.. ITEM# {){) '-(
PIN QTY
NOTE:
. \ 0 ·,y ~
If the mechanic filling out this form is contracted maintenance, they must se their A&P or AME # in place of employee number.
GMM / APPENDIX A -FORMS CA-49 MAINTENANCE DISCREPANCY RECORD PAGE I OF I
REV 19 06/20.'I 5
r---------------------- --.-------------------------------------- ,,___-;-
1 CAA The Netherlands
2 AUTHORISED REL~E CE ~ FICATE EASA Form 1
3 Form Tracking Number
..
ND 095809
4 - Hugen Hengelder 17 - 6902 PA Zevenaar 5 Work Order/Contract/Invoice
Maintenance For Aircraft b.v. Phone (31)(0)316 - 58 11 oo. Fax (31)(0)316 - 24 78 77 32110172
6 Item 7 Description 8 Part No.
extinguisher HAL-035-AVH
12 Remarks
Overhauled incl. Hydrostatic test and refill , CMM 100-9750 Rev 4
Last hydrostatic testdate: 01/11
Manufacture date 03/02
13a Certifies that the items identified above were manufactured in conformity to:
D approved design data and are in condition for safe operation
D non-approved design data specified in block 12
13b Authorised Signature 13c Approval/Authorisation Number
13d Name 13e Date (dd mmm yyyy)
EASA Form 1 - Issue 2
14a
9 Qty 10 Serial No. 11 Status/Work
1 002676C Overhauled
00 PART-145.A.50 Release to Service D Other regulation specified in block 12
Certifies that unless otherwise specified in block 12, the work identified in block 11
and described in block 12, was accomplished in accordance with PART-145 and in
respect to that worMejil'f~ered ready for release to service.
14b Authorised Signature/ l.AJ~W} 14c Certificate/Approval Ref. Number
W/.'fif!Y M'i NL.145.1180
14d Name H. Hermsen
14e Date (dd mmm yyyy) 20-jan-2011
- Maintenance For Aircraft b.v. P.O. box 24 - NL 6900 AA Zevenaar, The Netherlands
Hengelder 17 - 6902 PA Zevenaar Phone (31) (0) 316 58 11 00. Fax (31) (0) 316 24 78 77
Overhaul of fire extinguishers, carbondioxide-, air-, oxygen- and emergency equipment
WORKSHOP - REPORT II.ANDll: 301170
CUSTOMER Tyrolean Airways WO HUGEN NO. 32110172
DATE 20-1-2011 ORDER NO. R0588710
Description Flag Fire extinguisher Quantity: 1
P/N: HAL-035-AVH cyl.size: CU
S/N: 002676C CYLSIZE:
THE COMPONENT WAS Overhauled incl. Hydrostatic test and refill
@ Normal O Critical O AOG lil Warranty
@ Internal Coated @ External Coated @ Internal _External Coated
PARTICULARS None
Replaced Parts
QTY DESCRIPTION
Neck seal
seal
P/N 11178
261653
Authorized by the Department of Civil Aviation (no . NL.145.1180) - Member of F.M. Hugen Holding bv
~-., Part received by TM
TYROLEAN AIRWAYS f/4L03SAVH PN : ····· ····· ···· ··· ··· ······ ····· ··· ····· ·· ···· ·· ·· ········ ······ ··
Extended Incoming 'o SN: 002(, 7--6- C ············· ·· ····· ·· ···· ··········· ···· ······· ······ ··· ···· ····
~~ 02- .1 I< - .Zb-l '1 Inspection i.,. 1 'l.~~1.
P.O.: ................ ...... .... ..... .. .... .... ... ...... ......... .. ....
~ ,. "· s~~. 24- 01- 0Z.. Date: ...... .... ....... ... ... ............ .. .... ... ... ...... ... ... .. ....
