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Emission Repair Form - New Jersey

Emission Repair Form Form. This is a New Jersey form and can be used in Motor Vehicle Commission Statewide .
 Fillable pdf Last Modified 3/3/2010
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YOUR VEHICLE HAS FAILED THE EMISSION INSPECTION This letter is designed to help New Jersey motorists obtain proper emission-related repairs. In accordance with the State's current inspection program regulations, a motorist whose vehicle fails the emission inspection is required to either: 1) have repairs performed at a New Jersey registered Emission Repair Facility (ERF), or 2) complete the repairs themselves. After the necessary repairs are made, the motorist has the choice of having the vehicle re-inspected at either a Centralized Inspection Facility (CIF) or a Private Inspection Facility (PIF). To locate an ERF near your home or place of business, motorists may check in their phone directory for local ERFs or search for a registered ERF by using the Clean Air website: www.njinspection.com (Select "Find an Emission Repair Facility" in the "Online Services" box). Motorists may also contact the toll-free Help Desk at 1-(888)-NJ-MOTOR (888-656-6867). Motorists returning to either a CIF or a PIF for re-inspection must have the following documents: 1) the Vehicle Inspection Report (VIR) for the failed emission inspection(s), 2) an Emission Repair Form completed by the ERF or the vehicle owner, and 3) the receipt(s) for any emission-related repairs or parts. Re-inspecting vehicles is prohibited unless the proper forms and receipts are presented along with the vehicle in question and the proper credentials (valid/original driver's license, insurance and registration cards). If repairs are completed by you: 1) A receipt is not required if the repairs did not require the installation of additional parts. The Emission Repair Form* must clearly state what was done to repair the vehicle. 1) If repairs are completed at an ERF: The Emission Repair Form* must clearly indicate the correct ERF Identification Number. The Emission Repair Form* must list all repairs, including any repair(s) suggested by the technician, but rejected by the vehicle owner. All receipts and invoices are necessary. 2) 2) 3) * Emission Repair Form is on reverse side If the vehicle's failure was not emission-related (i.e.: broken headlight, cracked windshield, etc.), a motorist may have the vehicle repaired by any repair facility, or they may do it themselves. Receipts are not required for non emission-related items or gas cap failures. Emission failures related to the vehicle in a "Not Ready" status, in some cases, may be resolved by completing a "Drive Cycle". Refer to the vehicle owner's manual for more information. Ask your dealer or repair shop if they are an ERF BEFORE you authorize them to work on your vehicle. Emission-related repairs performed by a dealer or repair shop that is NOT an ERF will NOT be accepted as valid repairs and the vehicle will NOT be reinspected. Thank You! Clean Air Program New Jersey Motor Vehicle Commission American LegalNet, Inc. www.FormsWorkFlow.com Motor Vehicle Commission STATE OF NEW JERSEY VEHICLE INSPECTION REPORT EMISSION REPAIR FORM IF YOUR VEHICLE FAILED EMISSION INSPECTION When you have your vehicle repaired, the REPAIR INFORMATION section below must be completed and presented when the vehicle is re-inspected. **THIS COMPLETED REPORT MUST BE PRESENTED FOR RE-INSPECTION** FACILITY or PERSON PERFORMING REPAIRS: STREET: CITY: DATE OF REPAIR: STATE: ZIP: CERTIFIED REPAIR TECHNICIAN ID NUMBER: REPAIR FACILITY ID NUMBER: FACILITY PHONE NUMBER: REPAIR CATEGORY WARRANTY REPAIR EMISSION REPAIR TAMPER REPAIR EST. NOT REPAIRED REPAIR CATEGORY WARRANTY REPAIR EMISSION REPAIR TAMPER REPAIR EST. NOT REPAIRED 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. PCV System Thermostatic Air Cleaner Air Injection System Air Pump Air Filter EGR System ­ other EGR Valve Evap Em Controls ­ Other Fuel Cap Vapor Lines Charcoal Canister Catalytic Converter or Thermal Reactor Ignition System - Other 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. Spark Plugs/Ign Wires Timing Fuel Filter Carburetor Adjustment Carb Rebuild/Replace Fuel Injection System ­ other Fuel Injection System other Engine Mechanical ­ other Vacuum Hoses/Fittings Computer System or ECM Oxygen Sensor Other Electronic Sensor Other Repairs/Unknown TOTAL COST OF PARTS: $ TOTAL COST OF LABOR: $ Revised 10/13/09 American LegalNet, Inc. www.FormsWorkFlow.com
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