i · g3 ebmpast #w3g300-er40-75 0600110041303003rrew3 g3 ebmpast #w3g300-er40-75 0600 l...

'I STE-CLAJRE, QUEBECCANADA GOE 2VO H345

)ate: Customer:

2013/05/16

PARTS NAME PART NUMBER

DEF Dosing Valve Coolimz 21575532 DEF Pump Module Cooling

Module ACM Cooling NOx Sensor Inlet Cooling NOx Sensor Outlet Cooling

SCR Assemblv Cooling Engine Transmission Air Filter El. Alternator 1 Motor Alternator 2 Motor Belt Belt

Front Bellow Front Bellow Rear Bellow Tao- Bellow Tag Bellow Auxiliary Axle Tag NEW TAG DATE COULE Front Axle Differential Air Drver Steering Box

ompr�,;;,;;or Bio; i>article filterCondenser Motor 1

Condenser Motor 2

Condenser Motor 3

Condenser Motor 4

Evaoorator Motor Drver Seat Driver Radiator CAC Radiator 1 Radiator 2 Tires

Wheel Size .

PALNJ' COLOR

BLACK (STD) 'HITE

0ILVER

-- -- ---- ----- -----

21576178 21870087 21636091 22014032

21437514 MOTEUR VOLVO H345 572138 530206 564119 564119 5061285 5060110 630258 630162 630260 630162 630258 621808 621808 611351 621864 21440978 661137 950001 21470436 565881

565881

565881

565881

564216 950332 864372 21576796 21576796 21576796

BASISLACK (ST ANDO¥'\ BASISLACK (STANDOX) BASlSLACK (STANDOX)

COACH FINAL RECORD

Serial No.: Coach No. 2PCH33490EC712450 #

Rev.:

MAKE I MODEL SERJAL

VOLVO 044404300530109038 05604

#PIECE DU FOURNISSEUR: 21870087 13160190 1314407316644E06

25898 CONTINENTAL AUTOMOTIVE SYSTEMS INC 1312103616643E07 #22014032 VOLVO #21488930 T12400002925168 VOLVO D13H435 0131025671 ALLISON #E018853 !S66!0369293NELSON DIVISION #7182 SN REV A: ROBERT BOSCH #0124655079 270213 1332 REV A: ROBERT BOSCH #0124655079 270213 1331 DAYCO, MARK IV INDUSTRIES CANADA #21-2212 DAYCO #21-2112 GOODYEAR #1R12631 GOODYEAR CANADA INC. #IR12-406 GOODYEAR TIRE & RUBBER CO. #!Rll-243 GOODYEAR CANADA INC. #1Rl2-406 GOODYEAR #!R12631 MOULES ET MODELES PCM INC. #621808 El58 MOULES ET MODELES PCM INC. #621808 210113 REV A: DANA CORP.COMMERCIAL YEH. #K26929 Pl3052032F ARVINMERITOR, INC. 52037 #RC23165NFCF24 3.58 SNWK00514696 VOLVO #(21440978) ZF #8098 955 817 BITZER REV. A: 4NFCY-012 2584164270 VOLVO 278513114 EBMPAST #W3G300-ER40-75

.

0600110041303003RRDW3 G3

EBMPAST #W3G300-ER40-75 0600110041303003RREW3 G3

EBMPAST #W3G300-ER40-75 0600 l 10041303003RR5W3 G3

EBMPAST #W3G300-ER40-75 0600110041303003RR6W3 G3

AMETEK ROTRON #150215-00 06MARl3003024 ALCO CONTROL #064904 REV Ac !SRI #86728-01/00 63122408882-8 REV A: TITANX #1040254-CR S201030352-CS00124 REV A: TITANX #1040254-CR S 181040254-CRO 1855 REV A: TlTANX #1040254-CR S021003673-C01347 MICHELIN 76184 B6D735CX1513, B6D735CX0913, B6D735CXl513. B6D735CX1513. B6D735CX1513, B6D735CX1513. B6D735CXl513 B6D735CX0913, B6D735CXl613 ACCUR!DE 29300PK-SL V21 ALCOA 894641DB

894642DB 894643DB

PAINT SECTION MAKE NUMBER

MIX 571 PREY. 000 PREY. 013

COACH FINAL RECORD I STE-CLAIRE, QUEBEC Serial No.:

CANADA G0R 2V0 H345 2PCH33490EC712450

'

)ate: Customer:

2013/05/16

WHITE (ROOF PANEL) IMRON ELITE (DUPONT)

CLEAR COAT IMRON ELITE (DUPONT)

INTERIOR TRIM SECTION MATERIAL COLOR

FLOOR COVERING GERFLOR SHIP

LEATHERETTE BLACK

GREY

FABRIC NAH 184

NAE 184

CARPET N/A

OPTIONAL EQUIPMENT SECTION

- EXTERIOR DOOR LOCKS: KEY CODE; NS8718 - KEYLESS IGNITION SWITCH- _lJ.UX. PREHKlJ.TING SYSTEM READY- OVERHEAD A/C SYSTEM- DIFFERENTIAL RATIO 3. 58- ENGINE BRAKE ON Dl3 ENGINE- ROAD SPEED GOVERNOR 71 MPH- IDLE SHUTDOWN: 15 MINUTES - FUEL PRO 382- ULTIMATE ENG. WARRANTY 5Y/500,000 MI., PARTS & LABOR (UE-5513)- JILLISON AUT. TRANS. WARRANTY/5 YEARS (W/O RET.)- DURAERIGHT WHEEL PROTECTORS- CHROME NUTS & HUBS- SPLASH GUARDS BETWEEN DIFF. AND TAG AXLES- QUICK FRONT KNEELING SUSP. (LOW & HIGH BUOY) - ISRI 6832 DRIVER SEAT 3PT. SEAT BELT AIR SUSP. W/ARMRESTS- SIRIUS SATELLITE RADIO (AM/FM/CD) DASH INST.- TWO EXTRA SPEJ,KERS IN DRIVER AREA- MICROPHONE OUTLET IN L.H MODESTY PANEL- VIDEO SYSTEM COMPONENTRY WITH DVD- 1.5" WIDE SCREEN MONITORS UNDER PARCEL RACK (EA) QTE. 4 - CENTRAL 15" FIXED MONITOR QTE. l - WIRING ONLY FOR BACK UP CAMERA- ADDITIONAL ll0V OUTLET IN #1 PARCEL RACK LH- SINGLE 1800 WATT INVERTOR- TOILET PAPER ROLL DISPENSER (900656)- SINK COVERED WITH STEEL PALTE PAINTED BEIGE- PASSENGER SIDE WINDOW BLINDS- CLOSED-TYPE Pfa.RCEL RACKS- AMAYA SEATS WITH SEAT BELTS, 56 PASS., A2T&V- NO CARD TABLE- SEAT LAYOUT#: D3608290-l-10-l - ll0V GRAY OUTLET (564188) IN MODESTY PANELS

Coach No.

#

Rev.:

832133 EF

8430S

NUMBER

0764

860424

860585

864276

864')79

CHl--'4U /l-/::S4::SA-incif-'l::C I DRIVER/VEHICLE EXAMINATION REPORT inSPECT 1.100.1

California Highway Patrol 1551 Benicia Road Vallejo, CA 94591 Phone: (707) 648-4180 Internationally Accredited Agency CHP407F/343A

USDOT: 260010 Phone#: (707)585-9110 Fax#: (707)584-4713 MC/MX#: 165764

State#: 322487

Driver: License#: Date of Birth: CoDriver:

License#: Date of Birth:

Report Number: CAA161170890 Inspection Date: 0512312018 Start: 1 :40 PM PT End: 2:30 PM PT Inspection Level: V - Terminal HM Inspection Type: None

State:

State:

Location: SANTA ROSA AREA Milepost: Shipper: N/A Highway: County: SONOMA

VEHICLE IDENTIFICATION

Origin: NIA Destination: N/A

Bill of Lading: NIA Cargo: EMPTY

!.!nil I,'J2!a Mfil& � � Plate Equipment ID VIN GVWR CVSA Existing CVSA # 1 BU PREO 2014 CA CP78743 1402 2PCH33490EC712450 53000

BRAKE ADJUSTMENTS Axle# Right Left Chamber

1 N/A NIA

DISC

2. N/A N/A

DISC

3. N/A N/A

DISC

VIOLATIONS:No violations were discovered

HazMat: No HM transported

Special Checks: No data for special checks

State Information:

Placard: Cargo Tank:

Beat/Sub Area: 5407; Odometer: 298779; File Code Number: 219371; PUC: 21509; Regulated Vehicle: Y; Pre-Cleared Vehicle: N; Fuel Type: D; Passenger Capacity: 56; Veh #1 Type: 64; Bus Type: 1; SPAS Cert: 2128/2018

Report Prepared By: Badge#: I. N. DUOA A16117

X

Copy Received By:

X

1111111111111111111111111111111111111111111111 Page 1 of 1 00260010 CA CAA 161170890

CHP407F/343A-inSPECT DRIVERNEHICLE EXAMINATION REPORT ,.., IL inSPECT 1.0.96

,,,,,��· r:�.o-"k°'\ C l"f . H" h p t I 11.; ,, 1,,,;•· ''"' a I orma 19 way a ro J:';.'1�; i,i'�•i,,,�l•�i: ,ii�! '{,,:: ·;l-'.t�j!11b:ti 1551 Benicia Road..•. ,, •• ,, ,,I, Vallejo, CA 94591

