Registered Owner's Name Plate Number Address Postal Code ...

1 P=PASS F=FAIL NA=Not ApplicableVSSROI2018 Page 1 of 4 The original record of inspection must be given to the customer regardless of whether the vehicle passes or vehicle record OF inspection TRUCK AND TRUCK-TRACTORUnit NumberAddressPostal CodePhone NumberMakeModelYearOdometer vehicle InformationpsiDrums/RotorsLinings/PadsPu sh Rod TravelmmLEFTFRONTRIGHTD rums/RotorsLinings/PadsPush Rod TravelDrums/RotorsLinings/PadsPush Rod TravelDrums/RotorsLinings/PadsPush Rod TravelDrums/RotorsLinings/PadsPush Rod Travelpsimmpsipsimmpsipsimmpsimmmmmmpsim mpsimmpsimmpsipsimmpsipsipsimmmmmmpsimmP ark Brake LiningWheel Torque CheckedLeftmmRightmmTransmmInnerft lbsOuterft lbs Type of vehicle Gross vehicle Weight Registered psimmpsimmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmRegistered Owner's Name Plate NumbermmDrums/RotorsmmmmLinings/Padsmmmm Push Rod TravelmmpsipsimmmmpsipsimmmmDrum Brakes:Disc Brakes:P=PASS F=FAIL NA=Not ApplicableVSSROI2018 Page 2 of 4 commercial vehicle record OF inspection TRUCK AND TRUCK-TRACTORNOTES:NOTES:NOTES.

2 Accelerator Pedal/Throttle Exhaust Emission Control Systems and Drive Clutch and Clutch Engine/Transmission Engine/Shut Liquefied Petroleum Gas (LPG or Propane) Fuel Compressed Natural Gas (CNG) Fuel Suspension & Frame Axle Attaching & Tracking Axle & Axle Spring & Spring Hydraulic System Brake Vacuum Assist (Boost) Hydraulic Assist (Boost) Air Assist (Boost) Air-Over-Hydraulic Brake Brake System Indicator Drum Brake System Air Air Supply Air Air Tank Check Brake Treadle Valve and Trailer Hand Brake Valves & Proportioning, Inversion or Modulation Towing vehicle (Tractor) Protection Engine Start Safety Gear Position Engine or Accessory Drive Hybrid Electric vehicle & Electric vehicle Power Train Gasoline or Diesel Fuel Pressurized or Liquefied Fuel System (LPG, CNG, & LNG) * SEE APPENDIX A* Liquefied Natural Gas (LNG) Fuel Air Self-Steer and Controlled-Steer Shock Absorber/Strut Disc Brake System Mechanical Parking Spring-Applied Air-Released Parking Spring-Applied Hydraulic-Released Parking Anti-Lock Brake System (ABS) Stability Control Brake Air System Brake Drum Brake System S-Cam Drum Brake Brake Shoe Travel (Wedge Brakes)

3 Disc Brake System Anti-Lock Brake System (ABS) Stability Control Brake PerformanceSection 1 - Power TrainAPPENDIX "A"Section 2 - SuspensionSection 3H - Hydraulic BrakesSection 3A - Air BrakesComponentComponentComponentCompone ntComponentComponentComponentComponentCo mponentComponentPPPPPFFFFFNANANANANAPPPP PFFFFFNANANANANAP=PASS F=FAIL NA=Not ApplicableVSSROI2018 Page 3 of 4 commercial vehicle record OF inspection TRUCK AND TRUCK-TRACTORNOTES:NOTES:NOTES:NOTES: Parking Brake & Emergency Steering Control and Power Steering System (Hydraulic and Electric) Steering Operation (Active Steer Axle) Fire Hazard Warning Windshield Required Reflex Retro-Reflective Hood or Engine Tilt Air-Suspended Cab and Passenger- vehicle Cargo Frame, Rails & Unitized Body Cab or Cargo Cargo Tank or Body, Device or Equipment Attached or Mounted to the Self-Steer and Controlled-Steer Heater & Windshield Fuel-Burning Auxiliary Chain/"Headache" Auxiliary Controls and Auxiliary Drive Instrument Panel Headlamp Trailer Cord (output to towed vehicle )

4 Side Rear Interior Sun Exterior Windshield Sun Rear-View Seat Belt/Occupant Fender/Mud FlapSection 3A - Air BrakesSection 4 - SteeringSection 5 - Instruments and Auxiliary EquipmentSection 6 - LampsSection 7 - Electrical SystemSection 8 - BodyComponentComponentComponentComponent ComponentComponentComponentComponentComp onentComponentComponentComponentPPPPPPFF FFFFNANANANANANAPPPPPPFFFFFFNANANANANANA P=PASS F=FAIL NA=Not ApplicableVSSROI2018 Page 4 of 4 commercial vehicle record OF inspection TRUCK AND TRUCK-TRACTOR Certification Customer AcknowledgmentDate of InspectionTechnician Number Facility Number Signature NOTES:NOTES:NOTES:The vehicle for which this record of inspection is issued has _____ the inspection and I certify it has been inspected in accordance with the vehicle inspection Regulation, Alberta Regulation 211/2006 and the applicable inspection (Year/Month/Day)Customer SignatureI understand if a vehicle inspection identifies defects and repairs are required, once repaired, the vehicleand this record of inspection (ROI) may be presented to any vehicle inspection Facility within 10 days ofthe initial inspection and only the failed items noted on this ROI are required to be re-inspected.

5 If the vehicle is not returned for re- inspection within 10 days of the initial date of inspection , a new inspection must be Refrigeration/Heater Unit Fuel System (Reefer or Auxiliary Power Unit (APU)) Tire Tread Tire Tread Tire Sidewall & Manufacturer Tire Inflation Wheel Wheel Hitch Assembly, Structure & Attaching Secondary Attachment (Safety Chain or Cable) Pintle Hook, Pin Hitch, or Coupler Ball Type Aerodynamic Device & Wheel/Rim (Applies to all wheel types) Multi-Piece Spoke Wheel/Demountable Rim Disc Wheel Wheel Fasteners (Nuts, Bolts and Studs) Roll-Coupling Automated Coupling Fifth Wheel Oscillating Fifth Wheel CouplerSection 8 - BodySection 9 - Tires and WheelsSection 10 - Couplers and HitchesComponentComponentComponentCompon entComponentComponentPPPFFFNANANAPPPFFFN ANANA