2 authorized release certificate 6327094 1.000 5. …cmm 49-61-04, rev 2, dated sep / 15/2001...
Post on 24-Sep-2020
5 Views
Preview:
TRANSCRIPT
!..Approving Civil Aviation Authority / Country;
FAA/United States
2· AUTHORIZED RELEASE CERTIFICATE 3. Form Tracking Number:
. FAA Form 8130-3, AIRWORTHINESS AP PROV AL TAG
4. Organization Name and Address:
6. Item: 7. Descri tion:
ELECTRONIC SEQUENCE UNIT. SPEE
12. Remarks:
Unit was REPAIRED IAW
Hamilton Sundstrand - Phoenix Hamilton Sundstrand Division United Technologies Corporation 1007 E. University Dr. Phoenix, AZ85034 JW23941K
6327094 1.000
5. Work Order/Contract/Invoice Number:
w.o. 9595193
Cust. P.O. 9-88998
8. Part Number: : 10. Serial Number: 11 . Status ork:
164540-J 0JA 1114 REPAIRED
CMM 49-61-04, Rev 2, Dated Sep/ 15/2001
FUNCTIONAL TEST PERFORMED IN ACCORDANCE WITH SPECIFICATION ESR0385, REV F, DATED 02 / 11/ 1999
TT TSR TCSN TCSR TCSI
21198. 90 0 . 00
3 2677 . 0 0 0.00
1 7 1 90.00
Pertinent detail of the workscope identified in Block 11 are on file at this repair station under work order no.
Work performed by Repai r Stati on JW239 41K
9595193
Certifies tha t the work specified in Block 11/12 was carried out in accordance with EASA Part 145 and in respect to that work the (product/article) is considered
ready for release to service under EASA Part 145 approval no. EASA 145-4905.
Qt Other regulation specified in Block 12
Certifies that unless o therwise specified in Block 12, the work identified in
Block 11 and described in Block 12 was accomplished in accordance with
Title 14, Code of Federal Regulations, part 43 and in respect to that work,
the items are approved for return to service.
Miller, Jessie
nsibilities
14c. Approval/Certificate No.
JW23941K
14e. Date (dd/mmm/yyyy): 14/Oct /2015
It is important to understand that the existence of this document alone does not automatically constitute authority to install the aircraft engine/propeller/article. Where the
user/installer performs work in accordance with the national regulations of an airworthiness authority different than the airworthiness authority of the country specified in
Block I, it is essential that the user/installer ensures that his/her airworthiness authority accepts aircraft engine(s)/propeller(s)/article(s) from the airworthiness authority of the
country specified in block I. Statements in Blocks 13a and 14a do not constitute installation certification. In all cases, aircraft maintenance records must contain an installation
certification issued in accordance with the national regulations by the user/installer before the aircraft may be nown.
FAA Form 8 130-3 (02-14) NSN: 0052-00-0/2-9005
SHOP FINDINGS REPORT HAMIL TON SUNDSTRAND PHX 1007 E UNIVERSITY DR PHOENIX, AZ, 85034-6513, USA
Certificate # FAA# JW23941 K
End Assembly Item ELECTRONIC SEQUENCE UNIT, SPEE
Customer Name: COMMUTAIR PO #: 9-88998 Receive Date: 06/24/15 TAT Days (less holds): 23
Unit Information:
OEM Part Number: OEM Serial Number:
Incoming
164540-303A 1114
P/N: 164540-303A
Outgoing
164540-303A 1114
Date Printed: 14/Oct/2015 Page: 1 of 2 HS ORDER: 6327094 SO
HS LINE: 1.000
SIN: 1114
Part Description : ELECTRONIC SEQUENCE UNIT, ELECTRONIC SEQUENCE UNIT, SPEE Model: A/C Tail#: Removal Date: Sched/Unsched: TT: TSR: TSI: TCSN: TCSR: TCSI: Configuration In:
Configuration Out:
ESU-4 55820 N876CA 06/08/1 5 Unscheduled 21198.90 UNK 7034.90 32677.00 UNK 17190.00 MOD: N/A DOM: N/A MOO: N/A DOM: N/A
Customer Stated Reason for Removal:
ESU-4 55820
21198.90 0.00 7034.90 32677.00 0.00 17190.00
APU FLR LIGHT ILLUMINATED WHILE APU RUNNING
Finding During This Shop Visit: Incoming Visual Inspection:
SERVICE WEAR AND SCRATCHES EXTREML Y DIRTY, BITE 1-4 SHOWING WHITE Incoming Test Performed Yes Did Test Fail Yes
Primary Failure: PWA CHASSIS MOUNTED PARAMETER OUT OF SPEC/LEAKY .