Phone: (707) 648-4180 Internationally Accredited Agency CHP407F/343A

USDOT: 260010 Phone#: (707)585-9110Fax#: (707)584-4713MC/MX#: 165764

State#: 322487

Driver: License#: Date of Birth: Co Driver: License#: Date of Birth:

Report Number: CAA161170758Inspection Date: 02/28/2018Start: 12:10 PM PD End: 1:30 PM PDInspection Level: V - TerminalHM Inspection Type: None

State:

State:

Location: SANT A ROSA AREAHighway:

Milepost: Shipper: N/A

County: SONOMA

VEHICLE IDENTIFICATION

Origin: N/ADestination: N/A

Bill of Lading: N/Aeargo: EMPTY

!.!nil Il,'ml Mlalsla Y= Sttlll Plate Equipment ID 1402

VIN GVWR CVSA Existing CVSA# 25221157 1 BU PREO 2014 CA CP78743

BRAKE ADJUSTMENTS Axle# 1 2. JRight N/A N/A N/ALeft N/A N/A N/AChamber DISC DISC DISC

VIOLATIONS:No violations were discovered

HazMat: No HM transported

Special Checks: No data for special checks

State Information:

2PCH33490EC712450 53000

Placard: Cargo Tank:

Beat/Sub Area: 5407; Odometer: 289661; File Code Number: 219371; PUC: 21509; Regulated Vehicle: Y; Pre-Cleared Vehicle: N; Fuel Type: D; Passenger Capacity: 56; Veh #1 Type: 64; Bus Type: 1; SPAB Cert: 02/28/2018

Report Prepared By: Badge#: Copy Received By: I. N. DUOA A16117

x_____________ x ____________ _

Page 1 of 1 II I I I Ill I II I I Ill Ill I II IIIIIIIIIIIII IIII IIII Ill

00260010 CA CAA161170758

TIRES

VEHICLE REPAIR & SERVICE FORM

MILEAGE: 33/, 0�3I

MECHANIC:

ITEMS REPAIRED OR REPLACED

TIRE PRESURES BRAKE PADS

Left front M Right front w- Left front /,;2./) Right front/Z;J) Left front l J Right front r l

Left 0/drive I ] Right 0/drive I l Left 0/dr Right 0/dr Left 0/dr I l Right 0/dr [ J

Left I/drive f l Right I/drive I l Left 1/dr Right 1/dr __ Left 1/dr I l Right 1/dr I l

Left tag f l Right tag I l Left tag Right tag __ Left tag I l Right tag [ l

Windshields Wiper Blades Batteries

Engine belts: Cooling fans: _______ A/C _______ Alts.: ___ _

Warranty Part Numbers for replacement:

1: ----------------------------

2: -----------------------

3: ----------'-------------,----

4: -------------------'-----�

5: -----------------------

6: _______________________ _

LIST REPAIRS AND DISCRIPTION OF WORK

TOTAL WORK HOURS: -----

Vehicle Inspection Report

uN1T# llfov DATE 7- z_-:,-Jq MILEAGE J:'> � � ,y,-(3 ------

OK DEF .

� [ ] 1.Entrance door, operation, markings, hand rails

· [ ] 2.lnstruments, dash lights, switches, knobs, levers, readouts, gauges

� [ ] 3.Horns- air and electric( ] 4. Drivers, seat- mounting, adjustment, seat belt[ ] 5.Air compressor/governor- cut in/cut out 85 min-130 max psi

� [ ] 6.Brake air leaks- 2 psi/minute (static), 3 psi/minute (applied) l7"J [ ] 7.Low air warning- audible and or visual 60 psi min

[ ] 10.Restroom- lighting, seat, venting, flush, dump valves, holding tank(s)

d

i

[ ] 8.Air tanks- drain, test check valves, perform split system test [ ] 9.Fire extinguisher, triangle reflectors(3), first aid kit (optional)

jj [ ] 11.Exterior lights, turn signals, emergency flashers, back up alarm and lights

� [ ] 12.Windshields, wipers, squirters, defrosters, sun shades, mirrors [ J 13.Windows- cracks, mounting, leaks, labeling

i,l' [ ] 14.Emergency exits- roof hatches, side windows, labeling and operation

� [ ] 15.Multimedia system- PA, audio/video, CD/DVD, amp, speakers ( ] 16.HVAC- function, fans, motor brushes, filters, leaks

j,4 [ ] 17.Passenger seats- mounting, seat belts, condition, sliding (if W/C equipped) � [ ] 18.lnterior lighting and markings [ill [ ] 19.Luggage b2ys- latches, handles, door operation, lighting [Q [ ] 20.Batteries- fl;ud, terminals, cables, corrosion, hold down, shut off switch fl)ll [ ]

.21.Engine bay-cleanliness, fluid

.

leaks, fluid levels, belts, pulleys, mounts_.;.· -------s;·-1)9 ( ] 2

�o

�imJ.W"'P.Ssories- mounting, cab_les, hoses, function-€1· �

.lli�sf;..,,,,cl! -,,_ z,, ( ] [)(l.2 �lt::r�� mounting, cables, ductrng, pulleys, output ,J� rrr11...,.,,.;fl'l'-'r-"f" !)I] [ ] 24. x aust- leaks, mounting, tail pipe, overall condition bi;] ( J 25.Fuel systerr- leaks, hose routing, securement, tank mounting, filler necks/caps � ( ] 26.Cooling sy,t•,m- leaks, radiator, hoses, miter box, fan clutch, coolant level

i [ ] 27.Air system cverall- air dryer, valves, lines, hoses

( ( ] 28.Brakes- liner,g thickness, rotors, cracks, chambers, adjustment, operation[ ( ] 29.Parking bra'<e- push/pull, release/apply, stays applied with complete loss of air

[ ] 30.Whe_els, fre,s- cracks, lug nuts/studs, tread depth, separation, pressure [o4 [ J 31.Hubs- enrj play, leaks, ABS sensor, overall condition [b/l [ ] 32.Suspension- air bags, radius rods, bushings, shocks, mounting, leveling valves [1)ll, [ ] 33.Steering- king pins, ball joints, linkage, steering box, hoses, noise, function (pci [ ] 34.Transmission/differential- funetion, leaks, fluid level, vents, mounting [Ill, [ ] 35.Drive shaft- U-joints, slip join:, dents, clocking, safety hoop, straps, bolts lid [ ] 36.Frame- cracks, dents, damage, rust, holes, crossmembers, mounting

�/, b'l, ( ] 37.C�assis and undercarriage- overall condition, lubrication, dirt, grime build up

/'1� ] [ ] 'ie !t,.l:c@IL11a1c lift operaurn1, safe-g;s, r.1arlm1gs, leal .. s, fl:nd !eve! ea1_1JlneSS

Notes: _____________________________ _

Mechanic

This inspec r< n is equal to: Annual 49CFR 39f3.17-23 Apendix and VIC 34505 Title 13 CCR 1232(b)

· ·---·-----



TIRES

Left fronl I l Riqht front [ J

Left O/drivc, [ l Rigl1t O/drive [ ]

Lefl I/drive I ] Right I/drive [ ]

Left tag I J Right tag [ l

Windshields ________ _

TIRE PRESURES

Left front Right front_�

Left O/dr Righi O/dr

Left 1/dr Right 1/dr __

Left tag Right tag __

Wiper Blades

BRAKE PADS

Left front

Left O/dr

Left 1/dr

Left tag

Batteries

[ J Right front I l

[ l

[ l

[ l

Right 0/dr [ ]

Right 1/dr I l

Right tag I ]

Engine belts: Cooling fans:. _______ A/C: ______ Alts.: ____ _


1: -----------------------

3: _____________________________ _

4: _______ ---c-------------------

5: ___________________________ _

6: _______________________ _



J


MILEAGE: (33/J, :;_3 l{ I

MECHANIC: _ _ �_/4tvtldP.._· __ J __


Left fronl I l Rrght front [ J

Lefl 0/drrvR I ] Rrght 0/drive [ ]

Left I/drive f r Right I/drive [ ]


TIRE PRESURES _.BRAKE PADS

Left front __ Right front__ Left front [ ] Right front f l

Left 0/dr __ Right 0/dr ___ Left 0/dr [ ] Right 0/dr [ ]

Left 1/dr ___ Right 1/dr__ Left 1/dr [ J Right 1/dr f ]

Left tag ___ Right tag__ Left tag [ J Right tag f J

Windshields _________ Wiper Blades ______ Batteries _______ _

Engine belts: Cooling fans: _ ______ NC: _______ Alts.: _____ _


3: -----------------------�----

4: _______ ------2'-::--------------------

5: _________ ;:------------------->

6: -----------------------




UNIT 1t/!f.l/l�OATE (r-JA:J '/9 MILEAGE:l.'.3� 25Y° MECHANIC: ef �_-_


Left front f l Right front [ J

Left O/drivc I ] Right O/drive [ J

Left I/drive f ] Right I/drive [ J



Left front __ Right front__ Left front [ ) Right front I

Left O/dr ___ Right O/dr __ Left O/dr [ J Right O/dr [ ]

