Prescribed by DTR 4500.9-R MOTOR VEHICLE INSPECTION ...

1 MOTOR VEHICLE INSPECTION (TRANSPORTING HAZARDOUS MATERIALS)(Read Instructions before completing this form.)This form applies to all vehicles which must bemarked or placarded in accordance with Title 49 BILL OF LADING/TRANSPORTATION CONTROL NUMBERSECTION 1 - CARRIER/GOVERNMENT ORGANIZATION3. DATE/TIME OF INSPECTION4. LOCATION OF INSPECTION5. OPERATOR(S) NAME(S)6. OPERATOR(S) LICENSE NUMBER(S)7. MEDICAL EXAMINER'S CERTIFICATE*8.(X if satisfactory at origin) ENDORSEMENTb. VALID LEASE*c. ROUTE PLANd. ERG OR EQUIVALENT COMMERCIAL:e. DRIVER'S VEHICLE INSPECTION REPORT*f. COPY OF 49 CFR PART 3979. CVSA DECAL DISPLAYED ONCOMMERCIAL EQUIPMENT*a. TRUCK/TRACTORb. TRAILERYESNOSECTION II - MECHANICAL INSPECTION All items shall be checked on empty equipment prior to loading. Items with an asterisk shall be checked on all incoming loaded TYPE OF VEHICLE (S)11.

2 VEHICLE NUMBER(S)ORIGIN(1)DESTINATION(2)SATUNSAT SATUNSAT12. PART INSPECTED(X as applicable)a. SPARE ELECTRICAL FUSESb. HORN OPERATIVEc. STEERING SYSTEMd. WINDSHIELD/WIPERSe. MIRRORSf. WARNING EQUIPMENTg. FIRE EXTINGUISHER*h. ELECTRICAL WIRING i. LIGHTS AND REFLECTORS j. FUEL SYSTEM*ORIGIN(1)DESTINATION(2)SATUNSATSA TUNSATk. EXHAUST SYSTEMl. BRAKE SYSTEM*m. SUSPENSIONn. COUPLING DEVICESo. CARGO SPACEp. LANDING GEAR*q. TIRES, WHEELS, *s. TARPAULIN*t. OTHER (Specify)COMMENTS(3)13. INSPECTION RESULTS (X one) ACCEPTED(If rejected give reason under "Remarks". Equipment will be approved if deficiencies are corrected prior to loading.)REJECTED15. REMARKS16. INSPECTOR SIGNATURE (Origin)17. INSPECTOR SIGNATURE (Destination)25. INSPECTOR SIGNATURE (Origin)26. DRIVER(S) SIGNATURE (Origin)27. INSPECTOR SIGNATURE (Destination)28.

3 DRIVER(S) SIGNATURE (Destination)SECTION III - POST LOADING INSPECTION18. LOADED IAW APPLICABLE SEGREGATION/COMPATIBILITY TABLE OF 49 CFR19. LOAD PROPERLY SECURED TO PREVENT APPLIED TO CLOSED VEHICLE ; TARPAULIN APPLIED ON OPEN EQUIPMENT21. PROPER PLACARDS APPLIED22. SHIPPING PAPERS/DD FORM 2890 FOR GOVERNMENT VEHICLE SHIPMENTS23. COPY OF DD FORM 626 FOR DRIVER24. SHIPPED UNDER DOT SPECIAL PERMIT 868 ORIGIN(1)DESTINATION(2)SATUNSATSATUNSATC OMMENTS(3) This section applies to Commercial and Government/Military vehicles. All items will bechecked prior to release of loaded equipment and shall be checked on all incoming FORM 626, OCT 2011 PREVIOUS EDITION IS OBSOLETE. Page 1 of 3 PagesYES NO14. SATELLITE MOTOR SURVEILLANCE SYSTEM: (X one)ACCEPTEDREJECTED Adobe Professional by DTR I - DOCUMENTATIONG eneral Instructions.

4 All items (2 through 9) will be checked at origin prior to loading. Items with an asterisk (*) apply to commercial operators orequipment only. Only Items 2 through 7 are required to bechecked at 1 through 5. Self 6. Enter operator's Commercial Driver's License (CDL)number or Military OF-346 License Number. CDL and OF-346must have the HAZMAT and other appropriate endorsements IAW49 CFR 7. *Enter the expiration date listed on the Medical Examiner' Hazardous Materials Certification. In accordance with applicable service regulations, ensure operator has been certifiedto transport hazardous materials. Check the expiration date on driver's HAZMAT Certification. b. *Valid Lease. shipper will ensure a copy of the appropriatecontract or lease is carried in all leased vehicles and is availablefor INSPECTION .