Other Failures: Discussion
************************************************************
* INCOMING TEST RESULTS: Unit failed incoming test,
temperatures out of spec.
REASON FOR RETURN: APU FLR LIGHT ILLUMINATED WHILE APU
RUNNING.
UNABLE TO VERIFY THE CUSTOMERS COMPLAINT
FAILURE ANALYSIS: Temperature portions of test failed .
ACTIONS COMPLETED: Calibrated temperatures to spec,
replaced name plate.
NVM ANALYSIS: N/A
SHOP FINDINGS REPORT Date Printed: 14/Oct/2015 Page: 2 of 2
HAMIL TON SUNDSTRAND PHX 1007 E UNIVERSITY DR PHOENIX, AZ, 85034-6513, USA
HS ORDER: 6327094 SO
HS LINE: 1.000
Certificate # FAA# JW23941 K
Discussion (continued)
MOD/UPGRADE: N/A
FINAL TEST RESULTS: Unit passed final ATP.
************************************************************ *
Justified Removal: Yes Removal Reason Verified: Yes Induced Failure: No Disposition: REPAIRED Cause and Corrective Action / Certificate
Unit was REPAIRED IAW
CMM 49-61-04, Rev 2, Dated Sep/15/2001
FUNCTIONAL TEST PERFORMED IN ACCORDANCE WITH SPECIFICATION
ESR0385, REV F, DATED 02/11/1999 Labor Performed this Visit:
Item REPAIR
Parts Replaced This Visit: Qty Part Number
· 1 160504-1
1 4500577
Description
PLATE
PLATE, MODIFICATION
Description WORKSCOPE
Reason Replaced
Broken/Cracked/Damaged
Broken/Cracked/Damaged
.. 1 4500577 PLATE, MODIFICATION Repair Responsibility
*Condition: Blank= New, R = Rotables, S = Serviceable, C = Consignment, D = Airworthy
Last HS Return Data: Sales Order: 6324677 ST Work Performed: Date Received: 06/22/15 Date Shipped: 06/23/15 Days Since Last Visit: Reason For Removal: MIS DIRECTED SHIPMENT
Service Bulletins Incorporated/Work Performed on Previous Visits:
Facility Description Item
Phoenix WORKSCOPE REPAIR
Facility Description Item
Facility Description Item
Phoenix WORKSCOPE REPAIR
Facility Description Item
San Diego WORKSCOPE REPAIR (LEVEL 2)
Facility Description Item
San Diego WORKSCOPE REPAIR (LEVEL 2)
Condition*
114
Shop Date
02/28/07
Shop Date
Shop Date
12/06/08
Shop Date
03/06/07
Shop Date
12/16/08
If there are any questions or comments about this report please contact your customer account representative.
I
1 App<ov,ng Competent Autnonty / Country 2 Autonte Comptt1n le / Pays
DIRECTION GENERALE DE
L'AVIATION CIVILE FRANCE
4 Organ,sat1on Name and Addres s Nom et Adieu• de l"OrganisfM :
6 Item 7. Oescnpt,on .. m DHCf"lption
1 APU APS500C7B
12 Remarks Rtmarques
L1. TSN. 5851 CSN 22212 TSl· 6 CSI 10
L2_ U NIT WAS TESTED IAW E/M 40C7B REVS July 01 .2011 LJ. SB STATUS: REFER TO LOG BOOK & SHOP REPORT 5368644.
