n a

OKSee

Notes

ok a

b

c

d

e

f

g

h

i

j

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

Inspector's Name:

u

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.

Transmission (if electronic Automated)

Active Fault Codes

Inactive Fault Codes

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

Applicable)

Model no data plate

11376

Odometer Mileage 8565

Engine CPL No.

8565

na

na

Photo of front of vehicle (Stright on hood closed) yes

no

DPF equipped no

naEngine HP Rating

automated

Connect JPRO. Print diagnostics report.

USED TRUCK INSPECTION FORM

Engine Make

no info

Engine Serial No.

cat

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

Engine Family Code

Hours

Year no data plate

Full VIN

no info

no data plate

Engine Model

no info

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

no communication from unit

no data plate

na

SCR equipped

ECU Mileage

2. Minimum Required Pictures

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

being inspected missing data tag

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

Serial #’s ( If Applicable) missing data tag

missing data tag

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

year) missing data tag

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

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

& Tank Configuration) yes

Photo of the right side of the vehicle from front to rear yes

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

x j

x k

x l

x m

x n

x o

x p

x q

x r

x s

x t

xu

x v

x w

x x

x y

x z

x aa

x bb

x cc Upholstery (Cloth, Vinyl/Cloth, Leather, Vinyl, Button-Tuck) low

Interior Level (Mid, Low, High) basic

Dual Beds - Y or N

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

(None)

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

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

Photo of rear of vehicle yes

hub

no

no

cabover

steel

steel

Interior photo from passenger’s door yes

45° exterior photo from right rear corner yes

Right side drive tires

3. Specifications

45° exterior photo from left rear corner yes

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

wall) If Applicable na

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

wall) If Applicable na

Photo of Odometer (clearly showing current miles/kilometers)

steel

single

n

Fuel Tank 2 Capacity

Fuel Tank 3 Capacity

na Sleeper Size in Inches - Back wall of Sleeper to Curtain

Fuel Tanks - (Steel or Aluminum )

single

horizontal

5th Wheel (Air, Stationary, None )

Frame - ( Steel or Aluminum )

Frame - (Double or Single )

Exhaust - ( Single or Dual )

Exhaust - ( Vertical or Horizontal )

none

na

Photo of Right side of engine na

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

differential) yes

Left side drive tires yes

yes

Photo of DPF system na

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

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

Chassis Fairings ( None, Full, Partial ) full

yes

Photo of Left side of engine

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

entire right side) yes

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

entire left side) yes

Interior photo from driver’s door yes

Photo of oil pan

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

Power Steering ( Y or N ) yes

Air Conditioning ( Y or N ) yes

Interior Type ( Basic or Premium) basic

yes

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

1

na

na

diesel

Fuel Tank 1 Capacity

air

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

x dd

x ee

x ff

x gg

x hh

x ii

x jj

x kk

x ll

x mm

x nn

x oo

x pp

x qq

x rr

x ss

x tt

x uu

x vv

x ww

x xx

x yy

ok a

ok b

ok c

ok d

ok e

ok f

ok g

ok h

ok i

ok j

ok k

na l

ok m

ok n

x o

x p

ok q

ok r

ok s

ok t

ok u

ok v

ok w

ok x

ok y

z

ok aa

ok bb

ok a

na b

PTO ( Y or N) n

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

Wet Line Kit - ( Y or N )

Build Date (month/year)

automated

Suspension (Air Ride, Heavy Duty, Spring) springs

na

Front Axle -Load Capacity na

none

Seat Suspension (Dual Air, LH Air, None) button tuck

Interior Color black

n

2008

Front Axle Position - ( Set Back or Set Forward ) set forward

Rear Axle Make na no data plate

Rear Axle Load Capacity na

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

single

Transmission Model na

Transmission Speeds na

Transmission Type - ( Automated or Manual )

4. Engine Compartment

Record coolant protection level - Temp and SCA

Engine Oil - Level

Coolant - Level

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

Exhaust system - manifold, turbo & piping

Protection:

Radiator, reservoir, hoses

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

Check engine for irregular noies, vibrations, misses, etc

Clutch pedal free stroke

Emission Snap Test Performance

Transmission - Make

Belt - Alignmrent , Condition & Adjustment

A/C compressor, clutch & brackets

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

Coolant - Condition

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

na

leaking air

Gauge reading:

Fan hub, clutch, blade, shroud

Starter & solenoid - Proper mounting / Damage

Engine Oil - Condition

Exhaust system - manifold, turbo & piping

Engine Fuel Leaks

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

Enter the measurement:

5. Interior

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

-32

12.3

ok c

ok d

ok e

x f

x g

ok h

ok i

ok j

k

x l

ok m

ok n

o

x p

x q

x r

ok s

ok t

ok u

okv

ok w

ok x

ok y

ok a

ok b

ok c

ok d

ok e

ok f

ok g

ok h

ok i

ok j

ok k

ok l

ok m

ok n

ok o

ok p

ok q

ok r

ok s

ok t

ok u

ok v

ok w

ok x

y

z

ok a

Clean Idle Decal

Paint Defects yes

Paint Defects yes

Seat Belts & Bunk Restraints

6. Exterior

Brake hoses- cracking & chafing

Driveshafts, u-joints, yokes, carrier bearing

Transmission & rear axle - condition & leaks

Rear axle & suspension alignment

7. Powertrain: Ride Along With Driver

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

Shocks, bushings & mount brackets

Wheel seals - leaks with build up

mph glass broke

Mirrors- heated & power operation & condition

Parking brake

Radio & speakers

Horn - City/ Air

Dash, gauges, switches & interior lights

60

mat

na

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

Check engine oil pressure

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.