5 (49 CFR and (c)(2)). c. Route Plan. Prior to loading any Hazard , , or (Explosives) for shipment, ensure that the operatorpossesses a written route plan in accordance with 49 CFR Part397. Route Plan requirements for Hazard Class 7 (Radioactive)materials are found in 49 CFR d. Emergency Response Guidebook (ERG) or Equivalent. Commercial operators must be in possession of an ERG orequivalent document. shipper will provide applicable ERGpage(s) to military operators. e. *Driver's VEHICLE INSPECTION Report. Review the operator'sVehicle INSPECTION Report. Ensure that there are no defects listedon the report that would affect the safe operation of the VEHICLE . f. Copy of 49 CFR Part 397. Operators are required byregulation to have in their possession a copy of 49 CFR Part 397(Transportation of Hazardous Materials Driving and ParkingRules).

6 If military operators do not possess this document, shipperwill provide a copy to 9. *Commercial VEHICLE Safety Alliance (CVSA) Decal. Check to see if equipment has a current CVSA decal and markapplicable box. Vehicles without CVSA, check documentation ofthe last VEHICLE periodic INSPECTION and perform DD Form II - MECHANICAL INSPECTIONG eneral Instructions. All items ( through ) will be checked on all incomingempty equipment prior to loading. All UNSATISFACTORY conditions must be corrected prior to loading. Items with anasterisk (*) shall be checked on all incoming loaded equipment. Unsatisfactory conditions that would affect the safe off-loading ofthe equipment must be corrected prior to II (Continued)Item Spare Electrical Fuses. Check to ensure that at least onespare fuse for each type of installed fuse is carried on the VEHICLE as aspare or VEHICLE is equipped with an overload protection device(circuit breaker).

7 (49 CFR ) b. Horn Operative. Ensure that horn is securely mounted and ofsufficient volume to serve purpose. (49 CFR ) c. Steering System. The steering wheel shall be secure and mustnot have any spokes cracked through or missing. The steeringcolumn must be securely fastened. Universal joints shall not be worn,faulty or repaired by welding. The steering gear box shall not haveloose or missing mounting bolts or cracks in the gear box mountingbrackets. The pitman arm on the steering gear output shaft shall notbe loose. Steering wheel shall turn freely through the limit of travel inboth directions. All components of a power steering system must bein operating condition. No parts shall be loose or broken. Belts shallnot be frayed, cracked or slipping. The power steering system shallnot be leaking. (49 CFR 396 Appendix G) d.

8 Windshield/Wipers. Inspect to ensure that windshield is freefrom breaks, cracks or defects that would make operation of thevehicle unsafe; that the view of the driver is not obscured and that thewindshield wipers are operational and wiper blades are in serviceablecondition. Defroster must be operative when conditions require. (49 CFR , and ) e. Mirrors. Every VEHICLE must be equipped with two rear visionmirrors located so as to reflect to the driver a view of the highway tothe rear along both sides of the VEHICLE . Mirrors shall not be crackedor dirty. (49 CFR ) f. Warning Equipment. Equipment must include threebidirectional emergency reflective triangles that conform to therequirements of FMVSS No. 125. FLAME PRODUCING DEVICESARE PROHIBITED. (49 CFR ) g. Fire Extinguisher. Military vehicles must be equipped with one serviceable fire extinguisher with an Underwriters Laboratories ratingof 10 BC or more.

9 (Commercial MOTOR vehicles must be equippedwith one serviceable 10 BC Fire Extinguisher). Fire extinguishermust be located so that it is readily accessible for use and securelymounted on the VEHICLE . The fire extinguisher must be designed,constructed and maintained to permit visual determination of whetherit is fully charged. (49 CFR ) h. Electrical Wiring: Electrical wiring must be clean and properlysecured. Insulation must not be frayed, cracked or otherwise in poorcondition. There shall be no uninsulated wires, improper splices orconnections. Wires and electrical fixtures inside the cargo area mustbe protected from the lading. (49 CFR )DD FORM 626, OCT 2011 Page 2 of 3 Pages INSTRUCTIONSSECTION II (Continued) i.

10 Lights/Reflectors. (Head, tail, turn signal, brake, clearance,marker and identification lights, Emergency Flashers). Inspect tosee that all lighting devices and reflectors required are operable, ofproper color and properly mounted. Ensure that lights andreflectors are not obscured by dirt or grease or have broken lenses. High/Low beam switch must be operative. Emergency Flashersmust be operative on both the front and rear of VEHICLE . (49 , 25, and 26) j. Fuel System. Inspect fuel tank and lines to ensure that theyare in serviceable condition, free from leaks, or evidence of leakageand securely mounted. Ensure that fuel tank filler cap is notmissing. Examine cap for defective gasket or plugged vent. Inspect filler necks to see that they are in completely serviceablecondition and not leaking at joints. (49 CFR ) k.