Left 1/dr _ __ Right 1/dr__ Left 1/dr [ ] Right 1/dr [ ]

Left tag ___ Right tag__ Left tag [ ] Right tag [ l

Windshields _________ Wiper Blades ______ Batteries ______ _,,,,.,

Engine belts: Cooling fans: _______ A/C: _______ Alts': __ �M��m Warranty Part Numbers for replacement:

1: ____________________________ _

3=-----------,--------------------

4: __________________________ _

5: ---

--------------------

6: -----------------------


TOTAL WORK HOURS: ----- MECHANIC'S SIGNATURE��-

� - ·


MILEAGE0 =w1,t,Jq



Left front [ l Right front [ J

left O/drive [ ] Right O/drive [ ]

Left I/drive f J Right I/drive f J

Left t.ag [ J Right tag [ l


Left front Right front _ _

Left O/dr Right O/dr



Wiper Blades

Left front [ J Right front [ l

Left O/dr f l Right O/dr [ J

Left 1/dr [ l Right 1/dr [ l

Left tag [ l Right t.ag [ l

Batteries

Engine belts: Cooling fans: _______ A/C: _ _ _ _ ___ Alts.: ___ _


2=--------------,---------------

3: ____________________________ �

4: ___________ -,-,-____ __:: _________ _

TOTAL WORK HOURS: ----- MECHANIC'S $fGNATUR

. ... , ·-

-}


UNIT# /'-/(!)� DATE fo�.5' /tf/ MILEAGE ..:3:z&, t,3 9 , OK DEF

l'i) [ ] 1.Entrance door, operation, markings, hand rails , [jlJ [ ] 2.lnstruments, dash lights, switches, knobs, levers, readouts, gauges

� [ ] 3. Horns- air and electric [ ] 4. Drivers. seat- mounting, adjustment, seat belt [ ] 5.Air compressor/governor- cut in/cut out 85 min-130 max psi

N(1 [ ] 6.Brake air leaks- 2 psi/minute (static), 3 psi/minute (applied) 1XJ [ ] 7.Low air warning- audible and or visual 60 psi min [\l'.j [ ] 8.Air tanks- drain, test check valves, perform split system test [Sil [ ] 9.Fire extinguisher, triangle reflectors(3), first aid kit (optional) D,11 [ ] 10.Restroom- lighting, seat, venting, flush, dump valves, holding tank(s) [.)Q [ ] 11.Exterior lights, turn signals, emergency flashers, back up alarm and lights [Ill [ ] 12.Windshields, wioers, squirters, defrosters, sun shades, mirrors [)4. [ ] 13.Windows- cracks, mounting, leaks, labeling [)(i [ ] 14. Emergency exits- roof hatches, side windows, labeling and operation ['bl) [ ] 15.Multimedia' system- PA, audio/video, CD/DVD, amp, speakers [� [ ] 16.HVAC-function, fans, motor brushes, filters, leaks [� [ ] 17.Passenger seats- rnou�ting, seat belts, condition, sliding (ifW/C equipped) [Jill [ ] 18.lnterior lighting and ma,kings M [ ] 19.luggage bays- latches, :, 1ndles, door operation, lighting M [ ] 20.Batteries- fliud, terminals, .cables, corrosion, hold down, shut off switch M [ ] 21.Engine bay- cleanliness, fUd leaks, fluid levels, belts, pulleys, mounts M [ ] 22.Engine accessories- mountii·g, cables, hoses, function (i)ll [ ] 23.Alternators- mounting

., cables, ducting, pulleys, output

[}(] [ ] 24.Exhaust- leaks, mounting, tail ,•ipe, overall condition[)l! [ ] 25.Fuel system- leaks, hose routing securement, tank mounting, filler necks/caps [M [ ] 26.Cooling system- leaks, radiator, h.1ses, miter box, fan clutch, coolant level [,ii(] [ ] 27.Air system overall- air dryer, valves. lines, hoses

� [ ] 28.Brakes- lining thickness, rotors, cras�s. chambers, adjustment, operation [ ] 29.Parking brake- push/pull, release/app,,,, stays applied with complete loss of air [ ] 30.Whe_els, tires- cracks, lug nuts/studs, t1'.,d depth, separation, pressure

[0 [ ]'31.Hubs- end play, leaks, ABS sensor, ove,a,ll c·ondition [j£J [ ] 32.Suspension- air bags, radius rods, bushings, .,hocks, mounting, leveling valves [� [ ] 33.Steering- king pins, ball joints, linkage steerin::i bLX, hoses, noise, function � [ ] 34.Transmission/differential- function, lea,:G, fluid level, vents, mounting [)cl [ ] 35.Drive shaft- U-joints, slip joint, dents, clocking, safe� hoop, straps, bolts [i>'! [ ] 36.Frame- cracks, dents, damage, rust, hoi,,.;, crossmernbers, mounting

!h [1)1] [ ] 37.Chassis and undercarriage- overall cond1.'ion, lubricatirn\ dirt, grime build up

'1riJrt] [ ] 38.Wheeltliair lif:I: 9Fl9Fatie1;, sofs'F;,, markinea, leahs, floic.! ,'.,,.rel, clea?li□ess

Notes: -----------------------

"..-<. Mechanic: __ ;J f.11116$

This inspectior. '; equal to: Annua .•,9CFR 396.17-23 Apend : and V/C 34505 Title 13 CCR 1232(b)


UNIT #l!/.c1,,_ DATE: J/" It j f/ MILEAGE :32.f i.ft/'1 I


TIRES

Left front [ l Right front [ ]

Left 0/drive [ ] Right 0/drive [ J

Left I/drive [ J Right I/drive [ J

Left tag [ J Right tag [ ]


Left front __ Right front__ Left front [ ] Right front [ ]

Left 0/dr __ Right 0/dr __ Left 0/dr [ J Right 0/dr [ ]

Left 1/dr __ Right 1/dr__ Left 1/dr [ ] Right 1/dr [ ]

Left tag ___ Right tag__ Left tag [ ] Right tag [ ]

Windshields ___ !._/ _____ Wiper Blades ____ _


1=----------,------------------1

2: -------------------------

3: _______ ___: _________ _

4: ________________________ _

5: ________________________ _

6:. __________________ :__ _____ _

LIST REPAIRS AND DJSCRJPTION OF WORK

TOTAL WORK HOURS: _____ MECHAN•c·ss,o,A,u�@!�

.;:_> '

VEHICLE REPAIR & SERVICE FORM .• _ ,

UNIT#i'/t>Z- DATE 'f �j (.;;-Jq MILEAGE:.3'2'7, f'/:J MECHANIC J/4-�f/'Sfate{;:66 ' I



Left O/drive [ ] Right O/drive [ ]

Left I/drive [ ] Right I/drive [ J

Left tag [ ] Right tag [ ]

Windshields _______ _

TIRE PRESURES

Left front Right front __




Wiper Blades

BRAKE PADS

Left front [ .( Right front �

Left O/dr [ J Right 0/dr [ l

Left 1/dr [ l Right 1/dr [ ]

Left tag [ l Right tag [ ]

Batteries

Engine belts: Cooling fans: ______ NC: ______ Alts.: _______ _


1: __________________________ _

2: __________________________ _

3: __________________________ _

4: __________________________ _

5: __________________________ _

6: ---------

-----------------

UST REPAIRS AND DISCRIPTION OF WORK


Vehicle Inspection - Report

DATE'-J-f-lC/ MILEAGE ....S:24, , 2...'{fs I OK DEF

rA [ ] 1.Entrance door, operation, markings, hand rails - @{I [ ]_ 2.lnstruments, dash lights, switches, knobs, levers, readouts, gauges

f)lJ [ ] 3.Horns- air and electricfJa, [ ] 4. Driver& seat- mounting, adjustment, seat belt� [ ] 5.Air compressor/governor- cut in/cut out 85 min-130 max psi� [ ] 6.Brake air leaks- 2 psi/minute {static), 3 psi/minute (applied)

� [ ] 7.Low air warning- audible and or visual 60 psi min [ ] 8.Air tanks- drain, test check valves, perform split system test [ ] 9.Fire ex1inguisher, triangle reflectors(3), first aid kit (optional)

_ [;4 1 a.Restroom- lighting, seat,@!§'flush; dump valves, holding tank(s)[!:,r" [ ] 11.Ex1erior lights, t�rn signals, emergency flashers, back up alarm and ll�iall!S.-[ ] � 12. Windshields, wipers, squirters, defrosters, sun shades, mirrors -� [ ] 13.Windows- cracks, mounting, leaks, labeling � [ ] 14.Emergency exits- roof hatches, side windows, labeling and operation Ila, [ ] 15.Multimedia system- PA, audio/video, CD/DVD, amp, speakers [ ] Jc116.HVAC- function, fans, motor brushes.�aks [ ] i)l 17.Passenger seats- mounting, seat belts, condition, sliding (ifW/C equipped) lJ [ ] 18.lnterior lighting and markings � [ ] 19.luggage bays- latches, handles, door operation, lighting u4 [ ] 20.Batteries- fliud, terminals, cables, corrosion, hold down, shut off switch f)(L [ ] 21.Engine bay- cleanliness, fluid leaks, fluid levels, belts, pulleys, mounts

i

[ ] 22.Engine accessories- mounting, cables, hoses, function [ ] 23.Alternators- mounting, cables, ducting, pulleys, output [ J 24.Exhaust- leaks, mounting, tail pipe, overall condition [ ] 25.Fuel system- leaks, hose routing, securement, tank mounting, filler necks/caps [ ] 26.Cooling system- leaks, radiator, hoses, miter box, fan clutch, coolant level

