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DATE WHEN THIS FORM WAS COMPLETED

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SHOP

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Car Number / Initial

Construction Date

Appl. Date Reflectives

Agrega carros en el tab Registro

WAS A DATA ANALYSIS PERFORMED BEFORE COMPLETING THIS FORM TO EVALUATE THE MAINTENANCE HISTORY OF APPLICABLE CAR(S) AND DETERMINE IF ANYTHING ADDITIONAL NEEDS TO BE INSPECTED AT THIS SHOPPING? IF YES, DESCRIBE ON ITEM 11

YES NO

4) RAILINC ALERTS — AS OF TODAY ARE THERE ANY OPEN ALERTS?

SEE ATTACHED RAILINC CORRESPONDING SCREEN

REGARDLESS, SHOP MUST CHECK IF THERE ARE ANY ALERTS ON RAILINC APPLICABLE FOR CARS REFERRED ON THIS SCOPE OF WORK.

5) CHECK CONDITION OF EXTERIOR PAINT

Shop must send pictures of exterior paint condition.

6) GASKET & ORING MATERIAL TO BE APPLIED

7) AAR OR FRA SPECIAL REQUIREMENTS

8) BO REASON

9) DATA RELIABILITY ANALYSIS — IN ADDITION TO THE INFORMATION DESCRIBED HEREIN AND, DURING THE SERVICE RELIABILITY ASSESSMENT DATA ANALYSIS PERFORMED, WERE THERE ANY ISSUES FOUND THAT MAY REQUIRE ADDITIONAL ATTENTION AT THIS SHOPPING?

NO YES

10) SPECIAL BILLING INSTRUCTIONS

ALL MECH REPS TO BE SENT TO PAN AMERICAN RAILWAY CO.

11) ADDITIONAL COMMENTS

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