Liquid Controls DMS Delivery - Manual (Page 42)

42
Tickets
Vehicle Inspection Ticket
08/08/05 12:40:22
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DRIVER’S VEHICLE INSPECTION REPORT
Completion of this report required
by Federal Law 49 CFR 396.11 and
396.13
Liquid Controls, LLC
105 Albrecht Drive
Lake Bluff, IL 60044-2242
(800) 458-5262
Date:
Driver #
Truck/Tractor:
Reference:
Odometer Mileage
Engine:
Transmission:
Clutch:
Steering Mechanism:
Horn:
Windshield Wipers/Washers:
Rear Vision Mirrors:
Lighting Devices and Reflectors:
Parking Brakes:
Service Brakes:
Tires:
Wheels and Rims:
Emergency Equipment
ERS Test OK at 150 Feet:
Vehicle Condition OK:
_________________________________________
Reporting Driver’s Signature
Defects Corrected?
Defects Explained?
_________________________________________
Mechanic’s Signature
_________________________________________
Reviewing Driver’s Signature
Out of Gas Ticket
08/08/05 09:20:13
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OUT OF GAS REPORT
Liquid Controls, LLC
105 Albrecht Drive
Lake Bluff, IL 60044-2242
(800) 458-5262
DATE:
A. B. Costello
123 Main Street
Anytown, USA 55555
Account #
Tank #
Driver #
Truck Unit ID
Transaction Code
Temperature
PSI
Tank Filled
_________________________________________
Reporting Driver’s Signature