[i,t [ ] 27.Air system overall- air dryer, valves, lines, hoses tiJ [ ] 28.Brakes- lining thickness, rotors, cracks, chambers, adjustment, operation

@ [ ] 29.Parking brake- push/pull, re

-lease/apply, stays applied with complete loss of air

[ ] 30.Whe_els, tires- cracks, lug nuts/studs, tread depth, separation, pressure[Jltl, [ ]' 31.Hubs- end play, leaks, ABS sensor, overall condition ['A, [ ] 32.Suspension- air bags, radius rods, bushings, s

_ hocks, mounting, leveling valves

(iJll. [ ] 33.Steering- king pins, ball joints, linkage, steering box, hoses, noise, function (dd [ -] 34.Transmission/differential- function, leaks, fluid level, vents, mounting

� [ ] 35.Drive shaft- U-joints, slip joint, dents, clocking, safety hoop, straps, bolts [ ] 36.Frame- cracks, dents, damage, rust, holes, crossmembers, mounting [ ] 37.Chassis and undercarriage- overall condition, lubrication, dirt, grime build up

1::-,[ ] [ ] gg_wbeelchair lift- operation .....retys, markings leaks t!11id 'onl, olssAliAOGG

-ad' LU.�Cd�.S

/tl'()v� /145s:tk.lt$t.iL -�p

- '!fee 69,JN'f

Y-it11!A'-

Notes:. _____________________________ _

Mechanic:._:J_____,_/+f}'l.-"-'---'

!{S:"'"'-____ _

This inspection is equal to: Annual 49CFR 396.17-23 Apendixvd VIC 34505 Title 13 C 2(b)


UNIT# /fpt-oATE: 3-B .. I q


TIRES TIRE PRESURES BRAKE PADS

Left front [ ] Right front [ ]

Left 0/drive [ ] Right 0/drive [ ]

Left I/drive [ ] Right I/drive [ ]

Left tag [ J Right tag [ J

Windshields. _______ _

Left front

Left 0/dr

Left 1/dr

Left tag

Wiper Blades

Right front__

Right 0/dr

Right 1/dr__

Right tag__

Left front [ ] Right front [ ]

Left 0/dr f l Right 0/dr [ ]


Left tag [ l Right tag [ ]

Batteries

Engine belts: Cooling fans: ______ A/C:. ______ Alts.: ________


1: __________________________ _

2=------,-----------------------

3: ______________________ ..:__ ___ _

4: __________________________ _

5: --------------------------

6: _________________________ _


I I

�/11-aS,(J Cl-/J-IJlJl 'S}Tf5£,. Fil& Fil� 1.vnY- /f/th/ .;JI'./{!,

D[l/{!Sl/tt!M) Wft.51/-Ge Jvf""' /,!.es-dt/ tJ tr?,-

v

TOTAL WORK HOURS: ____ _ MECHANIC'S SIGNATURE· ,

'




Left front f l Right front [ ]


Left I/drive [ ] Right I/drive. [ ]

Left front

Left O/dr

Left 1/dr

Right front __

Right O/dr

Right 1/dr __

Left front [ J Right front f J

Left O/dr [ l Right O/dr [ ]


Left tag [ J Right tag [ J Left tag Right tag __ Left tag ( l Right tag [ J

Windshields ________ _ Wiper Blades Batteries

Engine belts: Cooling fans: _______ A/C:. ______ Alts.: ________ _


1: ___ --,-_____________________ _

2: _________________________ _

3: ___________________________ _

4-_________________________ _

5·. __________________________ _

6· _________________________ _




UNIT#iL

/())_ DATEJ--L-f-/1 MILEAGE 72 7J/,9-9KfaEF ('--f.)- ] 1.Entrance door, operation, markings, hand rails ['-1 J ] 2. Instruments, dash lights, switches, knobs, levers, readouts, gauges [\.fj ] 3.Horns- air and electric [tfJ ] 4.Drivers seat- mounting, adjustment, seat belt ["11 ] 5.Air compressor/governor- cut in/cut out 85 min-130 max psi [.Y[ ] 6.Brake air leaks- 2 psi/minute (static), 3 psi/minute (applied) v(r J 7.Low air warning- audible and or visual 60 psi min [..f;-[ ] 8.Air tanks- drain, test check valves, perform split system test [,1;-[ ] 9 Fire extinguisher, triangle reflectors(3), first aid kit (optional) [--1 J ] 10.Restroom- lighting, seat, venting, flush, dump valves, holding tank(s) [,,,Y[ ] 11.Exterior lights, turn signals, emergency flashers, back up alarm and lights [t.Vf] 12.Windshields, wipers, squirters, defrosters, sun shades, mirrors [..-(J ] 13. Windows- cracks, mounting, leaks, labeling [ -f [ ] 14. Emergency exits- roof hatches, side windows. labeling and operation [v([ ] 15.Multimedia system- PA, audio/video. CD/DVD, amp, speakers [.,(! ] 16.HVAC- function, fans, motor brushes, filters, leal<s [ -f [ ] 17. Passenger seats- mounting, seat belts, condition, sliding (if W/C equipped) [,.yf" ] 18. Interior lighting and markings [vrl-] 19.Luggage bays- latches, handles, door operation, lighting [.-(l ] 20.Batteries- fliud, terminals, cables, corrosion, hold down, shut off switch [71 ] 21.Engine bay- cleanliness, fluid leaks, fluid levels, belts, pulleys, mounts [-'JJ,] 22 Engine accessories- mounting, cables, hoses, function [ '1 l ] 23.Alternators- mounting, cables, ducting, pulleys, output ['-f[ ] 24.Exhaust- leaks, mounting, tail pipe, overall condition [..rJ ] 25.Fuel system- leaks, hose routing, securement, tank mounting, filler necks/caps [-{[] 26.Coolmg system- leaks, radiator, hoses, miter box, fan clutch, coolant level [0J ] 27 Air system overall- air dryer, valves, lines, hoses [..{"J ] 28.Brakes- lining thickness, rotors, cracks, chambers, adjustment, operation [0)---] 29. Parking brake- push/pull, release/apply, stays applied with complete loss of air [ .j'" J ] 30. Wheels, tires- cracks, lug nuts/studs, tread depth, separation, pressure ['1[ ] 31.Hubs- end play, leaks, ABS sensor, overall condition [t-l'l ] 32.Suspension- air bags, radius rods, bushings, shocks, mounting, leveling valves ['11 ] 33.Steering- king pins, ball joints, linkage, steering box, hoses, noise, function [ >f[ ] 34.Transmission/differential- function, leaks, fluid level, vents, mounting [vfl J 35. Drive shaft- U-joints, slip joint, dents, clocking, safety hoop, straps, bolts [ ,n ] 36. Frame- cracks, dents, damage, rust, holes, crossmembers, mounting [-f [ ] 37.Chassis and undercarriage- overall condition, lubrication, .dirt, grime build up

....f--t1"TJB'Wheelchair lift- operation, safetys, markings, leaks, fluid level, cleanliness

Notes: __ ___________________________ �

Mechanic: __ C--_ _ /_-_�------�Signature:,.,_�=9---------�

This inspection is equal to: Annual 49CFR 39617-23 Apendix G and V/C 34505 Title 13 CCR 1232(b)

. ,:


UNIT#}if:tJZ,, DATE J-1k-1'1 ITEMS REPAIRED OR REPLACED


Left front {.], Right front [ ]


Left I/drive [ J Right I/drive [ J


Left front Right front __ Left front [ J Righi front [ J

Left 0/dr Right 0/dr Left 0/dr [ ] Right 0/dr [ J

Left 1/dr Right 1/dr _ _ Left 1/dr [ ] .Right l{dr [ ] ,_ ·-�

Left tag Right tag __ Left tag [ l Right tag [ J

Windshields _______ _ Wiper Blades Batteries

Engine belts: Coo1ing fans: ______ NC: ______ Alts.: _______ _

. Warranty .!'art Numbers for replacement:

:1: _________________________ _

2: --------------------------

3: _________________________ _ ,

4: --------------------------

5: --------------------------


TOTAL WORK HOURS: ___ c___ MECHANIC'S SIGNATUR


uN1T#/foJ.. DATE f /iJ-/t/ MILEAGE J!l.J,,, f& , OK DEF

; [ ] 1.Entrance door, operation, markings, hand rails

, [ ] 2.lnstruments, dash lights, switches, knobs, levers, readouts, gauges [ ] 3.Horns- air and electric

b(l [ ] 4. Driver>a seat- mounting, adjustment, seat belt !,I] [ ] 5.Air compressor/governor- cut in/cut out 85 min-130 max psi !:}] [ ] 6.Brake air leaks- 2 psi/minute (static), 3 psi/minute (applied)

