SMOG CHECK-IN FORM

CALIFORNIA LICENSED OFFICIAL SMOG CHECK STATION
1650 Monument Blvd, Concord, CA 94520 • Tel: 925-685-0101 • ARD #: 293848
Customer Information
Notice at Collection: We collect your name, contact information, and vehicle details to perform the smog inspection, maintain required records, and (with your permission) send service reminders and offers. We do not sell your personal information. See our Privacy Policy for your California privacy rights.
Vehicle Information
Inspection Points
Cal / Fed:
Aftermarket Parts
Inspection Results
SMOG Inspection:
Pricing
Authorization

I hereby authorize the smog inspection to be done and grant you and/or your employees to operate the vehicle herein described for the purpose of testing and/or inspection. SMOG INSPECTION FEES DUE WHETHER VEHICLE PASSES OR FAILS THE SMOG CHECK.

Yo he leido y entiendo las condiciones de este contrato y doy permiso para que se le haga la inspeccion de smog a mi vehiculo.

State of California requires your vehicle to be tested on a dynamometer which puts pressure on certain parts of your vehicle. There is a possibility that certain problems may occur during the test especially if your vehicle has worn drive systems or parts. We will take all necessary precautions for your vehicle; however we cannot be responsible for system or part failures during test.