TM
no fau lt found 0 new equipment 0 technic~l non conformance 0
by repai rstation with TYR repair or
purchase order
incoming inspection El testequipment after 0
requested by TYR cali bration
Reason for ex tended incomi ng inspect ion: -
Compl etion of initial . 24 , '1 . oz_ . ;:>RI,./ Signature: ....... 9..~ ............. incom ing inspection by TM: Date................... Code . ..... ... ....
-· - I ,~ -=-.::: - .. r..-;a
yes no TS
technica l nonconformance D w Remarks:
confirmed by repairstation /AIC&t11Nu /N.f"l'ECr1 ON
copy to TM D @j Pf!:'R. rOIJ. M l!30
copy to TE D ~ iVJr/-l oo,:r-
F!/..//J tNCi S
Info to shop manager
/I or to shop foreman D i Modstatus
~ shelf-l ife-start after calibration: (mmm/dd./yy)
~ Of/ I ~ .(lltjo3 2002 #
Applicable for new eq uipment on ly: TS
CAL period: /2 170,vr/.l Bezeichnung (Deutsch):
CAL station I : Cost at purchase:
CAL station 2: DT-Kennnummer:
Location: Inventory number:
Extended incoming inspection yes no ~ ':; ,, Signature: ~ M ::~ satisfactory completed by TS : ~ D Date: J..1.J<!. .~ Pt . Code: . ./.-IQ~ ..
303 I? "\" - ,
Completion of paperwork 2 ~ ,o,,c(_ Code: .. . C:9.P. Signat~~----- ---by TM: Date : ... .... : .... .......
TYR Fonn 2024 Rev. 3
. ·· . ... , .. ,.··,.
,··<!: ~ ·._ .;\/.
'·'· ', ' · . ..- ~ .
. ·. ;~·'ii{ :i~,: . -
./
TO:
TYROLEAN AIRWAYS FUERSTENWEG 190
INNSBRUCK AUSTRIA 6020
HUGEN MAINTENANCE FOR AIRCRAFT DORPSTRAAT 26 P.O. BOX 24 BABBERICH NETHERLANDS 6909 AL Approval No: RLD-1180
the following item:
R E P A I R 0 R D E R
Al - WITHIN 2 WEEKS
Fax No: 31 316-247 - 877 Attn: HENK HERMSEN
Telephone Number Facsimile Number
VAT Number
ORDER NO .
PAGE
ORDER DATE
43 512 22221800 43 512 286295
023R-2519
2
26/08/2002
-------------------------------------------------------------------------------=================================================--Item No.
Qty UOM Part Number / Serial Number Keyword/ Description
TSN TSO TSR Remarks Account No ATA (- - -- - For Internal Use Only - -- ------) =====================~~=============================================================================== =========================-- -
'7 -, ;~
105
106
107
108
1 EA
1 EA
1 EA
1 EA
HAL035AVH BOTTLE
HAL035AVH BOTTLE
HAL035AVH BOTTLE
HAL035AVH BOTTLE
/ 002673C UNKH / PORTABLE FIRE EXTINGUISHER UNKL
/ 002674C UNKH / PORTABLE FIRE EXTINGUISHER UNKL
/ 002675C UNKH / PORTABLE FIRE EXTINGUISHER UNKL
/ 002676C UNKH / PORTABLE FIRE EXTINGUISHER UNKL
UNKH UNKH 042100 26 UNKL UNKL Price Quoted : 0.00 EUR
UNKH UNKH 042100 26 UNKL UNKL
Price Quoted : 0.00 EUR
UNKH UNKH 042100 26 UNKL UNKL
Price Quoted : 0.00 EUR
UNKH UNKH 042100 26 UNKL UNKL
Price Quoted : 0 . 00 EUR I j --------- -------------------------------------------------=====-==-==----------===========-===----================================ ·, COMMENTS/INSTRUCTIONS: Rego UNK l!