� [ ] 7.Low air warning- audible and or visual 60 psi min [ ] 8.Ai_r tanks- drain, test check valves, perform split system test [ ] 9.Fire extinguisher, triangle r ctors(3), first aid kit (optional)

[ ] IC,J 10.Restr-oom- lighting, seat, entin flush, dump valves, holding tank(s) [ ] � 11.Exterior light

�. ignals, ergency flashers, back up alarm and lii□ba-<

[ ] � 12.Windshields wiper , squirters, defrosters, sun shades, mirrors ,pJf;( [\l] [ ] 13.Windows- era s, mounting, leaks, labeling 'i}j� , lii(] [ ] 14.Emergency exits- roof hatches, side windows, labeling and operatic fJl>Pfi5 !)(,I [J 15.Multimedia system- PA, audio/video,

�D, amp, speakers

[ ] 13(] 16.HVAC-function, fans, motor brushes ilter , leaks l)!] [ ] )?.Passenger seats- mounting, seat belts, condition, sliding (ifW/C equipped)[)!J [ ] 18.lnterior lighting and markings fl) [ ] 1 ii.luggage bays- latches, handles, door operation, lighting l!H [ ] 20.Batteries- fliud, terminals, cables, corrosion, hold down, shut off sw

. itch

� [ ] 21.Engine bay- cleanliness, fluid leaks, fluid levels, belts, pulleys, mounts jjlj_ [ ] 22.Engine accessories- mounting, cables, hoses, function � [ ] 23.Alternators- mounting, cables, ducting, pulleys, output b1J. [ J 24.Exhaust- leaks, mounting, tail pipe, overall condition !kl [ ] 25.Fuel system- leaks, hose routing, securement, tank mounting, filler necks/caps IA, [ ] 26.Cooling system- leaks, radiator, hoses, miter box, fan clutch, coolant level rD(]' [ ] 27.Air system overall- air dryer, valves, lines, hoses f1l [ ] 28.Brakes- lining thickness, rotors, cracks, chambers, adjustment, operation ii(] [ ] 29.Parking brake- push/pull, release/apply, stays applied with complete loss of air, 4 iUJr/fV7

. [ 'J M 30.Whe_els, tires- cracks, lug nuts/studs, tread depth, separation, pressure �� · M [ J31.Hubs- end play, leaks, ABS sensor, overall condition

i [ ] 32.Suspension- air bags, radius rods, bushings, shocks, mounting, leveling valves [ ] 33.Steering- king pins, ball joints, linkage, steering box, hoses, noise, function

[ [ • l 34. Transmission/differential- function, leaks, fluid level, vents, mounting

ff/A

·1 [ ] 35. Drive shaft- U-joints, slip joint, dents, clocking, safety hoop, straps, bolts[ ] 36.Frame- cracks, dents, damage, rust, holes, crossmembers, mounting[ J 37.Chassis and undercarriage- overall condition, lubrication, dirt, grime build up

. .

Notes: _____________________________ _

Mechanic: ___________ �Signature: _____ 4--_______ _ . 2{

This inspection is equal to: Annual 49CFR 396.17-23 Apendix G anQV/Cy450!>,Title 13 CCR 1232(b)


UNIT #l!Mv DATE /-lo19 MILEAGE0� ,:,1/P-,.



Left front f l Right front [ l Left front Right front_ .. Left front [ ] Right front [ l

Left 0/drive [ ] Right 0/drive [ l Left 0/dr Right 0/dr Left 0/dr [ l Right 0/dr [ ]

Left I/drive [ l Right I/drive [ l Left 1/dr Right 1/dr __ Left 1/dr [ l Right 1/dr [ ]

Left tag [ l Right tag [ l Left tag Right tag __ Left tag [ l Right tag [ ]

Windshields Wiper Blades J. Batteries

Engine belts: Cooling fans:. _______ NC: _ _____ Alts.:. ________ _


1: _________________________ _

2: -----

------------------

3: -----------------------

4: _________________________ ---'--,

5: _________________________ _

6: --------------------


TOTAL WORK HOURS: ----- MECHANIC"S SIGNATU


_, . .

UNIT#J40J... DATE:\Q.-5-l8 MILEAGE:3/�,2.,\" MECHANIC \,o::J :;,,,


TIRES

Left front [ l Right front [ J

Left O/drive [ /R,ght O/drive [ �

Left I/drive [1Right I/drive [v]


Windshields. ________ _

TIRE PRESURES



Left 1/dr Right 1/dr _ _


Wiper Blades

BRAKE PADS

Left front [ ] Right front [ J



Left tag [ l Right tag [ J

Batteries

Engine bells: Cooling fans: _______ A/C: ______ Alts.: ______ __c __


1: ----------------------------

2: ___________________________ _

3: ----------------------------

4: -----------------------

5: -----------------------

6: -----------------------

LJ ST REPAIRS AND DISCRIPTION OF WORK

TOTAL WORK HOURS: ____ _ MECHANIC'


UNIT# ! '--fc'j_ DATE l/-z2�1 <r MILEAGE 7 /<;?LI£ OK))EF [J.(J ] 1.Entrance door, operation, markings, hand rai!s [t.(J ] 2.lnstruments, dash lights, switches, knobs, levers, readouts, gauges [if,1 ] 3.Horns- air and electric ["1.J ] 4.Drivers seat- mounting, adjustment, seat belt [.{ J ] 5.Air compressor/governor- cut in/cut out 85 min-130 max psi [ t.( J ] 6. Brake air leaks- 2 psi/minute (static), 3 psi/minute (applied) [ .r'J ] 7.Low air warning- audible and or visual 60 psi min [,,('J ] 8.Air tanks- drain, test check valves, perform split system test [ '{,[ ] 9.Fire extinguisher, triangle reflectors(3), first aid kit (optional) r,{:r ] 10 Restroom- lighting, seat, venting, flush, dump valves, holding tank(s) [ ,f J ] 11.Exterior lights, turn signals, emergency flashers, back up alarm and lights [,{ [ ] 12.Windshields, wipers, squirters, defrosters, sun shades, mirrors [\.Y,1 ] 13.Windows- cracks, mounting, leaks, labeling [.,f J ] 14.Emergency exits- roof hatches, side windows, labeling and operation [.,([ ] 15.Multimedia system- PA, audio/video, CD/DVD, amp, speakers [u'[ ] 16.HVAC- function, fans, motor brushes, filters, leaks [;.r'J ] 17.Passenger seats- mounting, seat belts, condition, sliding (ifW/C equipped) [---(J ] 18.lnterior lighting and markings [ "] J ] 19.Luggage bays- latches, handles, door operation, lighting [.,(J ] 20.Batteries- fliud, terminals, cables, corrosion, hold down, shut off switch [.,f.) ] 21.Engine bay- cleanliness, fluid leaks, fluid levels, belts, pulleys, mounts [ ,f J-. ] 22. Engine accessories- mounting, cables, hoses, function [ .r'J ] 23.Alternators- mounting, cables, ducting, pulleys, output � J 24. Exhaust- leaks, mounting, tail pipe, overall cond1t1on [ ·1] ] 25. Fuel system- leaks, hose routing, securement, tank mounting, filler necks/caps[.(J ] 26.Cooling system- leaks, radiator, hoses, miter box, fan clutch, coolant level[ .{ [ ] 27.Air system overall- air dryer, valves, lines, hoses[.Yt ] 28.Brakes- lining thickness, rotors, cracks, chambers, adjustment, operation[.,-r[ ] 29.Parking brake- push/pull, release/apply, stays applied with complete loss of air[.,r'[ ] 30.Wheels, tires- cracks, lug nuts/studs, tread depth, separation, pressure[.-Yl ] 31. Hubs- end play, leaks, ABS sensor, overall condition[ i,Y[ ] 32.Suspensi on- air bags, radius rods, bushings, shocks, mounting, leveling valves[..rf] 33.Steering- king pins, ball joints, linkage, steering box, hoses, noise, function[ -r'.) ] 34. Transmission/differential- function, leaks, fluid level, vents, mounting[..f L ] 35.Drive shaft- U-joints, slip joint, dents, clocking, safety hoop, straps, bolts [,,r'J>] 36.Frame- cracks, dents, damage, rust, holes, crossmembers, mounting [ .{[ ] 37.Chassis and undercarriage- overall condition, lubrication, dirt, grime build up

�heelchair lift- operation, safetys, markings, leaks, fluid level, cleanliness

Notes: ----------------------------------

Mechanic: ___ f;=- _�/_::.. ______ �Signature:.�_y7 ___ -___________ _

This inspection is equal to: Annual 49CFR 396 17-23 Apendix G and V/C 34505 Title 13 CCR 1232(b)


MILEAGE ,_3#,, 3&3 , OK DEF [¥,1 [ ] 1.Entrance door, operation, markings, hand rails

· [-jlj [ ] 2.lnstruments, dash lights, switches, knobs, levers, readouts, gauges[!lJ [ ] 3.Horns- air and electric['i(J [ ] 4.Drivers seat- mounting, adjustment, seat belt[;ll [ ] 5.Air compressor/governor- cut in/cut out 85 min-130 max psi(It] [ ] 6.Brake air leaks- 2 psi/minute (static), 3 psi/minute (applied)rfl] [ ] 7.Low air warning- audible and or visual 60 psi min[\/,) [ ] 8.Air tanks- drain, test check valves, perform split system test[It] [ ] 9.Fire extinguisher, triangle

