Section_J_-_Atch_4_-_Vehicle_Repair_Request.pdf

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HSFLAR-15-R-00001
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Section J - Attachment 4

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FTC-OST-66 (4-86)

VEHICLE

REPAIR

REQUEST

TAG NO. MILEAGE PARKED IN SPACE IF

APPLICABLE

DATE

AGENCY DRIVER TIME

CHECK AND

BRIEFLY

EXPLAIN ANY

DEFICIENCIES

IN THE

FOLLOWING:

AIR CONDITIONER

ALTERNATOR - BATTERY

BODY DAMAGE

BRAKES - CLUTCH

ENGINE

EXHAUST

HEATER/DEFROSTER

INSPECTION, MILES

LEAKS

LIGHTS/TURN SIGNALS

RADIATOR

STARTER

STEERING

TIRES

Attachment 4

Attachment 4

TRANSMISSION

W/S WASHER

W/S WIPERS

OTHER REMARKS

MOTOR POOL USE

ONLY

ACTION TAKEN DATE AND TIME AGENCY

NOTIFIED

MECHANIC DATE AND TIME PICKED UP

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