L4. LOG BOOK DELIVERED wtTH ITS ENGINE
AUTHORISED RELEASE CERTIFICATE Certificat Liberatoire Autorise
EASA FORM 1 Formulaire 1 de l'EASA
REVIMA APU SAS 1, AVENUE OU LATHAM 47
B P 12 - 76490 CAUOEBEC-EN-CA UX FRANCE
let. 33 (0) 2 JS 56 35 00 Fax 33 (0) 2 JS 56 35 56
8_ Par1 No. 9 Oty 10. Serial No. N•CHpte:n 01, N• Urie
167301-101A 1 SP-E025164
L S. THE PRESERVATION IS VALID UNTIL. DEC 02,2017
This WOd Identified in block 11 and descnbeCI ~ hU Dttn accompkshe<J tn ICCO<danu "',a. ,, CFR ~rt CJ ano ,n ,esp,e:cs IO lhat wOf11 . lhe items are appcoveo !of 1e1urr 10 stfVice unaer oer1if.ea1t N" 06EY992X
13a. Certifies !hat the items 1d e nt1fied above were manufactur ed in conform1ly to · Cer11he: quc tu •~ment s ident1his c,-<Mssus om e,e IObftqU11es contorm4!m cnl ouA .
14a. ~ Part 145 A 50 Release to Service Appro b.&lion pour ,emise en service S•lon Pa nie 145.A.S0
3 Form Tracking Number N· de reJ)ere Ou FOfmul• ite
1076
SO: 5368644 1,000
5 \f'Jork Order I Contract / Invoice Bon de commande I Contrat / Factu, e
07196351 41 151
11 Status / VVOrk Et.al I Travaux
Inspected/ Tested
g Other regulaI1on specified In bio,:.k i 2 Autrc rtgle~nta11on p,tc,stt en c.ase 12
0 approve<J des+gn data ano a,e in a :ht safe t ,atiA domlfes de conccpc'.on .1pprouwu •1 s~ot 1 • f0<1, nne'r,'\ ,w.cu, iti
0 non-approved design dala spec.1flad 1n 1
Certifies that unless otherwise specrfied in block 12, lhe work identified in block 11 and described in block 12. was accomphshed in accordance with Part 145 and 1n respect to that wOfk the items are constdered ready tor release to serv,cc
donnfes Ot concepoon non app,Ou¥HS s l)ec,t!Hs <Ulns I• use 12
13b Aulhcf,sed Signature 13c. Apl)(oval/Aulh0r1sa1ion Number Sig~t:a11e .auto1is.6-e Numt ro d"a9tt1T1enw ·.au10f1)alt0n
N IA N IA 13d. Name 13e Oa1e l dd mmm yyyy)
N om Date tu mmm ..aaaJ
N IA N IA USER/IN STALLER RESPONSIBILITIES I Responsabllit8s de rutthsaleur/installateur This certificate-does not automattcalty consl1tute authority to install the ,~em(s). C• doc:umenl ne constllut p~ t0tcfmen1 rautons111ort d',nstali.tr r(es} 11em(s)
CcrtitM' qu•, s.auf 1ndic.11ion conlniire sptcir'tet en case 12, k:s trav.aux idcntif~s en c.ase 11 et dt trits en cue 12 on1 i1e 1uhses confonnimen1 Ji la pan.e u s et q u·.au "u oe us t,,1vo1u1:, lu Pte:cts sont cons,derffs prt tes a 1,a ,em,se en serv1te.