S/N UNK ;;J FOR CERTIFICATION ! ! TAT TAC
UNK . OH UNK. OL . Ref : UNK
/ /1
Date : 99/99/9999 Strip report and acknowledgement req CE~IFIED DOCUMENT OF AIRWORTHINESS acc. JAA REGULATIONS REQ'D! ! ' ~ ==================================== =~ ========- ============================================================================ ., Ordered By: M. SONDEREGGER ,j Authorised By: . H. WINTER Ship To: TYROLEAN AIRWAYS : FUERSTENWEG 190
I~SBRUCK AUSTRIA
'\
6020
11 All repairs in connection with this order must be carried out by J.A . A. APPROVED ORGANISATIONS!! ~ If you have any questions regarding this order please contact Mrs. Marion Sonderegger; 1
phone#43-512-2222-1832 or fax#43-512-286 - 293 l ! !
0
"" "' ~ ·tn I
~ '-l
"' 0) § 1.D ~
00
------ - maintenance for aircraft bv P.O. box 24 - NL 6900 AA Zevenaar , The Netherlands Dorpstraat 26 - 6909 AL Babberich Phone (31) (0) 316 24 74 94. Fax (3 1) (0) 316 24 78 77
02-7898 24. SEP. 2002
Overhaul of fire extinguishers, carbondioxide-, air-, oxygen- and emergency equipment
WORKSHOP - REPORT CUSTOMER
DATE
F.+ ·i'.\! ·:H:1-.4VH S/~ i ut1260'...:C-OO"-H; ac·
rART1CUU\RS N~ . .i:K
RApiaced Parts
o-r\( DESCRIPTION t'il\1
0.
,
(Jn;r -;f,tf:
cy!.si?ei
WO HUGEN NO.
ORDER NO.
1/ cu
Authorized by the Department of Civil Aviation (no. RLD- 1180) - Member of F.M . Hugen Holding bv
Eino ,._;
2 Rijksluchtvaartdienst
The Netherlands
4 -6 Item 7 Description
extinguisher
13 Remarks
A member of the JAA
Hugen maintenance for aircraft bv.
8 Part No.
HAL-035-A VH
Inspected ,CMM 26-25-02\1 Rev 2
MFG date : 3/02
JAA FOR:. ONE AUTHORISED RELEASE CERTIFICATE
Dorpstraat 26 - 6909 AL Babberich
Phone (31)(0)316 - 247494. Fax (31)(0)316 - 247877
9 Eligibility* 10 Qty 11 Serial/Batch No.
VARIOl,JS 10 002669C to 002678C
Limited life parts will normally be accompanied by maintenance history including life used.
3 Certificate Ref. No.
038J 2Q
5 Work Order/Contract/Invoice
3?Q?.d.?37
12 Status/Work
nspected
. 4
C)
t----------------------------------,----------------------------------1 "-> 14 D Airworthiness D Conformity only
Certifies that the part(s) identified above except as otherwise specified in block 13 was (were) manufactured/inspected in accordance with the applicable design data and with the airworthiness regulations of the stated country. (See over)
15 Signature 16 Approval Reference Number
19 ~ JAR-145.50 Release to Service D Other regulation specified in block 13 xx
Certifies that the work specified above except as otherwise specified in block 13 was carried out in accordance with JAR-145 and in respect to that work, the part(s) is (are) considered ready for release to service . (See over)
20 21 Approval Reference Number
RLD-1180
I
'-l 0,
c.o CX>
f---------+-------+-----:2~~~~~------~~
Signatu,e) ~ (¥}
22 Name ~ ~ 17 Name 18 Date (d/m/y) ) M3 23 Date (d/m/y)
1 't Veit 3-9-02 JAA Form One - Issue 3 *Installer must cross-check eligibility with applicable technical data
.".•,
,. .:._ 1>-· ·- 1: . ' ..
r /I S::ID . .... ,.,. ... • aerospace me. 98 Columbus St.,
Pointe Claire, Quebec, Canada H9R 4K4
Tel : 514-630-7777 Fax: 514-630-9999
~ :.~-:::'.>
PACKING SLIP FROM:
CASP Sales Order CASP aerospace inc. 08 Columbus St.. Pointe Claire,
Customer P.O.
