| License Plate | Inspection Date | ||
|---|---|---|---|
| Vehicle Make | Vehicle Model | ||
| Year | VIN |
| Item | Pass | Fail | Comments |
|---|---|---|---|
| Exhaust System Integrity | |||
| Emission Control Devices Present | |||
| Check Engine/MIL Status |
| Test | Measured Value | Limit | Pass | Fail |
|---|---|---|---|---|
| CO (%) | ||||
| HC (ppm) | ||||
| NOx (ppm) | ||||
| Opacity (%) |
| Inspector Name | Signature |
|---|