14d. Name Nom
ft.f RS # RV 0208 Jean-F'ran~ois JULIEN
14c Cen~icate/Approval Ref No ,r du Ctn1fiC.ltJAgrlment
FR.145.0553
14e. Date (dd mmm yyyy) Date {jj mmm HH)
1 0 JUN 2016
Wiere the user/installer performs work 11'1 accordance wnh regulalions of an airworthiness autho<1ly different than the a irwonhiness authority specified n black 1. it is essential that the user/installer ensures that hIs/her airworthiness authorny accepls 1Iems from the airworthiness aulho,ity specified in block 1. Ouand r1111Kateu,rin""1a1eur travail!@ s•lon les 11g1emer-.a110ns cf1-1ne au1or•t a e na\oligat11111t a,ne,eme ae 1·au10fO oe na....gal>IACt mentionf'lee Clans la c ase 1 . .i n 1 nse ntiel qu.e foh1os.ateurfinstau1eu, s·assure que son a utontt oe na""labdlle acce pte les ,u~ms ht>eres p;,r rautor11e oe: Nl'-,gatutite ment.onneeaans La c.ase 1.
Statements in blocks 13a and 14a do nol consltlute installation certlf1caoon In all cases a,, crafl marntenance records must con tain an 1nsta1lat1on certif~tion issued In accordance w,th the na11onal regulations by the user/installer before the aircraft may be flown Lelli ,noica110ns pc1nees en cases 13a e1 14a ne cons111uent pas une cer1if1c.1110n ae monlage. Dans 1ous les cas le dossie• <fer11re1ien de rae,onel OOlt comenir une cer1,rica11on c'ins1a11a1100 d~ltwee confotmCment auj( reg1tmen1s natlOnau,c par ruhhsateur/inslallaleur avant que raeronel puIsse 110Ier
EASA Form 1 Issue 2 1 f ormulair-e 1 de l'EASA Edition 2
I
I I
i
LRU Inventory
APU APS500C7B At receipt
PIN SIN Descr iption
4951651-3 0393 VALVE-START BY-PASS
161798-2 10024 VALVE, SOLENOID FUEL
161798-4 6451 VALVE, SOLENOID FUEL
161798-2 10229 . VALVE, SOLENOID FUEL
169885-1 N/A VALVE, DIVERTER-LUBE OIL
4950072 N/A SWITCH, OIL PRESSURE-
160260-3 N/A SWITCH, HIGH OIL TEMPERATURE
4950251-1 V38-T0400 PUMP FUEL
26519-1 NOT DISASSEMBLED PLUG, IGNITOR-GA5 TURBINE ENGi
4950525 N/A PICKUP, MAGNETIC 169886-2 N/A OIL FILTER PRESSURE INDICATOR
172338-100 NOT DISASSEMBLED MANIFOLD ASSY, FUEL-LIGHTWEIGH 4503159 NOT DISASSEMBLED HOLDER ASSY, NOZZLE-START FUEL
1674S7-100A V28-S236 HARNESS ASSY 110418-1 Jl3450233 EXCITER, TURBINE IGNITION 4500873 08-06-23 CONTROL ASSY-ENGINE ACCELERATI 4951798 N OT DISASSEMBLED CHECK VALVE 115352-2 510390157 CABLE, IGNITION
PIN: 167301-101A S/N · SP-E025164
At d eparture
PIN SIN 4951651-3 0393
161798-2 10024
161798-4 6451
161798-2 10229
169885-1 N/A
-4·950072 N/'A
160260-3 N/A 4950251-1 V38-T0400
26519-1 N/A 4950525 ,. N/A 169886-2 N/A
172338-100 NOT DISASSEMBLED
4S03159 NOT DISASSEMBLED
167457- l00A V28-S236
110418-1 )13450233
4500873 08-06-23
4951798 NOT DISASSEMBLED
115352-2 S10390157
22/06/2016
SO· 5368644
TSN TSO W orkscope
UNK UNK Continuous time
UNK UNK Continuous t ime
UNK UNK Continuous time
UNK UNK Continuous time
UNK UNK Continuous time
UNK UN I< Continuous time UNK UNK Continuous time
UNK UNK Cont inuous time
0,00 0,00 SUPPLIED PART
UNK UNK Continuous t ime
UNK UNK Continuous time
UN K UNK Continuous time
UNK UNK Continuous time