�efl s(3), first aid kit (optional)

[ ] [,tT 10.Restroom- lighting, seat, ntin ush, dump valves, holding tank(s)

� [ ] 11._Exterior lights, turn signals, ergency flashers, back up alarm and lights [ ] 12.Windshields, wipers, squirters, defrosters, sun shades, mirrors [ ] 13.Windows- cracks, mounting, leaks, labeling

[ � [ ] 14.Emergency exits- roof hatches, side windows, labeling and operation [jll [ j 15.Multimedia system- PA, audio/videoJ��D, amp, speakers [ ] I('.] 16.HVAC- function, fans, motor brushe filte , leaks[I)(! [ ] 17.Passenger seats- mounting, seat belts, condition, sliding (if W/C equipped) [� [ ] 18.lnterior lighting and markings [� [ ] 19.luggage bays- latches, handles, door operation, lighting [x'.) [ ] 20.Batteries- fliud, terminals, cables, corrosion, hold down, shut off switch

� [ ] 21.Engine b

.ay- cleanliness, fluid leaks, fluid levels, belts, pulleys, mounts

[ ] 22.Engine accessories- mounting, cables, hoses, function [ ] 23.Alternators- mounting, cables, ducting, pulleys, output

[ii] [ ] 24.Exhaust- leqks, mounting, tail pipe, overall condition[jl [ ] 25.Fuel S¥sJem- leaks, hose routing, securement, tank mounting, filler necks/caps[l('.J [ ] 26.Cooling<iwstem- leaks, radiator, hoses, miter box, fan clutch, coolant level . . ,,,,,,. [)CJ [ J.27

=t, m overall- air d er, valves, Imes, hoses --4'.¥i""1ft(b pl,,l)l'/J ,t;r<./[ ] !):] 2 .Brak - · mg thickn , rotors, cracks, chambers, adjustment, operation � ti? fl}f;;b

� [ ] 29. ing brake- push/pull, release/apply, stays applied with complete loss of air Peft [ ] 30.Whe_els, tires- cracks, lug nuts/studs, tread depth, separation, pressure

� it [ p1.Hubs- end play, leaks, ABS sensor, overall condition flt] [ ] 32.Suspension- air bags, radius rods, bushings, shocks, mounting, leveling valves Lub [ ] O(i 33.Steering- king pins, ball joints, linkage, steering box, hoses, noise, funct

.io

J@

n . _ . liJl [ ] 34.Transmission/differential- function, leaks, fluid level, vents, mounting ' f] � 35.Drive shaft- U-joints, slip joint, dents, clocking, safety hoop, straps, bolts,

·] [] 36.Frame- cracks, dents, damage, rust, holes, crossmembers, mounting] [ ] 37.Chassis and undercarriage- overall condition, lubrication, dirt, grime build up

//Ir . air 1 - operat10 , , · , , · . , an mess

Notes .. · ______________________________ _

This inspection is equal to: Annual 49CFR 396.17-23 Apendi

�'- . ':-�· ..

VEHICLE REPAIR & SERVICE FORM /·:"

MECHANIC: __ £.'_'A_�-=::' '�]_.;:_


Left front f l Right front [ ]





Left front. __ Right front__ _ Left front [ ] Right front [ ]

Left O/dr __ Right O/dr __ Left O/dr ( ] Right O/dr [ ]

Left 1/dr ___ Right 1/dr__ Left 1/dr /¾ Right 1/dr (L'J

Left tag ___ Right tag__ Left tag [ ] Right tag [ ]

Windshields ________ Wiper Blades _____ Batteries ______ _

Engine belts: Cooling fans:. ______ NC:. ______ Alts.: _____ __ _


1: _________________________ _

2: ________________ _..:..�---------

3; _____________ _,s ___________ _

4: _________________________ _

5: -----------------------

6: -

----------------------

Li ST REPAIRS AND DISCRIPTION OF WORK



UNIT#iL/O'J- DATE Jr}-/g'--/1 MILEAGE ff/ _f /l/OKJ)EF [l,Q ] 1.Entrance door, operation, markings, hand rails [if J ] 2.lnstruments, dash lights, switches, knobs, levers, readouts, gauges [ 'j'J ] 3.Horns- air and electric [ i{,r ] 4Drivers seat- rnounting, adjustment, seat belt [t(J ] 5.Air compressor/governor- cut in/cut out 85 min-130 max psi [ '(J ] 6.Brake air leaks- 2 psi/minute (static), 3 psi/minute (applied) [..,('[ ] 7.Low air warning- audible and or visual 60 psi min [.,Yl ] 8.Air tanks- drain, test check valves, perform split system test [ .r'[ ] 9.Fire extinguisher, triangle reflectors(3), first aid kit (optional) [,,l'j ] 10. Restroom- lighting, seat, venting, flush, dump valves, holding tank(s) ["1.,1. ] 11.Exterior lights, turn signals, emergency flashers, back up alarm and lights [..{J ] 12 Windshields, wipers, squirters, defrosters, sun shades, mirrors ["1 [ ] 13.Windows- cracks, mounting, leaks, labeling [-0 ] 14. Emergency exits- roof hatches, side windows, labeling and operation [ .(J ] 15.Multimedia system- PA, audio/video, CD/DVD, amp, speakers [i,f,,.[ ] 16.HVAC- function, fans, motor brushes, filters, leaks [./fJ ] 17. Passenger seats- mounting, seat belts, condition, sliding (if W/C equipped) [.f J ] 18 Interior lighting and markings [ .-(J ] 19.Luggage bays- latches, handles, door operation, lighting [ ,,( [ ] 20.Batteries- fliud, terminals, cables, corrosion, hold down, shut off switch [ ] J?4-,.21.Engine bay- cleanliness, fluid leaks, fluid levels, belts, pulleys, mounts L,,('(] 22.Engine accessories- mounting, cables, hoses, function [...vJ' ] 23.Alternators- mounting, cables, ducting, pulleys, output [.,y'J ] 24.Exhaust- leaks, mounting, tail pipe, overall condition [-t:[ ] 25.Fuel system- leaks, hose routing, securement, tank mounting, filler necks/caps [,1 J ] 26.Cooling system- leaks, radiator, hoses, miter box, fan clutch, coolant level [ .,(,,[ ] 27.Air system overall- air dryer, valves, lines, hoses [.J]',,[ ] 28.Brakes- lining thickness, rotors, cracks, chambers, adjustment, operation [-f J ] 29.Parking brake- push/pull, release/apply, stays applied with complete loss of air [.,(J ] 30.Wheels, tires- cracks, lug nuts/studs, tread depth, separation, pressure [ 11,,f ] 31.Hubs- end play, leaks, ABS sensor, overall condition [,,f,,.[ ] 32.Suspension- air bags, radius rods, bushings, shocks, mounting, leveling valves [v'.[ [ ] 33.Steering- king pins, ball joints, linkage, steering box, hoses, noise, function [t,fJ ] 34.Transmission/differential- function, leaks, fluid level, vents, mounting [ v!'J ] 35.Drive shaft- U-joints, slip joint, dents, clocking, safety hoop,. straps, bolts [vf' Yl 36. Frame- cracks, dents, damage, rust, holes, crossmembers, mounting [-.([ ] 37.Chassis and undercarriage- overall condition, lubrication, dirt, grime build up

, [ ] [ J ;.3_ Wheelchair lift- operation, safetys, markings, leaks, fluid level, cleanliness

Notes: {! .a O / � I / --c C, k..

Mechanic.·_ -�C�r-_ _,_)_-:.:: ______ �Signature: ----C �

This inspection is equal to: Annual 49CFR 396.17-23 Apendix G and V/C 34505 Title 13 CCR 1232(b)

. . ·:· ,


UNIT #)_tflJ]/ DATE:/1 • /�-,& MILEAGE: B ,s; /J-/ MECHANIC. f �,-ITEMS REPAIRED OR REPLACED

TIRES

Left front f ] Right front [ J





Left front __ Right front__ Left front [ ] Right front [ J

Left O/dr __ Right O/dr __ Left O/dr [ ] Right O/dr [ ]

Left 1/dr ___ Right 1/dr__ Left 1/dr [ J Right 1/dr [ ]

