California Code of Regulations › Title 13 - Motor Vehicles › Division 3 - Air Resources Board › Chapter 13 - Voluntary Accelerated Vehicle Retirement Enterprises › Article 1 - Voluntary Accelerated Light-Duty Vehicle Retirement Enterprises › Appendix A

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
VEHICLE FUNCTIONAL AND EQUIPMENT ELIGIBILITY
					 INSPECTION FORM
Legal Owner:___________________________
Address:___________________________
City:___________________________
Zip:___________________________
VIN:___________________________
License Number:___________________________
Make:___________________________
Model:___________________________
Model Year:___________________________
Odometer Reading:___________________________
VEHICLE QUALIFICATION
Vehicle within 61-90 days of next scheduled Smog
							 Check:
yes
no
2602(c)
If yes, vehicle failed next scheduled Smog Check:
yes*
no
Vehicle registered in District for at least 24
							 months:
yes
no*
2603(a)(2)
Vehicle on BAR repair cost waiver
yes*
no
2603(a)(4)
Vehicle on BAR economic hardship extension
yes*
no
2603(a)(4)
Vehicle within 60 days of next scheduled Smog
							 Check:
yes
no
2603(a)(5)
If yes, vehicle passed next scheduled Smog Check:
yes
no*
The vehicle has been tampered with:
yes*
no
2603(a)(7)
The vehicle has been driven to the inspection site
yes
no*
2603(b)(1)
* Vehicle is not qualified for
							 the VAVR program.
EQUIPMENT ELIGIBILITY
The following shall be present and in
							 place:
2603(b)(3)
All doors
yes
no*
Hood
yes
no*
Dashboard
yes
no*
Driver's seat
yes
no*
One bumper
yes
no*
All side and/or quarter panels
yes
no*
Exhaust system
yes
no*
One headlight
yes
no*
One taillight
yes
no*
One brake light
yes
no*
One side window
yes
no*
Interior pedals operational
yes
no*
FUNCTIONAL ELIGIBILITY
The following shall be completed:
2603(b)(4)
Vehicle starts using keyed ignition
yes
no*
Vehicle starts without the use of starting
							 fluids or external battery
yes
no*
Vehicle driven forward for a minimum of 25
							 feet
yes
no*
Vehicle driven in reverse for a minimum of
							 25 feet
yes
no*
* Vehicle is not eligible for
							 the VAVR program.
INSPECTOR CERTIFICATION: (Check correct boxes.) I certify
					 that this vehicle has ( passed not passed) both the functional and equipment
					 eligibility inspections and ( is is not) eligible for acceptance into the VAVR
					 program pursuant to California Code of Regulations, Title 13, Sections
					 2602 and
					 2603.
Printed Name:___________________________
Date:___________________________
Signed:___________________________
The following should be completed if the vehicle is
					 eligible for acceptance into a VAVR program.
OWNER ACCEPTANCE: I accept receipt of this CERTIFICATION of
					 eligibility into a VAVR program. I agree not to alter the vehicle's equipment
					 or functionality from that presented to the inspector. I agree to maintain the
					 vehicle's condition and registration until the vehicle is retired.
Printed Name:___________________________
Date:___________________________
Signed:___________________________
1. New
					 appendix A filed 12-8-99; operative 1-7-2000 (Register 99, No.
					 50).
2. Repealer and new appendix A filed 7-13-2007; operative
					 8-12-2007 (Register 2007, No. 28).