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The truck is not exempt from the requirement for emission controls. It is exempt from the need to provide an OBD-I compliant interface within the State of California.
It has what most consider to be a pefectly good OBD-I connector and interface, although said interface may not meet the entirety of the specific requirements of the State of California. California Code allows Ford to opt for "OBD exempt" on the tune-up label, so that's what they do. You shouldn't read any more into it than this singular hyper-technical and legalistic issue.