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ANNUAL VEHICLE INSPECTION INSPECTOR CERTIFICATION M R VENDOR DATE LOCATION City state zip Name of Inspector Employee ID 396. 19 Inspector Qualifications It shall be the M R vendor s responsibility to ensure that the individual s performing an annual inspection under 396. Name of Government Agency Total Mo/Yrs Signature of Inspector Date I hereby certify that the mechanic/inspector mentioned above meets the requirements for a qualified inspector to perform the annual vehicle Inspection in compliance with the US Department of Transportation regulations for qualified inspectors. 17 is qualified as follows Understands the inspection criteria set forth in 49 CFR Part 393 and Appendix G of this subchapter and can identify defective components. Is knowledgeable of and has mastered the methods procedures tools and equipment used when performing an inspection and Is capable of performing an inspection by reason of experience training or both as follows I AM QUALIFIED TO PERFORM AN ANNUAL INESPECTION OF INTERMODAL EQUIPMENT BASED ON THE FOLLOWING Check and complete the appropriate sections a. Successfully completed a State or Federal sponsored training program or has a certificate from a State which qualifies this person to perform Intermodal equipment safety inspections. Name for Program/Certificate Date Location OR b. Have a combination of training or experience totaling at least one 1 year. Training and/or experience may consist of 1. Participation in a truck manufacturer sponsored training program or similar commercial training program designed to train students in truck operations and maintenance. Name of Program How Long Mo Yrs Experience as a mechanic or inspector working on Intermodal Equipment Name of M R Vendor for which you worked Total Mo/Yrs company or similar facility Name of Facility Total Mo/Yrs Experience as a commercial inspector for a State or Federal agency. Name of Owner/Supervisor Print Signature of Owner/Supervisor Date 500 International Drive Suite 130 Budd Lake NJ 07828 Office 973 298-8900. 17 is qualified as follows Understands the inspection criteria set forth in 49 CFR Part 393 and Appendix G of this subchapter and can identify defective components. Is knowledgeable of and has mastered the methods procedures tools and equipment used when performing an inspection and Is capable of performing an inspection by reason of experience training or both as follows I AM QUALIFIED TO PERFORM AN ANNUAL INESPECTION OF INTERMODAL EQUIPMENT BASED ON THE FOLLOWING Check and complete the appropriate sections a. Is knowledgeable of and has mastered the methods procedures tools and equipment used when performing an inspection and Is capable of performing an inspection by reason of experience training or both as follows I AM QUALIFIED TO PERFORM AN ANNUAL INESPECTION OF INTERMODAL EQUIPMENT BASED ON THE FOLLOWING Check and complete the appropriate sections a. Successfully completed a State or Federal sponsored training program or has a certificate from a State which qualifies this person to perform Intermodal equipment safety inspections. .