This is a combination Repair Record, Lubrication and Tire Repair or Replacement Record for your truck and trailer. It must be completed once with each inspection and returned to Evans. The report covers all maintenance performed since your previous inspection. You recognize that it is your responsibility to ensure the proper scheduled maintenance is performed and that appropriate records are submitted to the company.

REPAIR RECORD: Any and all repairs completed during the time period, must be listed in addition to all replacement parts, including such minor items as lights, reflectors, etc.
LUBRICATION & GREASE RECORD: Each lubrication (trans., suspension, driveline, diff., brakes, etc.) must be listed.
TIRE REPAIR & REPLACEMENT RECORD: List all tire and tube repairs, replacements, tire switches, rotations, etc.

** Please mark fields associated with a trailer (TRL) with “N/A” if you do not consistently pull the same equipment.

Signature:*	Print Name:	Date:
** Please note that while you can complete the form on a mobile device, you won't be able to upload any supporting documentation. Please switch to a desktop computer if you need to upload documents.
Upload Supporting Documents:

* By checking this box, I confirm that I have completed the maintenance tasks as detailed in this form and it is accurate to the best of my knowledge.