CA 90 Day/DOT Annual Inspection Form
Unit Number
RO Number
Date
No Problem Found
Repairs Needed
Repairs Completed
CERTIFICATION: THIS VEHICLE WAS INSPECTED IN ACCORDANCE WITH SECTION 396.17-23, APPENDIX G OF THE FEDERAL MOTOR CARRIER’S SAFETY REGULATION.
Inspector Name
Signature
Date
Technician Name
Signature
Date
Submit