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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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
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