U. S. DEPARTMENT OF AGRICULTURE NRCS-ADS-180 NATURAL RESOURCES CONSERVATION SERVICE 3 - 84 PREVENTIVE MAINTENANCE INSPECTION REPORT (Automotive Vehicles Only)

Property No. License No. A-

Location: Principal Driver: Date:

Make: Model (Year): Body Type: Mileage:

Last Chassis Lube: Date: Mileage: Last Inspection: Date: Mileage:

Last Oil Change: Date: Mileage: Last Tune Up: Date: Mileage:

Last Bearing Repack: Date: Mileage: Last Spark Plug Chg. Date: Mileage:

Code: "T"=OK; "R"=Repairs Needed (Instructions on the reverse side)

I BODY AND MISCELLANEOUS (For use by Principal or other Designated Driver Only)

Body, Glass Lights Dents Paint Water Leaks Bed. Trunk Rust Gauges Passenger Safety Belts License Plates Decals Jack, Wrench Heater, Defroster Tire Chains First Aid Kit Tires, Air Pres. Tires, Condition Locks and Catches Fire Extinguisher Accident Forms Monthly Safety Inspection AD-187C

II ENGINE Valve Cover Leaks Breather, PCV EGR Valve, and Controls Emission Controls Ignition System Carb., Linkage Spark Control Manifold Heat Valve Battery Cables, Battery Alternator, voltage Belts Radiator, Core Pressure Cap Antifreeze ºF Hoses Starter, Mount Wires Volts-drawdown Engine Mounts Exhaust System Pipes, Hangers, Clamps Catalytic Conv. Engine Condition: Air Conditioning Compression (If needed) 1 2 3 4 5 6 7 8 (E; G; F; or P)

III CHASSIS Suspension Steering Mechanism Alignment Shock Absorbers Bearings Clutch, Pedal Travel Trans., Linkage Drive Shaft Differential Oil Seals Master Cylinder Brake Pedal Action Wheel Cylinder Brake Lines Brake Fluid Rear Brake Shoes Thickness R.F. Pad Parking Brake Wheel Lugs Body Bolts Vehicle Condition (Excellent, E; Good, G; Fair, F; Poor, P)

REMARKS & RECOMMENDATIONS

Inspection cost $ Mechanic's Name

Name of Garage Mechanic's Sig. Time (Hours)

This form was electronically produced by National Production Services Staff