REGULATIONSPERIODIC INSPECTOR/BRAKE INSPECTOR QUALIFICATIONS 49 CFR PARTS 396.19 & 396.25

Federal Motor Carrier Regulations require motor carriers to ensure compliance with qualification of inspectors.

Understand the inspection criteria set forth in 49 CFR Parts 393 & 396, Appendix G to Subchapter B--Minimum Periodic InspectionStandards, and can identify defective components

Understand the brake service or inspection task to be accomplished and can perform that task

Be knowledgeable of and have mastered the methods, procedures, tools, and equipment used when performing an inspection or anassigned brake service or inspection task

Be capable of performing an inspection or assigned brake service or inspection by reason of experience, training, or both

Qualified Inspectors must meet one of the following criteria:

I. _____Have successfully completed an apprenticeship program sponsored by a state, a Canadian Province, a federal agency or a labor union, or a

training program approved by a State, Provincial, or Federal Agency, or has a certificate from a State or Canadian Province which qualifies the

person to perform the assigned brake service or inspection task or Commercial Vehicle Safety Inspection. Specify:

Program/Certificate Name_____________________________________________ Date Completed_____________________

City/State/Location_____________________________________________________________________________________

II._____Have a combination of periodic inspection/brake related training or experience totaling at least one (1) year. Such training or experience

may consist of the following:

(Check all that apply)

A_____Participation in a training program sponsored by a truck/vehicle or brake manufacturer or similar commercial training program

designed to train students in truck operation and maintenance, brake maintenance or inspection similar to the assigned brake service or

inspection tasks. Specify:Name of Program_______________________________________________________ Date Completed_____________________

B_____ (Total Years) Experience as a mechanic or inspector in a motor carrier maintenance program including experience performing

brake maintenance or inspection similar to the assigned brake service or inspection task. Specify:

Name of motor carrier___________________________________________________ Date Employed______________________

Name of motor carrier___________________________________________________ Date Employed______________________

C_____ (Total Years) Experience as a mechanic or inspector in truck maintenance at a commercial garage, fleet leasing company or

similar facility including experience performing brake maintenance or inspection similar to the assigned brake service or inspection task.

Specify:Name of Garage or Facility__________________________________________________ Date Employed___________________

Name of Garage or Facility__________________________________________________ Date Employed___________________

D_____ (Total Years) Experience as a commercial vehicle inspector for a State, Provincial, or Federal Government. Specify:

Name of Government Agency________________________________________________ Date_________________________

_____________________________________________ __________________________________________Inspector’s Name (Print) Inspector’s Signature

_____________________________________________ __________________________________________Inspector’s Supervisor’s Name (Print) Inspector’s Supervisor’s Signature

We certify the above information is true and correct to the best of our knowledge.

Inspection Facility Name:___________________________________________________ Phone Number___________________________

Address, City and State:_______________________________________________________________________ Date_________________

✔

LUIS HERRERARODRIGUEZ (lah)

RAYMOND COINERJR (rpc)

3181 Donald Lee Hollowell Parkway, Atlanta, GA 30318

406 TA Atlanta Onsite 404-794-8168

1/25/2019

3

406 TA Atlanta Onsite 11/30/2018

001 TA Ashland 4/21/2016

11

Powernet System TestBCT-460DTNA Page 1 of 3 Rev .3b

TA Atlanta - TA406 3181 Donald Lee Hollowell Parkway

Atlanta, GA

 Date: 05-07-2019

Test Number: 9

Tool ID: 11384Firmware: CM-1.05, LM-1.57

Tech ID: JOSH

Odometer: 222,362VIN: 3AKBCYCY6FDGE1824RO: 1

Complaint: No complaintsParts Replaced: -

Batteries Check - MainBattery Bank Test - Main - 1st Test

Pack Battery Type Number of Batteries Battery Temp CCA Rating OCV of Bank

Starting Standard 2 93 925 12.67V

# of Batteries Replaced   Battery Interconnect Test

0 

Voltage Drop - Neg

Voltage Drop - Pos

Total Voltage Drop Result

  - - - -

  83mV 21mV 104mV Good

Battery Bank Test - Main - 2nd Test

Pack Battery Type Number of Batteries Battery Temp CCA Rating OCV of Bank Result

- - - - - -

Starting Standard 2 89 925 12.53V Good

Batteries Check - AuxiliaryBattery Bank Test - Auxiliary - 1st Test

Pack Battery Type Number of Batteries Battery Temp CCA Rating OCV of Bank

- - - - -

# of Batteries Replaced   Battery Interconnect Test

- 

Voltage Drop - Neg

Voltage Drop - Pos

Total Voltage Drop Result

  - - - -

  - - - -

Battery Bank Test - Auxiliary - 2nd Test

Pack Battery Type Number of Batteries Battery Temp CCA Rating OCV of Bank Result

- - - - - -

- - - - - -

Powernet System TestBCT-460DTNA Page 2 of 3 Rev .3b

TA Atlanta - TA406 3181 Donald Lee Hollowell Parkway

Atlanta, GA

 Date: 05-07-2019

Test Number: 9

Tool ID: 11384Firmware: CM-1.05, LM-1.57

Tech ID: JOSH

Odometer: 222,362VIN: 3AKBCYCY6FDGE1824RO: 1

Complaint: No complaintsParts Replaced: -

Individual Batteries Check - MainIndividual Battery Bank Tests - Main

Battery Position Battery Type Battery Temp CCA Rating OCV Battery SN Battery Code Result

