Document EDRN37z7vjgyOQ2Nmj9NQMXV
Clean Air Act Title II: Tampering Inspection
Version 12.12.2019
INSPECTION REPORT
Facility Name:
vehicles/engines identified therein. EPA is providing this report as a matter of agency policy, and will contact you again only if needed.
Without making a determination that your business or organization is a small business, EPA is also providing you with a link to this Small Business Resources Information Sheet (https://www.epa.gov/compliance/small-business-resources-information-sheet) which provides an array of resources to help small businesses understand and comply with federal and state environmental laws.
Inspection Information
Inspection Number:
Inspection Date(s): August 2 , 2021
Regulatory Program(s): Clean Air Act Section 208
EPA Region/Program Conducting
Inspection: Region 7 ECAD/Air Branch
Company Name:
Facility Name:
Facility Street Address:
Facility city, state, zip code:
, Missouri, 6
Inspection Report Revision History
Revision #
Revision Date
Reason for Revision
Field Inspector Name Name of Approving Official
Inspector and Supervisor Approval
Field Inspector Signature
1 / /21
Date
Title
Approving Official Signature
Date
U.S. EPA On-Highway Tampering Inspection Guide
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Clean Air Act Title II: Tampering Inspection
Version 12.12.2019
INSPECTION REPORT
Facility Name: (Supplemental notes or narrative format may be used as preferred)
General Inspection Information
Inspector(s):
Tyler Salamasick, Sarah Clark
Arrival Date/Time:
Primary Facility Representative & Title:
wner
Departure Date/Time:
Facility Contact Phone/Email:
Time Inspector(s) Presented Credentials:
Permission to Enter Facility Granted?
If Yes, By whom? If No, explain.
Compliance Assistance Reference Materials Provided to
Facility
Photograph Range:
Notes (e.g. compliance actions taken by facility, purchased samples, other relevant background, etc.):
Photographer Name:
8/ /2021
SBREFA Form Exhaust Repair Guidelines Tampering Brochure Memo 1A Engine Switch Fact Sheet Copy of 203(a)(3)
208 or 114 Preservation Letter Discussion of Right to Claim CBI
Other: receipt for documents
Facility Business Activities
Types of Services (check all that apply)
Description/Observations (types and brands of parts that are manufactured or sold, types of
shop services provided, etc.)
Estimated Throughput (e.g., sales per month, installs per week)
Manufactures aftermarket parts (hardware or software)
Sells aftermarket parts (including drop shipments)
Service Shop
Fleet
Other:
Notes U.S. EPA On-Highway Tampering Inspection Guide
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Clean Air Act Title II: Tampering Inspection
Version 12.12.2019
Personnel Interviewed
Name
INSPECTION REPORT
Facility Name:
Title
Contact Info. (e.g., email, phone number)
Interviewed by (Last name of Inspector)
Documents Requested
Document Requested
Status
Document Provided
Document Request Denied
Facility Offered to Provide After Inspection
Other (add notes)
Document Provided
Document Request Denied
Facility Offered to Provide After Inspection
Other (add notes)
Document Provided
Document Request Denied
Facility Offered to Provide After Inspection
Other (add notes)
Document Provided
Document Request Denied
Facility Offered to Provide After Inspection
Other (add notes)
Document Provided
Document Request Denied
Facility Offered to Provide After Inspection
Other (add notes)
Notes/Comments
Vehicles Inspected/Observed
VIN (last 4 digits)
EPA Engine Family
Appearance of Tampering
(Yes/No/TBD)
OBD Scan Conducted?
(Yes/No)
Observations (e.g., Who Performed Apparent Tampering?)
U.S. EPA On-Highway Tampering Inspection Guide
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