UNK UNK Continuous t ime
UNK UNK Continuous time
UNK UNK Continuous time
UNK UNK Continuous time
UNK UNK Continuous time
~ iEIIIMA/,${/f} STATUS OF INSTALLED LIFE LIMITED PARTS
Customer R/O 41151
Revima APU S/O 5368644
APU TYPE APS 500 C78 P/N 167301-101A S/N SP-E025164 TSN 5851 TSO N/A TSI 6
CSN 22212 cso NIA CSI 10
DESCRIPTION P/N S/N TSN CSN Life limit Cycles remaining Removed from TURBINE WHEEL 4503778 HJ061 385,39 780 12000 11220 CONTINUOUS TIME
COMPRESSOR WHEEL 4505446 SIF2940 385,39 780 18000 17220 CONTINUOUS TIME
Completed by: 8JSERIN Sebastien ~ v_d (Stamp & Sign) Jt]zqq _,. ~
e--Date: June 10, 2016
6569 Jan. 12th 2012
I. Approving C ivil Aviation 2 • • 3. Form Tracking Number: Authority/Country: AUTHORIZED RELEASE CERTIFICATE
FAA I UNITED STATES PAI205493
FAA Form 8130-3, AIRWORT8INESS APPROVAL TAG
4. Organization Name and Address: 5. Work Order/Contract/Invoice
1S3RS90L Perform Air International, Inc. . 463 S. Hamilton Ct. Gilbert, AZ 85233 Number: . 5016013765
6. Item: 7. Description: 8. Part Number: 9. Quantity: 10. Serial Number: 11. Status/Work:
l VENT, APU BLOWER ASSY. 2 100904-4 I 063 1 REPAIRED
12. Remarks: Work Order: 205493 Technical Data: DWG. 2 100904 Revision Number: N Revision Date: 9/ 18/1990 Mechanic Performing Work: Glenn Davis
Work Completion Date: 8/ 19/2016 C ust Part Number: NIA Cust Serial Number: NIA OEM Aerospace Systems & Components
AD review accomplished.
Certifies thal the work specified in Block 11/12 was carried out in accordance with EASA Part 145 and in respect to that work the article is considered ready for release to service under EASA Part 145 approval no. EASA. 145.474 1.
13a. Certifies the Items Identified above were manufactured in conformity to: 14a. ~ 14 CFR 43.9 Return to Service ~ Other regulation specified in Block 12
D Approved design data and are In condition for safe operation Certifies that unless otherwise specified in block 12, the work identified in Block 11 and described in Block 12 was accomplished in accordance with Title 14, Code of Federal Regulations, part 43
D Non-approved design data specified In Block 12 and i/ spect to that worj he items are approved for return to service.
13b. Authorized Signature: 13c. Approval/Authorization No.: ::t~~ 14c. Approval/Certificate No.:
IS3R590L r
13d. Name (fyped or Printed): 13e. Date (dd/mmm/yyyy): 14d. Name (fyped or Printed): 14e. Date (dd/mmm/yyyy):
Dan Blake 19 Aug 2016
User/Installer Responsibilities
It is important to understand that the existence of this document alone does not automatically constitute authority to install the aircraft e11gi11e/propeller/article.
Where the user/installer performs work in accordance with the national regulations of an airworthiness authority different than the airworthiness authority of the country specified in Block I, it is essential that the user/installer ensures that his/her airworthiness accepts aircraft engine(s)/propeller(s)/article(s) from the airworthiness authority of the country specified in Block I.
