B Cdl E M

PARA RRR

- Vi = Good MVR.

cin = = 779-***-****

¥,. ae ., Se wee

CAMPOS,

= ~~ ¢ ADAM M.

Ce ne Subtotal: $ 4

ADAM CAMPOS Total: =

HASC ID# 198******* “= “

Reciprocal Courses Exp. Date = re -“ ce ‘“e M MOISES JR

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6.9110 WILDFLOWER CT

“KATY TX 77404-4223

12 Restrictions AK i

sengt 5 11" is Sex. M: 1

6 DD 36223010122230017488

1110 WILDFLOWER COURT

KD ALTSYS Tex

7a? 4) eee

: ADAM b172e

Public Burden Statement -

A Federal agency may not conduct or sponsor, and & person is not required to respond to, nor shall a person be subject to a pe!

that collection of information displays a current valid OMB Control Numbe

clLoud.Co

,

Ity for failure to comply with a collection of information subject to the requimments of the Paperwork Reduction Act unless

r. The OMB Control Number for this Information collection Is 2126-0006. Public reporting for this collection of information is estimated to be approximately one minute per response,

needed, and completing and reviewing the collection of information. All responses to this collection of information are mandatory. Send cop

other aspect of this collection of Information, including'suggestions for reducing this burden to: Information Collection Clearay

US.

co ts regarding this burden estimate or any

Officer, Federal Motor Cartier Safety Administration, MC-RRA, 1200 New Avenue, SE, Washington, D.C. 20590.

fede Mowrconer ‘Medical Examinér’s Certificate

Safety Administration {for Commercial Driver: Medical Certification)

I certify that have examined Last Name: CAMPOS JR.

FirstName: ADAM in accordance with (please check only one):

ime i

© the Federal Motor Carrier Safety Regulations (49 CFR 391.41-391.49) and, with knowledge of the driving duties, find this person is qualified, and, if applicable, only when (check all that apply) OR

O A as Motor Carrier Safety Regulations (49 CFR 391.41-391.49) with any applicable State variances (which will only be valid for intrastate operations),

WS Person Is qualified, and, if applicable, only when (check all that apply):

Wearing corrective lenses’

* O Accompanied by a

and, with knowledge of the driving duties,

OD Wearing hearing aid

waiver/exemption

O Accompanied by a Skill Performance Evaluation (SPE) Certificate

(C0 Driving within an exempt intracity zone (49. CFR 391.62) (Federal)

© qualified by operation of 49 CFR 391.64 (Federal)

OD Grandfathered from State requirements (State)

‘-

Medical Examiner's Certificate Expiration Date

-ntanelan Danart Farm ey

tr ——

_

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