1 Starting Standard 93 925 12.55 F877AJFFPBH2 Good

2 Starting Standard 91 925 12.55 F877AJFFPXH2 Good

Failed Individual Battery Bank Tests - Main

Battery Position Battery Type Battery Temp CCA Rating OCV Battery SN Battery Code Result

- - - - - - - -

Individual Batteries Check - AuxiliaryIndividual Battery Bank Tests - Auxiliary

Battery Position Battery Type Battery Temp CCA Rating OCV Battery SN Battery Code Result

- - - - - - - -

Failed Individual Battery Bank Tests - Auxiliary

Battery Position Battery Type Battery Temp CCA Rating OCV Battery SN Battery Code Result

- - - - - - - -

Powernet System TestBCT-460DTNA Page 3 of 3 Rev .3b

TA Atlanta - TA406 3181 Donald Lee Hollowell Parkway

Atlanta, GA

 Date: 05-07-2019

Test Number: 9

Tool ID: 11384Firmware: CM-1.05, LM-1.57

Tech ID: JOSH

Odometer: 222,362VIN: 3AKBCYCY6FDGE1824RO: 1

Complaint: No complaintsParts Replaced: -

Starting System CheckStarter Cables

Pos Voltage Drop Neg Voltage Drop Total Voltage Drop Result

278mV 338mV 616mV Starting Cables Fail

278mV 333mV 611mV Starter Cables Pass

Starter Test

Engine Type Number of Cylinders Begin Voltage Cranking Voltage Cranking Current Cranking RPM Start Enable Circuit Result

- - - - - - - -

- - - - - - - -

Diesel 8 12.5V 11.27V 629A 125 - Pass

Charging System CheckAlternator Cables

Pos Voltage Drop Neg Voltage Drop Total Voltage Drop Result

- - - -

24mV 18mV 42mV Charging Cables Pass

Alternator Test   RS Terminal Voltage

Rated Output Regulated Voltage Ripple Charging Current Result

 

-- - - - -

- - - - -

160A 14.76V 219.32mV 124A Pass

SummaryPretest Comments

Freightliner m2

Post Test Comments

DIAGNOSTIC REPORT

11:23 amMay 07, 2019Print Date:

Vehicle Make Freightliner

Model

Model Year

M2 106

2015

3AKBCYCY6FDGE1824 VIN

Vehicle Components

Component Software VersionDescription NetworkSerial Number

Engine Cummins 8.9L ISL 05317106 04048139

072517142935

20718004 G1 BDO

J1939 (High)73651497

Brakes WABCO E Basic(12V) 4S/4M E442 J1939

(High)/J1587

(Low)

??45??

Instrument Cluster Freightliner ICU3X-2013 11/42/00 04_3.2 60 J1939 (High)N/A

Bulkhead Module Freightliner BHM_L U.r.2.A0.07.30 J1939

(High)/J1587

(Low)

126180

Chassis Module Freightliner CHM_L U.r.2.A0.04.22 J1939 (High)N/A

Vehicle Key Data Points

ValueParameter DescriptionValueParameter Description

Battery Potential 12.60 volts Coolant Level Normal

Engine Oil Level Not Available Odometer 222,372.50 mi

Total Avg Fuel Econ 6.50 mpg Total Engine Hrs 6,857.50 hrs

Road Speed Limit 70.00 mph Cruise Spd Limit 70.00 mph

DPF Soot Level Low DPF Derate Low

Malfunction Indicator Lamp Off Red Stop Lamp Off

Amber Warning Lamp Off Protect Lamp Off

Parking Brake Switch On DPF Lamp Command Off

Exhaust System High Temperature Lamp CommandOff ABS Control Status Off

ABS Control Status, Trailer Not Available Engine Speed 0 rpm

Fuel 74% Diesel Exhaust Fluid 63%

Vehicle Issues

No Active Issues Found

Page 1 of 2

DIAGNOSTIC REPORT

11:23 amMay 07, 2019Print Date:

Faults

CountFMILookup CodeDescriptionComponentStatus

Inactive Bulkhead Module CHM power feed VBAT2 - low voltage SPN 6892 4 1

Inactive Bulkhead Module Wiper low speed circuit - current below expected value SPN 6971 5 1

Inactive Bulkhead Module Starter relay output - current below expected value SPN 6983 5 1

Inactive Bulkhead Module The CHM ignition input circuit is not measuring the same

state as the BHM ignition output circuit

SPN 6985 7 94

Inactive Bulkhead Module Right high beam headlamp circuit - current below

expected value

SPN 6991 5 1

Inactive Bulkhead Module Marker lamps - voltage below expected value SPN 882 4 1

Inactive Bulkhead Module Marker lamps - current below expected value SPN 882 5 1

Inactive Engine Power Supply Lost With Ignition On - Data Erratic,

Intermittent, or Incorrect. Supply voltage to the ECM fell

below 6.2-VDC momentarily, or the ECM

was not allowed to power down correctly (retain battery

voltage for 30 seconds after key OFF). – First occurrence

7043:29:15; Last occurrence 7043:47:48

1117 N/A 4

Page 2 of 2