COMPONENT WEAR ANALYSIS FOR VEHICLE FLUIDS PROCESSING FORM

Checkboxes

Engine

Transmission

Fuel Type

Transmission Type

Component Manufacturer

Component Model

Oil Manufacture

Oil Brand/Type

Oil Grade

Sump Capacity

Volume

Gal

Qt

L

Makeup Oil Added

Radio Buttons

Gal

Qt

L

Sample Date

Fuel Consumed since last sample

Miles/Hours since new/overhaul

Miles/Hours since last oil change

Filter Changed

Yes

No

Oil Changed

Yes

No

Additional Comments or Information

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