Left tag, ___ Right tag__ Left tag [ J Righi tag [ J

Windshields. ________ Wiper Blades. _____ Batteries ______ _

Engine belts: Cooling fans: ______ A/C: ______ Alts.:. _______ _


1: _________________________ �

2: _________________________ _

3: --------------------------

4: _________________________ _

5: _________________________ _

6: _________________________ _


1b

TOTAL WORK HOURS: ____ _ MECHANIC'S SIGNATURE:. _____ ___:_,. ___ _


UNIT# Jl/o:i- DATE g, �-/8 MILEAGE 6 08/ fff/0OK DEF [J(J [ ] 1.Entrance door, operation, markings, hand railsl\l) [ ] 2. Instruments, dash lights, switches, knobs, levers, readouts, gauges ·� [ ] 3. Horns- air and electric :bl] [ ] 4. Drivers. seat- mounting, adjustment, seat belt ttJ [ ] 5.Air compressor/governor- cut in/cut out 85 min-130 max psi !)c] [ ] 6.Brake air leaks- 2 psi/minute (static), 3 psi/minute (applied) � [ ] 7. Low air warning- audible and or visual 60 psi min '.t] [ J 8.Air tanks- drain, test check valves, perform split system test f><-1 [ ] 9.Fire extinguisher, triangle reflectors(3), first aid kit (optional) [ ] M'. 1 O.Restrobm- lighting, seat, @!§)flush, dump valves, holding tank(s) ·. t,lj [ ] 11.Exterior lights, turn signals, emergency flashers, back up alarm and lights � [ ] 12.Windshields, wipers, squirters, defrosters, sun shades, mirrors !KJ [ ] 13.Windows- cracks, mounting, leaks, labeling I)<] [ ] 14.Emergency exits- roof hatches, side windows, labeling and operation f>4 [ ] 15.Multimedia system- PA, audio/video, CD/DVD. amp, speakers [ ] j:,416.HVAC- function, fans, motor brushes�eaks 1/.K] [ ] 17.Passenger seats- mounting, seat belt�ition, sliding (if W/C equipped) li)ll [ ] 18.lnterior lighting and markings � [ ] 19 luggage bays- latches, handles, door operation, lighting 11':l f ] 20.Batteries- fliud, terminals, cables, corrosion, hold down, shut off switch �] i ] 21.Engine bay- cleanliness, fluid leaks, fluid levels, belts, pulleys, mounts /4 [ ] 22.Engine accessories- mounUng, cables, hoses, function f:fl [ ] 23.Alternators- mounting, cables, ducting, pulleys, output �] [ J 24.Exhaust- leaks, mounting, tail pipe, overall condition I[] [ ] 25. Fuel system- leaks, hose routing, securement, tank mounting, filler necps [ ] l'4 26.Cooling system- leaks, radiator, hoses, miter box, fan clutch,@9I,m\ lev JH>I) Ji(] [ ] 27.Air system overall- air dryer, valves, lines, hoses ()'] [ ] 28.Brakes- lining thickness, rotors, cracks, chambers, adjustment, operation [)l] [ ] 29.Parking brake- push/pull, release/apply, stays applied with complete loss of air lii.J [ ] 30.Whe_els, tires- cracks, lug nuts/studs, tread depth, separation, pressure fill [ f31.Hubs- end play, leaks, ABS sensor, overall condition fill [ ] 32.Suspension- air bags, radius rods, bushings, shocks, mounting, leveling valves !,ti [ ] 33.Steering- king pins, ball joints, linkage, steering box, hoses, noise, function l)<J [ ] 34. TransmIss1on/d1fferentIal- function, leaks, fluid level, vents, mounting fDl! [ ] 35.Drive shaft- U-joints, slip joint, dents, _clocking, safety hoop, straps, bolts biJ [ ] 36.Frame- cracks, dents, damage, rust, holes, crossmembers, mounting iil'.l [ ] 37.Chassis and undercarriage- overall condition, lubrication

8. , U� ss

Notes: _____________________________ _

Mechanic: .Jt1J?7(3S This inspection is equal to: Annual 49CFR 396.17-23 Apendi

,,---

d VIC 34505 Title 13 CCR 1232(b)


UNIT #L_1!,g DATE fl-?:,-/8 MILEAGE: cJ 0§1

0 'l!lJ MECHANIC: �'g;fITEMS REPAIRED OR REPLACED

TIRES




Left tag [ ] Right tag [ l


TIRE PRESURES





Wiper Blades

BRAKE PADS

Left front

Left O/dr

Left 1/dr

Left tag

Batteries

[ ] Right front [ ]

[ l

[ l

[ l

Right 0/dr [ ]

Right 1/dr [ ]

Right tag [ ]

Engine belts: Cooling fans: _______ NC: ______ Alts,: ________ _


1: ___________________________ _

2: ___________________________ _

3: ___________________________ _

4: _________________________ _

5: _________________________ _

6: -----------------------


s,S'� l

Dt?-ul U,s ..s ; oe vJ 11.Jt> Sil I t:t..J>


OK DEF


DATE b�½-Jf; � [ ] 1.Entrance door, operation, markings, hand rails

, � .[ ]. 2.lnstruments, dash lights, switches, knobs, levers, readouts, gauges � [ ] 3. Horns- air and electric � [ ] 4. Drivers_ seat- mounting, adjustment, seat belt D'J [ ] 5.Air compressor/governor- cut in/cut out 85 min-130 max psi 6'1 [ ] 6.Brake air leaks- 2 psi/minute (static), 3 psi/minute (applied) � [ ] 7.Low air warning- audible and or visual 60 psi min M [ ] 8.Air tanks- drain, test checi< valves, perform split system testl}l} [ ] 9.Fire extinguisher, triangle reflectors(3), first aid kit (optional) ,,A �[ l "'"10.Restroom- lighting, seat,�ntm flush, dump valves, holding tank{s) {),,-,rlJ,,_ V:.1-IAL t<P2 .• hwb M [ ] 11.Exterior lights, turn signa , ergency flashers, back up alarm a,!;nsdJJl�e::�� ,a VO<.lf-' �

[ ]12.Windshields, wipers, squirters, defrosters, sun shades, mirrors f;/1,,.,,;

.J .,sf Or;; [ ] 13.Windows- cracks, mounting, leaks, labeling u/l/S,,_,rWl6J"--JL...-----

--

[ ] 14.Emergency exits- roof hatches, side windows, labeling and op,�olie- -----b"l [ ] 15.Multimedia system- PA, audio/video, CD/DVD, amp, speakers [ ] ()d..16. HVAC- function, fans, motor brushes,�eaks Jo4 [ ] 17.Passenger seats- mounting, seat belts, condition, sliding (if W/C equipped) 1)4 [ ] 18.lnterior lighting and markings IL) [ ] 19.Luggage bays- latches, handles, door operation, lighting l)ll [ ] 20.Batteries- fliud, terminals, cables, corrosion, hold down, shut off switch [ l !421.Engine bay- cleanliness, fluid leaks, fluid levels, belts, pulleys, mounts� [ ] 22.Engine accessories- mounting, cables, hoses, function

[ ] 23.Alternators- mounting, cables, ducting, pulleys, output [ J 24.Exhaust- leaks, mounting, tail pipe, overall condition [ ] 25.Fuel system- leaks, hose routing, securement, tank mounting, filler necks/caps [ ] 26.Cooling system- leaks, radiator, hoses, miter box, fan clutch, coolant level [ ] 27.Air system overall- air dryer, valves, lines, hoses [ ] 28.Brakes- lining thickness, rotors, cracks, chambers, adjustment, operation [ ] 29.Parking brake- push/pull, release/apply, stays applied with complete loss of air

[b4 [ ] 30.Whe_!lls, tires- cracks, lug nuts/studs, tread depth, separation, pressure [ ]'31 .Hubs- end play, leaks, ABS sensor, overall condition

' [ ] 32.Suspension- air bags, radius rods, bushings, shocks, mounting, leveling valves [ ] 33.Steering- king pins, ball joints, linkage, steering box, hoses, noise, function [ ] 34.Transmission/differential- function, leaks, fluid level, vents, mounting

· [ ] 35.Drive shaft- U-joints, slip joint, dents, clocking, safety hoop, straps, bolts[ ] 36.Frame- cracks, dents, damage, rust, holes, crossmembers, mounting

. VJ [ ] 37.Chassis and undercarriage- overall condition, lubrication, dirt, grime build uptvJPrr1J-t-[t]�5�a�.\�ot�A�ijOO�)c�q��ir�li44,-.Q9µpe�c��wtinon□�-s�a�f��P�/�5�,ffll�ta�1!��iffR§�S�,➔l@�8�k�i�,��bl�iQ�lee•�}C�l�,e�leeaaff�l�iA*B*S�S------

Notes: ----------------------------------

Mechanic: :1,qmtfj This inspection is equal to: Annual 49CFR 396.17-23 Apend·

•• N

:


UNIT#� DATE ti-J_�-/!J MILEAGE J'tJ.tf, /p4:J- MECHANIC--;:('�';I



Left O/drive [ J Right O/drive [ ]

Left I/drive [ J Right //drive [ J

Left tag [ ] Right tag [ J

Windshields _______ _

TIRE PRESURES





Wiper Blades

BRAKE PADS

Left front [ ] Right front [ l

Left O/dr [ J Right O/dr [ J



Batteries

Engine belts: Cooling fans: ______ A/C: _____ _ Alts.: _______ _


1: ________________________ _

2: ________________________ _

3: ________________________ _

4: ________________________ _

5: ________________________ _

6: -----------------------


fc.€f'/1J-C6Y'J IVl,lS.SCtl}&. (6-oq- 0/J f2.tt.ot� (v'I-O'f0(2_..



