Document LJb28pE8bprMLJnkwQn8LEqX7
General Inspection Information
~ele2- ~ Fehx Inspector(s):1
I~~;~~::~:~~~~~ Ve!ez- l 13 ~,~~~ Inspection photo \o)~tl'" 'jj numbers:.
I
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Insp. TIme Start/End: 1-__ .:o_91:cP~__ ~~~!..>l'--
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PhotOgraPher:.
Location
of Inspection
Location of Goods (e.g., warehouse #1):
lA,~.LIA&toMJ
L en{\.( ~
-+- O<:Cd'V\ St..t(
CBP City/State/Zip:
Entry/Immediate Delivery (CBPForm 3461) Declaration Form -Imp of Motor vehicles/Engines (CBPForm 3520-1) Importation of Engines, Vehicles, and Equipment subject to Air Pollution Regulations (CBPForm 3520-21)
CBP Emaii:
Invoice Packing List
EPACertificate of Conformity
Other: Other: Other:
Importer Information
Name: A(\Q~l M~'4 Alt-veJ(J
Address: J2b'3 lo..t\e LaTon
City/State/Zip: A-t..llA.!(~ /112- 06-rO 2-
roc: .JIA\Yc) ~DJti"~ 1~1-qbq-3\ \\
10 Number: Check one:
1\ \
Oconsignee
rr- Lt-~t;C1V
n-
oManufacturer
Name:
Address:
City/State/Zip:
POC:
10 Number:
(from Entry Documents) Check one: Oconsignee
Name: Address: City/State/Zip:
poc: ID Number: Check one: Dconsignee
Name: Address: City/State/Zip:
POC: ID Number:
DBuyer
Oseller
OManufacturer
n- n- oManufacturer
~W.\!- Entry Number:1 l Entry Date:.
Product/Entry
l\\+1..=: -0
\ '2... \0 (1..1:-
HS Number:
Information
I
.
(from Entry Documents)
DescriPti~nOfProd~ct:llX'IZj~~
"kh~'Y\<. A-rv c
Quantity and Unlts:l-.------~...J_.......,"',._-----------__l
Total Value:
'),,0 ~ 01--
B
Notes
Permanent
label for competition
Exemption use under 40 CFR 1051.620
Claims/Applicability
Other:
Observations
General Information (as needed)
Manual or instruction
document observed? IND
Listed Model(s] :
Emissions Warranty? If Yes, how long? :
Equipment Weight :
User Manual/Instructions Did you photograph the document(s):?r
Engine DiSPlacement:~(speCifyunitS) Rated Power:
Rated Power RPM:
Type of Fuel:
(specifyunits)
[e.g., @ 7,000 rpm)
(e.g.,91 octane, UlSD)
Emission Control Information Label
Check Ves (V) or No (N) ECI label Present:
Company Information on ECI:
Can ECI label be removed without destroying:
Engine Family:
Did you obtain a photo of the ECllabel:
~
Evap'/Perm. Family: Emission Control Devices Listed:
Tune-up Specs Listed (Y/N):
r- Yes, on label
Refers to user manual I--
Not referenced on label
Compliance Period (l.e., useful life): Date of MFG:
Displacement: Type of Fuel:
Notes:
Compliance statement observed? (yes/no and whether exhaust, evap, both): MY(s) in statements:
I
Type of Equipment: _--=-A--I-=\....!...v
Model name:_~2?=..:O:........:C=c..
VIN/ESN:
"T"
Build Date: __ --!l.:::b+I~Z""O=__=._='2..==:$~
Other Info on ECI:
I
(as needed)
Visual Inspection Information
_
Crankcase Ventilation
_ _
_
(a-stroke
Crankcase vented to atmosphere?:
engines only, check Yes(Y) or No(N)
Fuel Tank: PAIR:
Intake Assembly/Filter: Muffler/Catalyst: Throttle Body: Fuel Injector: Carburetor: Spark Plug: Other (specify): Other (specify):
Notes
Observed Part Number
Evaporative Checks
tL.V_~:>.!.Jt~~~\L- Populate part numbers if visible. Mark "net visible" if not visible and include brand
name if possible. Obtain photos of each part.
Fuel Tank Material (Plastic/Metal): L.1 __
...J
Are all sections of the Fuel lines marked?
Fuel Line Markings (from tank I
to stop valve):
L--
---l
\7\,)'1.-tJ N~
Fuel Line Markings (from stop I
valve to carburetor): L-- ---l
CarbuJetor Inspection
A/F mixture and speed control screws inspection should be completed for all types of engines ( using hand toofs onlv). If adjustable,
Is idle speed control screw adjustable on vehicle(Y/N)? (check/or all 51 engines): Notes Is air/fuel mixture screw adjustable on vehicle(Y/N)? (check/or all 51 engines):
B
obtain photograph/video
of inspector adjusting it
Evidence taken (indicate how it was markedl:
Field Inspection Summary
Inspector Signature:
Supervisor Signature:
Digitally signed by
VICTOR
TU
VICTOR TU Date: 2024.04.05
15:43:19 -04'00'
Date:_~-+-{~--.:.I2----I-t
__
Date:
_
