Full Text
City of Woodburn Taxicab Inspection Form Date Received____________ Initial______ Initial Inspection_____ Reinspection____ Ordinance 2464 requires taxicab inspection prior to the issuance of a taxicab company permit and annually thereafter. The inspection is to be completed by an ASE certified mechanic. The inspection must be completed for each taxicab in service. Please provide this inspection form to an ASE certified mechanic and have them complete the inspection. The form must be completed by the ASE certified mechanic and returned by applicant to the City of Woodburn. FORMS WITHOUT AN ASE NUMBER WILL NOT BE ACCEPTED. Taxi Company Name: Taxi Business Telephone: Taxi Owner Name: Taxi Company Address: Address City, State Zip Code Vehicle#: Year: Make: Model: Color: VIN: License Plate No: Lic State: EXTERIOR PASS FAIL Reason for Failure GLASS: no broken or missing glass; windshield cracks (if applicable) do not interfere with driver's vision. SIDE VIEW MIRRORS: none missing, cracked or broken to the extent to obstruct vision. TIRES: fair to excellent condition; no wear bar level with the tread; no portion of tire groove worn flat, no visible cord or metal; no sidewall plugs. BODY CONDITION: no major body damage' no miss- ing body parts, etc. DOOR KNOBS AND HANDLES: in place and in good working order INTERIOR PASS FAIL Reason for Failure REAR VIEW MIRROR: in place FLOORBOARDS: are complete without holes SEAT BELTS: in place and in good working order; no missing components; any locks that will not engage or disengage; no tears or rips in fabric belts INTERIOR GENERAL CONDITION: clean and well maint- tained; free of litter, holes, tears and stains MECHANICAL PASS FAIL Reason for Failure HEAD LIGHTS: functioning; to include high and low beams TURN SIGNALS - FRONT: all bulbs working; no glass or plastic cover broken TURN SIGNALS - REAR: all bulbs working ; no glass or plastic cover broken TAIL LIGHTS: all bulbs working; no glass or plastic cover broken BRAKE LIGHTS: all bulbs working; no glass or plastic cover broken 11.08.2019 TAXI COMPANY INFORMATION VEHICLE INFORMATION Office Use Only-Do not write in this area Finance Department, 270 Montgomery St., Woodburn, OR 97071 Telephone: (503) 982-5222 Fax: (503) 982-5244 Page 1 of 2 ---PAGE BREAK--- MECHANICAL, cont'd PASS FAIL Reason for Failure BACKUP LIGHTS: all bulbs working; no glass or plastic cover broken HAZARD WARNING LIGHTS: all bulbs working; no glass or plastic cover broken WIPERS AND WASHERS: in good working order; no blades that are hard, cracked, frayed or ripped HORN: operative; button or ring not broken beyond use SPEEDOMETER: functioning BRAKES: fair to excellent condition; no grooved rotors or drums; any leaking caliper, wheel cylinder, master cylinder or line EMERGENCY/PARKING BRAKE: functioning; must hold vehicle at high idle EXHAUST SYSTEM: no holes or leaks in system FUEL SYSTEM: no fuel leaks STEERING: any looseness exceeding accepted tolerances, missing bolts or bent components; no leaks in pump or line DRIVE LINE/SUSPENSION: any shock absorber leaking, miss- ing grommets, won't recover when vehicle is pushed down- ward; broken or deteriorated motor or transmission mounts; u-joints loose; drive shaft bent; springs cracked or broken ENGINE: idles; no thick white or black smoke from exhaust; drive belts not cracked or loose beyond tolerances; oil leaks GENERAL PASS FAIL Reason for Failure OTHER: any condition that would place users of the vehicle or the general public at risk INSPECTION RESULT PASS: I have examined the above vehicle and to the best of my knowledge found no conditions that violate state or federal laws or place users of the vehicle or general public at risk. This inspection does not guarantee the safety of the vehicle, only that it has been inspected and has met the inspection requirements set forth above. FAIL: I certify that for the reason(s) shown above the vehicle does not comply with the inspection requirements set forth above. Shop/Business Name: Date of Inspection: Mechanic's Signature: Date: Mechanic's Name (Printed): ASE ID#: Finance Department, 270 Montgomery St., Woodburn, OR 97071 Telephone: (503) 982-5222 Fax: (503) 982-5244 Page 2 of 2 11.08.2019