Statements in Blocks 13a and 14a do not constitute installation certification. In all cases, aircraft maintenanc<, records must contain an installation certificate issued in accordance with the national regulations by the user/installer before the aircraft may be flown.
FAA Form 8130-3 (02-14) NSN: 0052-00-01 2-9005
Perform Air International, Inc. 463 South Hamilton Court Gilbert, Arizona 85233 Tel. (480) 610-3500 Fax. (480) 610-3501
FAA Repair Station IS3R590L ANAC Repair Station 1102-43/ANAC
EASA Repair Station EASA.145.4741 CAAC Repair Station F00100571
Customer Information
Customer Code: ALOII Customer Name: Fokker Services B.V.
Warranty Terms for Repair: 18 Months Warranty Terms for Overhaul: 18 Months
Information from Repair Order / Purchase Order
Repair Order#: 5016013765 Mfg PIN from RO/PO: 2100904-4
Nomenclature: VENT, APU BLOWER ASSY. RO/ PO Disposition: Repair
Date: 8/ 19/2016
Mfg SIN from RO/PO: 0631
Warranty Request: No
Reason for Removal: .. *TlME CONTROL••• Evaluate for Repair IA W OEM Specifications and provide a detailed quotation to include itemized costs of all applied SB's/Modifications and required estimated ship date. PMA material and DER repars must be clearly identified by line item and labeled on the quotation. FSI Must provide P specific written approval for each PMA part or DER repair utilized. Units with hard time requirements must have relevant Times/Cycles noted on certification. Do not sub-contract without prior authorization. RR: APU Vent fan !NOP. Worn/Broken.
Information for Part Received Work Order#: 205493 Mfg PIN Received: 2100904-4 Mfg SIN Received: 0631
Date Received: 8/4/2016
Fault Confirmed: Yes Normal Wear and Tear: Yes Any Unrelated Faults: Yes
Preliminary Inspection: AD review accomplished. See customer discrepancy. Dirty. Flange dented. Fan broken/damaged.
' ~arranty Granted: None
Warranty Comments: NIA
Information for Part Shipped Back
Mfg PIN Out: 2 100904-4
Customer PIN Out: NIA
Manual Ref#: DWU. 2100904
Mfg SIN Out:
Customer SIN Out:
0631
NIA
Status: REP AIRED
Teardown Procedure: Teardown,clean and inspected. Found annature commutator worn down, brushes gone, and windings delaminated IA W DWG 2100904 Rev. N, dated 9/18/1 990. Fan damaged. Parts placed on order.
Repair Procedure:
Test Procedure:
Replaced worn parts and assembled unit IA W DWG. 2100904 Rev N Dated 09/ 18/1990.
Unit beach tested good, no defects noted !AW DWG. 2100904 Rev N Dated 09/1 8/1990.
Modifications Incorporated: None
Mechanic:
Certificate #:
Date Repaired:
- v F-"""""""'2001 ,...1 00
Glenn Davis
3353886
8/19/2016
Inspector: Dan Blake
Date Inspected: 8/19/2016
-~A,
Stamp: _'._,_>.,,.4,·,.~--3 __ _ -~$~ ,'
R..¥Uiio.: l 1-0.i.:02/IJ/12
I • 1. Approving national aviation authority/country
Transport Canada
4 . Approved organization name and address
2 .
AUTHORIZED RELEASE CERTIFICATE Form One
Bombardier Inc.
