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NRCS ALABAMAMOTOR VEHICLE INSPECTION CHECKLISTFY-11Items contained in this checklist must pass the minimum safety inspection requirements.Sections A and B should be completed and signed by the designated individuals. Repairs should be completed prior to forwarding this form to the State Office. The completed inspection checklist, with original signatures, for each vehicle should be forwarded to Jean Sparks in the State Office by March 31, 2011.Tag No.: _______________ Vehicle VIN: _____________________________________________________________________________________________________Vehicle (Type) (Make) (Year) (Odometer Reading)Vehicle location:_____________________________ Driver: ___________________Items To Be Inspected By A Certified Mechanic: (Initial each item as checked. If repairs are needed, initial and provide the date repairs were completed.)Radiator _______________________________Brakes ________________________________Steering _______________________________Battery ________________________________Exhaust System _________________________Tires __________________________________Other (explain)_____________________________________________________Comments: _____________________________________________________________________________________________________________________(Use Back of Form If Additional Space Is Needed)INSPECTION PERFORMED AND REPAIRS COMPLETED:(PRINT OR TYPE NAME & AUTOSHOP)CERTIFIED MECHANIC: SIGNATURE: ____________________________ DATE: _________________ Items To Be Inspected By A Mechanic Or NRCS Employee:(Initial each item as checked. If Repair(s) is(are) needed, initial and provide the date repairs were completed.) Oil _______________________ Rear Lights _____________________Headlights ________________ Wipers __________________________Directional Lights __________ Heater __________________________ Horn _____________________ Windshield ______________________Defroster, _________________ Clean Condition __________________Door Glass _______________Mirrors ___________________FOLLOW MANUFACTURER’S RECOMMENDATION STANDARDS FOR MAINTENANCE.(Initial each item as checked. If repair(s) are needed, initial and provide date repairs was(were) completed.)Oil Change _________________ Air Filter ________________________Oil Filter ___________________ Diff. Oil Change ___________________Trans. Oil Change ___________ Chasis Lube ______________________Wheel Repack ______________ Univ. Joint Lube __________________Tune-Up ___________________ Plug Replace _____________________Brake Adj. __________________ Wheel Align. ______________________Tire Rotation ________________Comments: _____________________________________________________________ (Use Back Of Form If Additional Space Is Needed)CERTIFICATION: ALL MAINTENANCE HAS BEEN COMPLETED AND THE VEHICLE IS CONSIDERED SAFE AND RELIABLE. DATE REPAIR(S) WERE COMPLETED HAS BEEN NOTED TO THE APPROPRIATE ITEM.DRIVER:_________________________________________________________ (PRINT NAME) (SIGNATURE) (DATE) ................
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