Attachment_10_Tech_Insp_Form.pdf

VEHICLE TECHNICAL INSPECTION

ITEM

SUBTOTALS

DATE OF DELIVERY

MANUFACTURER MODEL SERIAL NO. AGE MILEAGE/HOURS CUM.

DIAGNOSIS

S A

TI

S

FA

C

TO

R

Y

R E

P A

IR

R E

P

LA

C E

MAN-

HOURS

LABOR

COST

OF

PARTS

ITEM DIAGNOSIS

S A

TI

S

FA

C

TO

R

Y

R E

P A

IR

R E

P

LA

C E

MAN-

HOURS

LABOR

COST

OF

PARTS

FRAME AND

BRACKETS

BUMPERS

TOWING

CONNECTIONS

FIFTH WHEEL

BRUSH GUARD

AND GRILLE

HOOD AND

FENDERS

BODY

CANVAS

PAINT

CAB AND DOORS

WINDSHIELD

AND WINDOWS

WIPER MOTOR

AND BLADES

HORN AND

MIRROR

HEATER

SPEEDOMETER &

TACHOMETER

AMMETER OR

VOLTMETER

GAUGES AND

SENDING UNITS

SEATS AND

UPHOLSTERY

FLOOR

INTERIOR TRIM

ENGINE OR

DRIVE MOTOR

CYL HEAD AND

BLOCK

VALVES AND

PISTON RINGS

INT AND EXH

MANIFOLDS

OIL PAN

OIL PUMP AND

LINES

OIL FILTER AND

ELEMENT

RADIATOR

THERMOSTAT

AND HOSES

WATER PUMP

AND FAN

DRIVE BELTS

AIR

COMPRESSOR

AIR GOVERNOR

AIR TANKS

AND LINES

GENERATOR OR

ALTERNATOR

REGULATOR

RECTIFIER

BATTERY

STARTER AND

SOLENOID

DISTRIBUTOR

AND POINTS

IGNITION COIL

SPARK PLUGS

AND CABLES

HEADLIGHTS

TAILLIGHTS

CLEARANCE AND

MARKER LIGHTS

SWITCHES

WIRING AND

CONNECTORS

CARBURETOR

AND GOVERNOR

AIR CLEANER

FUEL PUMP AND

FILTER

FUEL TANK AND

LINES

MUFFLER

EXHAUST AND

TAILPIPES

CLUTCH

SUBTOTALS

DLA FORM 1730, NOV 2004 (EG) EDITION OF MAY 83 MAY BE USED UNTIL EXHAUSTED

1 2 3 4 5 6 7 8CYLINDER

ITEM DIAGNOSIS

S A

TI

S

FA

C

TO

R

Y

R E

P A

IR

R E

P

LA

C E

MAN-

HOURS

LABOR

COST

OF

PARTS

ITEM DIAGNOSIS

S A

TI

S

FA

C

TO

R

Y

R E

P A

IR

R E

P

LA

C E

MAN-

HOURS

LABOR

COST

OF

PARTS

TRANSMISSION

TRANSFER

POWER TAKEOFF

DRIVE SHAFTS

AND U-JOINTS

DIFFERENTIAL

FRONT AXLE

INTERMEDIATE

AXLE

REAR AXLE

WINCH AND

CABLE

HOIST OR CRANE

SVC BRAKE

SYSTEM

MASTER

CYLINDER

AIR-HYDRAULIC

CYLINER

WHEEL

CYLINDERS

HAND BRAKE

SYSTEM

STEERING GEAR

AND CONTROLS

SPRINGS AND

SHACKLES

SHOCK

ABSORBERS

WHEELS

TIRES AND

TUBES

DATE OF INSPECTION INSTALLATION SIGNATURE OF INSPECTOR

REMARKS

SUBTOTALS

ORIGINAL ACQUISITION COST $

SUBTOTALS

RESULTS OF COMPRESSION TEST

DRY

WET

TOTAL REPAIR COSTS COSTS DUE TO ACCIDENT

TOTAL MAN-HOURS

LABOR

LABOR RATE PER

MAN-HOUR

TOTAL COST OF LABOR

TOTAL COST OF PARTS

TOTAL COST OF

REPAIRS

ONE-TIME REPAIR

EXPENDITURE LIMIT

TOTAL COST OF

PREVIOUS REPAIRS

CUMULATIVE REPAIR

EXPENDITURE LIMIT

COSTS OF LABOR AND

OVERHEAD

COST OF PARTS

TOTAL COST

OTHER COSTS (List)

ESTIMATED REPLACEMENT COST $

DLA FORM 1730, NOV 2004 (EG)