BOMBARDIER P.O Box 6087, station Centre-Ville Montreal, Quebec, Canada,
3. Form Tracking No.
170000315464 - 1
5. Work Order/Contract/Invoice
5008546525 <1-----.--------------------.--------",.,.,,......., ...... ____________ ,,_ _____ +.---------,---------; O' 6. Item 7. Description
8. Part No. 9 . Qty. 1
10. Serial/Batch No . ... -~
"Cl ... C:
,Q
E 0
SWITCH, BLEED AIR 95-42-15B6-50780 14
fer lo block 12
11. Status/Work
NEW
CCl.,_ __ _._ ______________________ _._ _______________ _______ _.__ ______ _._ _________ _._ ______ --1 -S 12. Remarks -~ CID# 890101196248 Cl i;:
cu = .Oil
0/C: 1241
CNS I 1 4 / 1 4 3 4
This document has been issued according to an approved computer generated signature procedure
·.::,1------------------------------------~ 13a. Certifies that the items identified above were manufactured in conformity to : .c -... 0
> Q.,
0 u
Ix]
D Approved design data and are in a condition for safe operation.
Non-approved design data specified in block 12. raai------------------------------------0 13b. Authorized Signature 13c. Certificate/Approval Ref. No. ~
B0462730 / 12 - 58 01-----,~+-'-"~=+-+...;:_-,+,1-----1----------------raal .... 13d. Name 13e. Date (dd/mmrn/yyyy) 26/OCT/2012
~ Michael Jernigan
t:;;L----------------L-----------------raal 1. u This certificate does not constitute authority to install. 2. Installers working in accordance w ith the national regulations of a country other than that specified in block 1 must ensure that their regulations recognize certifications from the country
specified.
3 . Statements in blocks 13a or 14 a do not constitute installation certification. In all cases, the technical record for the aircraft must contain an installation certification issued in accordance with the applicable national regulations before the aircraft may be flown.
Form One Manufacturing Q.A.(02-2009)
\ ,
I
1. Ap2ro~ing National Aviation 2. Authonty7Country:
FAA/UNITED ST ATES
4. Organization Name and Address:
.~ · •. -11
AUTHORIZED RELE~SE CERTIFICATE FAA i:ORM 8130-3, AIRWOR~J !NESS APPROVAL TAG
Hamilton Sundstrand Power Systems i Division of Hamilton Sundstrand Corporation' 4400 Ruffin Road PO Box 85757 I San Diego, CA 92186-5757 li PT1357NM 1_
3. Form Tracking Number:
1454996 SR 1.000
5. Work Orcrer/Contract/Invoice Number:
1454996 SR 204012973
6. Item: 7. Description: 8. Part Number. 9. ~ligibility:* I 0. Quantity atch Number: 12. Status/Work: 1 CABLE, IGNITION 115352-2 TSO Arti":le NIA
13. Remarks: AIRWORTIIlNESS APPROVAL-PARTS: THIS FORM IS NOT AN EXPORT APPROVAL.
\1
t:
t t
14. Certifies the items identified above were manufactured in conformity to:
Approved design data and are in condition for safe operation.
0 ,. Non-Approved design data specified in Block 13.
15. Authorized Signature ...
17. Name (Typed or Printed):
Rodrigo Tlngzon
16. ApprovaVAuthorization No.:,t ODAR F-810310-~
18. Date(m/d/y): 11/11/04
l
User/Installer R ,!sponsihilities
2 l.\'EW
CERTIFIED TRUE COP'l!:. ~c . APPROVED ffl~..L~l:Si!-~ -~-~=---~~ REGIONAL ONE INC
It is important to understand that the existence of this document alone does not automatically omstitute authority to install the part/component/assembly. Where the user/installer performs work in accordance with the national regulations of an airwotthiness authority different than the airworthiness authority of the country specified in Block 1, it is essential that the user/in!taller ensures- that• his/her airworthiness authority accepts ;1arts/components/assemblies from the airworthiness authority of the country ;pecified in Block 1. : ;: :>tatements in Blocks 14 and 19 do not constitute installation certification. In all cases aircra~ ·aintenance records must contain an installation certification issued in accordance with the national regulations by the user/installer before the aircraft may be flown. 1
'AA Form 8130-3 (6-01) *Installer must cross check eligibility with applicl.:ble technical data. NSN: 0052-00-0012-9005 /
top related