DATE S-7-/£ MILEAGE rJ..C/7,�35"' ,

OK DEF ['oil- [ ] 1.Entrance door, operation, markings, hand rails {� [ ] 2.lnstruments, dash lights, switches, knobs, levers, readouts, gauges � [ ] 3. Horns- air and electric fp4 [ J 4.Drivers seat- mounting, adjustment, seat belt ()4 [ J 5.Air compressor/governor- cut in/cut out 85 min-130 max psi � [ J 6.Brake air leaks- 2 psi/minute (static), 3 psi/minute (applied) 11)4 [ J 7.Low air warning- audible and or visual 60 psi min L� [ ] 8.Air tanks- drain, test check valves, perform split system test 114 [ J 9.Fire extinguisher, triangle reflectors(3), first aid kit (optional) (W [ ] 10.Restroom- lighting, seat, venting, flush, dump valves, holding tank(s)[;ii [ ] 11.Exterior light

�, turn · . nals, emergency flashers, back up alarm and lights

[ ] Cxi 12.Windshields ip r quirters, defrosters, sun shades, mirrors � [ J 13.Windows- era s, mounting, leaks, labeling !>'J_ [ ] 14.Emergency exits-roof hatches, side windows, labeling and operation M [ ] 15.Multimedia system- PA, audio/video, CD/DVD, amp, speakers [b4 [ J 16.HVAC-function, fans, motor brushes, filters, leaks 1\),4 [ ] 17.Passenger seats- mounting, seat belts, condition, sliding (ifW/C equipped)

a [ ] 18.lnterior lighting and markings [ ] 19.Luggage bays- latches, handles, door operation, lighting [ ] 20.Batteries- fliud, terminals, cabies, corrosion, hold down, shut off switchL.-------=-.....,_

9'] [ J 21.Engine bay-cleanliness, fluid leaks, fluid levels, belts, pulleys, ts //9/t2-(, � ) [ ] 1}4'.22.Engine accessories- mounting, cables, hoses, function 'f:.tf ll4c£

11 '� _,,

�l [ ] 23.Alternators-mounting, cables, ducting, pulleys, output

[ J 24.Exhaust- leaks, mounting, tail pipe, overall condition .[ ] 25.Fuel system- leaks, hose routing, securement, tank mounting, filler necks/caps

[J)a [ ] 26.Cooling system- leaks, radiator, hoses, miter box, fan clutch, coolant level liJ,4 [ ] 27.Air system overall- air dryer, valves, lines, hoses&iJ [ ] 28.Brakes- lining thickness, rotors, cracks, chambers, adjustment, operation ['c,4 [ ] 29.Parking brake- push/pull, release/apply, stays applied with complete loss of air [\/) [ ] 30.Whe�ls, tires- cracks, lug nuts/studs, tread depth, separation, pressure [14 [ J31.Hubs- end play, leaks, ABS sensor, overall condition [i.4 [ ] 32.Suspension-air bags, radius rods, bushings, shocks, mounting, leveling valves [>='] [ ] 33.Steering- king pins, ball joints, linkage, steering box, hoses, noise, function [g..J [ ] 34.Transmission/differential- function, leaks, fluid level, vents, mounting� [ ] 35.Drive shaft- U-joints, slip joint, dents, clocking, safety hoop, straps, bolts !i<:J [ ] 36.Frame- cracks, dents, damage, rust, holes, crossmembers, mounting

,J. rl£l [ ] 37.Chassis and_undercarriage- overall condition, lubrication, dirt, grime build up f'/A�l [ J 38.Wheelchair /rft- opemtroA, cah;;JF,ro, • :1a.k111gs, leaks, fla1d)evet, t1ea1:i1111ess

Notes: _____________________ -'---------

This inspection i_s ,;(iual to: Annual 49CFR 396.17-23 Apen v

.'\\

VEHICLE REPAIR & SERVICE FORM . . _.,,.,.• .. ·. ,

UNIT #/1/:bl DATE: 5-7-16 MILEAGE: :l..97, 23'{ MECHANIC_✓_4�VYJ�···_�= .. •'�





Left tag [ ] Right tag [ l


TIRE PRESURES

Left front Right front_ _

Left 0/dr Right 0/dr



Wiper Blades

BRAKE PADS

Left front [ J Right front [ J


Left 1/dr [ l Right 1/dr [ J


Batteries

Engine belts: Cooling fans:. _______ A/C: ______ Alts.: ________ _


1: ___________________________ _

2: ----------------------------3: ----------------------------

4: ___________________________ _

5: _________________________ _

6: _________________________ _


TOTAL WORK HOURS:----- MECHANIC'S SIGNATUR


MILEAGE: ,,2_,9�, 90?, MECHANIC:I



Left front f l Right front [ l Left front Right front _ _ Left front [ J Right front [ J

Left O/drive [ ] Right O/drive [ ] Left O/dr Right O/dr Left O/dr [ l Right 0/dr [ ]

Left I/drive [ ] Right I/drive [ l Left 1/dr Right 1/dr __ Left 1/dr [ l Right 1/dr [ ]

Left lag [ l Right tag [ l Left tag Right tag __ Left lag [ l Right tag [ J

Windshields Wiper Blades Batteries

Engine belts: Cooling fans: _______ A/C:______ Alls.: ______ __ _


1: ----------------------------

2: ___________________________ _

3: ___________________________ _

4: _________________________ _

5: ----------------------------

6: ----------------------------


TOTAL WORK HOURS:----- MECHANIC'S SIGNATU


UNIT# /.,YO� DATE/.f-t,�;f' MILEAGE 3_"/!/f, &'Ii" OK DEF [IQ [ ] 1.Entrance door, operation, markings, hand rails

, ryJ [ ] 2.lnstruments, dash lights, switches, knobs, levers, readouts, gauges f.A [ ] 3.Horns- air and electric [XJ [ ] 4. Driver,a seat- mounting, adjustment; seat belt [)ll [ ] 5.Air compressor/governor- cut in/cut out 85 min-130 max psi EA [ ] 6.Brake air leaks- 2 psi/minute (static), 3 psi/minute (applied) r,4 [ ] 7.Low air warning- audible and or visual 60 psi min[jll, [ ] 8.Air tanks- drain, test check valves, perform split system test [;4- [ ] 9.Fire extinguisher, triangle reflec ors(3), first aid kit (optional) r ] �1 0.Restroom- lighting, seat, entin lush, dump valves, holding tank(s)

� [ ] 11.Exterior lights, turn signals, emergency flashers. back up alarm and lights [ ] 12.Windshields, wipers, squirters, defrosters, sun shades, mirrors

� [ ] 13.Windows- cracks, mounting, leaks, labeling[ ] 14.Emergency exits- roof hatches, side w

_indows, labeling and operation

[ J 15 Multimedia system- PA, audio/video, �D, amp, speakersl)'ll16.HVAC-function, fans, motor brushes,�leaks

�, [ ] 17.Passenger seats- mounting, seat belts, condition, sliding (ifW/C equipped)

[ ] 18.lnterior lighting and markings [ ] 19.luggage bays- latches, handles, door operation, lighting

[}Ll [ ] 20.Batteries- fliud, terminals, cables, corrosion, hold down, shut off switch [.H [ ] 21.Engine bay- cleanliness, fluid leaks, fluid levels, belts, pulleys, mounts [l)G [ ] 22.Engine accessories- mounting, cables, hoses, function rilJ [ ] 23 Alternators- mounting, cables, ducting, pulleys, output

f1 [ ] 24.Exhaust- leaks, mounting, tail pipe, overall condition [ ] 25.Fuel system- leaks, hose routing, securement, tank mounting, filler necks/caps [)(26.Cooling system- leaks, radiator, hoses, miter box, fan clutch, E:5?iant leveQ

� [ ] 27.Air system overall- air dryer, valves, lines, hoses [ ] 28.Brakes- lining thickness, rotors, cracks, chambers, adjustment, operation [ ] 29.Parking brake- push/pull, release/apply, stays applied with complete loss of air

IY.] [ ] 30.Whe_els, tires- cracks, lug nuts/studs, tread depth, separation, pressure t\t-l [ ]31.Hubs- end play, leaks, ABS sensor, overall condition &'J [ ] 32.Suspension- air bags, radius rods, bushings, shocks, mounting, leveling valves

� [ ] 33.Steering- king pins, ball joints, linkage, steering box, hoses, noise, function [ ] 34. Transmission/differential- function, leaks, fluid level, vents, mounting [ ] 35.Drive shaft- U-joints, slip joint, dents, clocking, safety hoop, straps, bolts

f,iJ [ ] 36.Frame- cracks, dents, damage, rust, holes, crossmembers, mounting Oli [ ] 37.Chassis and undercarriage- overall condition, lubrication, dirt, grime build up

/U/t't/i-� [ J 3g '◊fJ:igglchalr Htt operation, saf�1iark1ngs, leaks, tlu1U level, clea1::Vinoec

Notes: ----------------------------------

Mechanic: _J /i»4G-S

This inspection is equal to: Annual 49CFR 396.17-23 Apendjix G .

TIRES






Left I/drive [ J Right I/drive [ ]

Left front

Left O/dr

Left 1/dr

Right front __

Right O/dr

Right 1/dr _ _

Left front [ J Right front [ J





Left tag

Wiper Blades

Right tag __ Left tag [ l Right tag [ ]

Batteries

Engine belts: Cooling fans: _______ A/C: _ __ _ __ Alts.: ________ _


1: ----------------------------

2: ___________________________ _

3: ----------------------------

4: ----------------------------

5: ----------------------------

6: ___________________________ _


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