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United States

United States

Phone: 1-516-826-4040
Fax: 1-516-826-0711

Phone: 1-516-826-4040
Fax: 1-516-826-0711

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Bus Safety Inspection

NEW YORK STATE DEPARTMENT OF TRANSPORTATION

MOTOR CARRIER SAFETY BUS SAFETY SECTION OPERATOR’S INSPECTION

FACILITY STATEMENT

OPERATOR NAME: *
OPERATOR ID NUMBER: *
ADDRESS: *
PHONE NUMBER: *
CURRENT INSP. LOCATION IF ANY:  *
#OF VEHICLES: *

I representing the above named Operator, by copy of this letter, request to have my vehicles inspected at the facility indicated below in accordance with NYCRR Title 17 Part 721.1 (D).I will notify the facility named below of any appointment(s) for inspections that are scheduled by the NYS Department of Transportation’s representative(s). I will give (30) thirty days prior notification in writing to the Department of Transportation’s representative(s) of any changes in inspection locations.

SIGNATURE:  *   TITLE:  *
DATE:  *    

FACILITY: *

ADDRESS:*

*
PHONE NUMBER: *

By copy of this letter I, * the representative of the above named facility will allow the above named Operator to have their vehicles inspected by the New York State Department of Transportation at this facility. I further agree to provide all necessary assistance needed to perform these inspections as required by NYCRR Title 17 Part 721.1 (D) nd will provide a facility which will meet all applicable OHSA and New York State Executive Title 9, Uniform Fire Prevention and Building Codes.

SIGNATURE:  *   TITLE: *
DATE:  *    

COMMENTS:

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