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Get MN Periodic Vehicle Inspection Report 2008

PERIODIC VEHICLE INSPECTION REPORT 1. Date MM/DD/YYYY 2. Insp.Location Address 3. Time AM / PM 4. DECAL 5. Veh Make 6. Mod. Yr 8. Odometer Reading C or H 9. VIN 10. Lic 12. Owner Name 13. Owner Str* Address 14. City State ZIP 15. Carrier Name 16. Carrier Str* Address 7. Unit 18. Owner USDOT PASS FAIL 19. Carrier USDOT N/A 20. Inspector Name 11. State 1. BRAKE SYSTEM c* Brake lamps a* Service Brakes d. Turn Signals 1. Adjustment e. Marker/ID/Clearance Lamps 2. Pads b. Parking Brake System f* Conspicuity Tape/Reflectors 6. LOAD SECUREMENT c* Brake Drum or Rotors 7. STEERING MECHANISM d. Brake Hose a* Steering Wheel Free Play Lash e. Brake Tubing f* Low Pressure/Vacuum and/or Low Air Warning Device b. Steering Column c* Front Axle Beam All Components Other Than Steering g. Tractor Protection Valve d. Steering Gear Box Column h. Air Compressor e. Pitman Arm i. Electric Brakes j. Hydraulic Brakes including Power assist over Hydraulic Engine Drive Hydraulic Booster f* Power Steering g. Ball Socket Joints h. Tie Rods Drag Link i. Nuts k. Vacuum Systems l* Brake Away Brakes on Trailer 2. COUPLING DEVICES a* 5th Wheel Mounting/King Pin b. Pintle Hooks Mounting Ball hitch c* Drawbar /Towbar Eye j. Steering System 8. SUSPENSION a* U-Bolts b. Spring Assembly c* Torque Radius or Tracking Components 9. FRAME/INCLUDING CROSS FRAMES a* Frame Members e. Safety Devices chains cables hooks f* Saddle Mounts b. Tire Wheel Clearance g. Locking Devices 3. EXHAUST SYSTEM 4. FUEL SYSTEM a* Visible Leak c* Adjustable Axle Assemblies sliding subframes Locking Devices 10. TIRES 11. WHEELS RIMS a* Lock or Slide Ring b. Wheels Rims b. Fuel Cap c* Fasteners lugs c* Securement of Tank d. Welds 5. LIGHTING DEVICES a* Headlamps 12. WINDSHIELDS/Glazing 13. WIPERS/WASHER DEFROSTERS b. Tail Lamps 14. REAR VISION MIRRORS 17. REAR END PROTECTION 15. HORN 18. HOOD FRONT BUMPER BODY PARTS 16. FIRE EXTINGUISHER TRIANGLES 19. WHEEL FLAPS THIS VEHICLE IS IN COMPLIANCE WITH 49 CFR 396. 17 APPENDIX G I hereby certify that the above information is true and accurate. Inspector Signature This is the only vehicle inspection form approved by the Minnesota State Patrol* 2008-9. Veh Make 6. Mod. Yr 8. Odometer Reading C or H 9. VIN 10. Lic 12. Owner Name 13. Owner Str* Address 14. City State ZIP 15. Carrier Name 16. Carrier Str* Address 7. Unit 18. Owner USDOT PASS FAIL 19. Carrier USDOT N/A 20. City State ZIP 15. Carrier Name 16. Carrier Str* Address 7. Unit 18. Owner USDOT PASS FAIL 19. Carrier USDOT N/A 20. Inspector Name 11. State 1. BRAKE SYSTEM c* Brake lamps a* Service Brakes d. Turn Signals 1. Adjustment e. Inspector Name 11. State 1. BRAKE SYSTEM c* Brake lamps a* Service Brakes d. Turn Signals 1. Adjustment e. Marker/ID/Clearance Lamps 2. Pads b. Parking Brake System f* Conspicuity Tape/Reflectors 6. LOAD SECUREMENT c* Brake Drum or Rotors 7. Marker/ID/Clearance Lamps 2. Pads b. Parking Brake System f* Conspicuity Tape/Reflectors 6. LOAD SECUREMENT c* Brake Drum or Rotors 7. STEERING MECHANISM d. Brake Hose a* Steering Wheel Free Play Lash e. Brake Tubing f* Low Pressure/Vacuum and/or Low Air Warning Device b. .

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