Windshield wipers & washers condition

Door hinges, latches, regulators & knobs

Seats - air operation & condition

Upholstery, carpet, mats, etc..

Sleeper / cab privacy curtains & tracks

Cabinets, doors & hinges

Glass - windshields, doors & mirrors

Air leaks - dash, foot valve, shift knob, etc... Check front and rear blower motors for abnormal noises and operation

at all speeds

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

30 1200 RPM:

door do not open from outside

n

Idle:

Air dryer

Check heater core for operation and leaks

Engine brake na

Check operation of all HVAC control on each control unit

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

150 psi

city horn only

not working

Suspension- springs,pins, hangers, etc.

Frame & Crossmembers

Lights & reflectors

Trailer cord, air lines, glad-hands, hangers

Fuel tanks & mounting

Batteries, cables & terminals

Mirrors & mounting brackets

Mud flaps, 1/4 fenders, brackets

Engine monitor display & LCD readout

150psi

ok b

ok c

ok d

oke

okf

okg

ok h

ok a

x b

ok 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

Size Size Size

Cut

Dry rot

Flat

Mismatch Tread/Casings

Wheel Damage

Irregular Wear

Recapped twice

Recapped three times

Make Make Make

Model

Faults Faults Faults

Tread Type

Recap

Virgin

Highway

Lug

Size 11r22.5 Size 11r22.5

11r22.5 Size 11r22.5 Size 11r22.5 Size 11r.225

Tread Tread Tread

32nds 32nds 32nds

Date Date

Type Type Type

Right Front Outside

gdyr

519

3 15

highway

recap

12

d

Date

Model 519 Model g316

4 14 Date 2 15

Type highway Type highway

Left Front Inside Right Front Inside

Make

Model

Date

Type

Tread

32nds

Faults

gdyr

519

7 12

highway

recap

11

d

Tread recap Tread recap

32nds 12 32nds 7

Faults d Faults d

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

Model Model

Date

Faults

Right Steer

Make ironman

Model 109

32nds 11 32nds

Date 4 15 Date

Type highway Type

Tread

10

gdyr Make gdyr

11 14

highway

virgin

Left Front Outside

Faults d Faults dOther

Make Codes

BF Goodrich

Bridgestone

Continental

Dunlop

9. Tires

alt inop

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

Fireston

Goodyear

General

Hankook

Kuhmo

Tread

Left Steer

Make ironman

Model 109

Michelin

Toyo virgin

Yokohama

Make

Check transmission lubricant for operating levels and metal shavings

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

shavings

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

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

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

Additional Notes

jarell jackson jarell jackson 5/31/2019

(PRINT NAME) (SIGNATURE) (Date)

Inspection completed by:

unit alternator fail inspection unit missing important data plates blow off could not be recorded due to over side oil tube all tires

on unit is dry rotted and will need to be replaced

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

AMAZON JARELL JACKSON

✘

AMAZON TRANSPORTATION SERVICE

TA Atlanta Onsite

3181 Donald Lee Hollowell Parkway, Atlanta, GA 30318

406

3457 6/4/2019

OT08003

08

TEMP / GA

Tractor Information

amazon

✘

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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 3/41 3/4

1/21/2

2 2

Steer✔

32nds32nds 32nds 32nds

Left Push Rod Travel RightShort StrokeLong Stroke

In:

In:

In:

Brake Thickness

Chamber: Chamber:

In:

✔

30 30

2 1/22 1/2

7/167/16

2 2 2 2

Front Drive✔

page 1 of 2

Odometer 11376

WST

VIN NO VIN PLATE FOUND

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

✘

AMAZON TRANSPORTATION SERVICE

TA Atlanta Onsite

3181 Donald Lee Hollowell Parkway, Atlanta, GA 30318

406

3457 6/4/2019

OT08003

08

Odometer

TEMP / GA

Tractor Information

VIN

WST

amazon

Section Comment

1. BRAKE SYSTEM a. Operation, Adjustments, Leaks(Service & Parking Brakes)

fail

1. BRAKE SYSTEM d. Automatic Brake Adjusters fail

10. TIRES a. Steer Tires fail

10. TIRES b. All other tires fail

10. TIRES c. Tires marked 'Not for highway use' or otherwisemarked and having like meaning

n

10. TIRES d. Installation of speed restricted tires unlessspecifically designated by motor carrier

n

Note needed repairs all tire are dry rotted and unit cannot be used

page 2 of 2

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_________________

✔

JARELL JACKSON (jmj)

RAYMOND COINERJR (rpc)

3181 Donald Lee Hollowell Parkway, Atlanta, GA 30318

406 TA Atlanta Onsite 404-794-8168

9/5/2018

3

406 TA Atlanta Onsite 8/29/2018

Penske 9/5/2017

11

6/7/2019 AMPNET

https://dtna.autometer.com/dashboard/data/ 1/1

OT08003

Cab right side Cab front

OT08003

Cab front right 45 Cab front left 45

OT08003

Cab front Cab rear

OT08003

Cab right rear 45 Cab left rear 45

OT08003

Tire Tire

OT08003

Tire Tire