CHAPTER I: DEPARTMENT OF TRANSPORTATION
SUBCHAPTER e: TRAFFIC SAFETY (EXCEPT HAZARDOUS MATERIALS)
PART 448 OFFICIAL TESTING STATIONS
SECTION 448.APPENDIX F MONTHLY VEHICLE INSPECTION STATION REPORT
Section 448.APPENDIX F Monthly Vehicle Inspection Station Report
(This form is to be used for reporting truck C/S only.)
|
For |
|
|
|
|
|||||||||||
|
|
(month) |
|
(year) |
|
|||||||||||
|
Station Name |
Station I.D. |
||||||||||||||
|
|
|
|
|||||||||||||
|
(Write the complete station name) |
(Four digits) |
||||||||||||||
|
A. |
Total number of C/S received (including re-orders) for reporting |
||||||||||||||
|
month |
|
||||||||||||||
|
|
|||||||||||||||
|
B. |
Total number of C/S placed on vehicles (including C/S used for |
|
|||||||||||||
|
windshield replacement, also report on Form SV1-1280) |
(4) |
|
|||||||||||||
|
|
|||||||||||||||
|
C. |
Total number of C/S returned to V.I.S. |
(5) |
|
|
|||||||||||
|
|
|||||||||||||||
|
D. |
Total number of C/S lost or stolen (also report |
|
|||||||||||||
|
on Form SV1-1241) |
(6) |
|
|
||||||||||||
|
|
|||||||||||||||
|
E. |
Total number of defective and mutilated C/S |
||||||||||||||
|
(also report on Form SV1-1280) |
(7) |
|
|
||||||||||||
|
|
|||||||||||||||
|
F. |
Total Items C, D, and E |
(8) |
|
||||||||||||
|
|
|||||||||||||||
|
G. |
Total Item B and F (This total must match Item A) |
|
|||||||||||||
|
|
|||||||||||||||
|
H. |
List serial numbers of C/S being returned to V.I.S. with this report |
||||||||||||||
|
(5): |
|||||||||||||||
|
|
No. |
|
thru No. |
|
|||||||||||
|
|
No. |
|
thru No. |
|
|||||||||||
|
|
|
|
|||||||||||||
|
|
(Signature of Station Owner/Operator) |
(Date) |
|||||||||||||
|
|
AGENCY NOTE: Numbers shown in parentheses are for V.I.S. office use only. This report must be received at the V.I.S. office by the 10th of the month. |
||||||||||||||
|
|
Send this report, together with all unused C/S, by Certified Mail, to: |
||||||||||||||
|
|
Vehicle inspection Section Illinois Department of Transportation 2300 South Dirksen Parkway Springfield, Illinois 62764 |
||||||||||||||
|
MSR-1-76-T |
Revision No. ½-76 |
||||||||||||||