P.O. Date
Quebec, Canada H9R 4K4
TEL: 514-630-777Z F8XS 514-630-9999
120593 Page 1
120593
02310251
Thu , Feb 28, 2002
••• ••• •••••••• •••••••-•••-• --- n--·••-••••••H•••••••••••••-••••••• • •••••• • ••••-•••••• • •••••••••·•••-• •••••••-•••••--
- •••·•-•••••• ••• -•••·••••••••••--~••••• • •••••••-•• •••••-·••·••••·•••••• ••••••••••·•••••••••••••·
Sold To:
¥~~f~\~A~WAYS (}2---3)-0257 TIROLER LUFTFAHRT -
FUERSTENWEG 190
A-6026 INNSBRUCK, TIROL
AUSTRIA
Tel: 011-43-512-2222 Fax: 011-43-512-286293
Date Shipped
Shipped By
Waybill
Freight Charges
Line
1 .
Item Number
WIRE TRANSFER
Description
CHARGE
00/00100
OHL
COLLECT
Shipped To CLAUDIA RAM TYROLEAN AIRWAYS
TIROLER LUFTFAHRT -
FUERSTENWEG 190
A-6026 INNSBRUCK, TIROL
AUSTRIA
Tel: 011-43-512-2222 Fax: 011-43-512-286293
Number of Boxes
Total Weight
Terms
F.OB.
Ordered
1
1
0
N-30
CASP AEROSPACE INC.
Quantity
Shipped Backordered UM
1 0 ea
2
3
100-9750 PORTABLE FIRE EXTINGUISHER HAL035AVH 10 10 0 ea.
200-9770 BRACKET 10 10 0 ea.
····················-----·-·--·········---·-···········--··················-····-·························---·-····-·································-·········--···
·-··--·--·····--·-················-·-··········-······-···············-·
ITEM 1 - 200-9770 MFG. DATE: 01-02
ITEM 2 - 100-9750 -MODEL HAL-035-AVH S/N F002669C--THRU-F002678C (INCLUSIVE) MFG. DATE:03-02
-fu 02-6729
Eingegangen
1 9. MRZ. 2002
I ·~ 1 .r \ ::-~ -tqca Tyco Suppression
Systems
Flag Fire
. .. ·. ·- -· .· .. · Rag f-ri1 t:qu,prnenl · ·
528 Bkr....----h,."d Pert Tccurr~eh ON. NSN 2L9 wnad.3
Tele: (519) 727-6722 Fax: (519) 72 7-3177
MANUFACTIJRER'S CERTITICATE OF CONFORMANCE
CUSTOMER ORDER HO. /+ -~ "7 '+ '/ b
Q1Y. PIN MODEL
I 100-9750 HAL-035-AVH
~ 1 w-;, .:;c HAL--035-A VH
J 100-9750 HAL--035-A VH
4- 100-9750 HAL--035-A VH
r; 100-9750 HAL-035-A VH
6 100-9750 HAL-035-AVH
7 100-9750 HAL-035-A VH
8 100-9750 HAL-035-A VH
Cf 100-9750 HAL-035-A VH
IC, 100-9750 HAL-035-A VH
t I 100-9750 HAL-035-A VH
11. . 100-9750 HAL-035-A VH ,~ 100-9750 HAL-035-A VH
I 4-- 100-9750 HAL-035-A VH
,s 100-9750 HAL-035-AV ... d
i b 100-9750 HAL-035-A VH
/ 7 100-9750 HAL-035-A VH
... I_({ 100-9750 HAL-035-A VH ---- 1 M-9750 HAL-035-A VH -----100-9750 ! HA.I;:01- ' ~ TT T J-... ,. -100-9750 HAL-OfS-A VH
- · -
FLAG SHOP ORDER NO. Cf 7 / C;}. 0
S/N
Fcc,:}.(69 c Foo).( 70 t YC C ;).G l / C F n r· .J r;. 7 :; e,. Foo-~6 7 3 r~ F-0ir'i .-:Jt 74-G f O o ,:]__ 6 1. c;· C
f-- " 1 /. )(,{_ C, () ::;-,.. . .:, . -
foo .:J.6 77L f- f ) o .:J (. 7 R l
f cAC: .1 c; 7 Cf C f-c o ~ 6 Rt)(, f r; r, ,;:;__ (-.. ~ i C
F n o .;z 6 S" J c_
F o o .:;;. ,~ :T. :, ("_
F no -~J 84- c ~ n n ::J ~ ~ -~ G
f () o J 6 8 b c .-:
lv{FG. DATE (M/YR)
o :~ -c~ , ' I
II
' ( ,, ,, I (
,,
I I
( I
( (
, I
( I
I,
I f ;
( f
(,
I f •
~ -
l .. , ,. i . ·
; 2 - 6 7 2 ·. 0
02- 6721 '
)32 - 672 2
.0 2 - 6 7 f 3-
,J 2 - 6 72 4
/J2- 672 5
.,0 2 - 6 7 2 6
.102 -6 727
.10 2 - 6 7 i ·: . .. ,
1'0 2 - 6 7 { ~ L.-.
r····
I •
!
-·-. \;.-.:~
nns [S TO CElTIFY 1HA T nm PRODUCT HEREON HAS BEEN [NSPECIED AND TESTED AND CONFORMS TO ALL
SPEOFlCA TIONS AND R.EQUlRE1v{ENrS DET All.ED ON 1lffi (X)ITTRACT OR PURO!ASE ORDER RECORDS TO
SUBST A TIA TE CONFORMANCE ARE MAINTAINED ON FILE BY FLAG FIRE EQUIPMEITT LI}.{lTE!). ~ ... .
· . . .
-AtJIBORlZED rNSPECTOR.:_:::=:'.:=::::==~3<-~-=----~'"t:.=:::::,..,, __ _ DATE(D/M/YR..): (),5-(-3-0~
fll.E·\ QX-1
F107-8d
IPMCID . .... ,... a.a - aerospace me.
CERTIFICATE OF CONFORMANCE
TRANSPORT CANADA AMO# 327-91
CUSTOMER: TYROLEAN AIRWAYS CUSTOMER P.O.: 02310251 I GASP ORDER: 120593
QTY. PART No. DESCRIPTION SERIAL No. LOT/BATCH No. MFG DATE
10
10
[i]
D
200-9770
100-9750
BRACKET (ITEM 1)
PORTABLE FIRE EXTINGUISHER
(HAL-035-AVH) (ITEM 2)
N/A
FOOZE6Cfc
-~F(X)Z61~t-X:W.S\UE~
CERTIFICATION STATEMENT
N/A 01-02
N/A 03-0Z
This is to certify that the aircraft parts described hereon were acquired from a source of supply that is consistent with the conditions under which
Transport Canada distributor approval number 327-91 has been granted. \
This is to certify that the material detailed above has been inspected and conforms to all purchase order requirements.
This is to certify that the material detailed above has been inspected, and conforms to the applicable drawing(s), specification(s), type design data
and/or purchase order requirements. Inspection and test reports are on file at this facility or with the manufactvrer, are available for review, and show
that materials, processes and finished parts were c9ntrolled and tested in compliance with all applicable specifications and contract requirements.
MAR 11 2002 Date (dd/mmm/yy)
.··,:·-· .... ::, ·:: · ,.
···:::·~:\:<
0)
.. , ........ 0)
·" 1 ... N [ .. w ,·,, i· ,, .
0 1··,. - '' ~ rv:· l> I j = Pen · . ..
L-------------------:::--:-==::-:-----:----::-::-:::--:---:----;:;::--;:;:--,-c:-::::-;-:----;:;:-;c-:;::-----:---;-:-:::-=-:=-:----- --------------' ~ " : ·
CASP Aerospace Inc. 98 Columbus St., Pointe Claire, QC, Canada H9R 4K4 ~ c.,; , ·.
T: 514-630-7777 F: 514-630-9999