Engine Maintenance

Records

PENN YAN AERO LYCOMING ENGINE SHIPPING LIST - MAJOR OVERHAUL CUSTOM

W/O # 28597-09 MODEL # TI0-540-S1AD S/N RL-7805-61A BARTELT AVIATION DATE 7/10/2009 CHECK OUT BY R. HAYES

y N NOTES ACCESSORIES BAFFLES FRONT x DUAL MAGNE TO P/N 1 0-682560-13 BAFFLES REAR x SIN G071GN01 BAFFLES SIDE x STARTER P/N 149-NL BREATHER FITTING x 1-STR SIN FN-190915 CARBURETOR x ALTERNATOR PIN NOT SUPPLIED SERVO x 1-45, 1-STR, 1-T SIN NOT SUPPLIED THROTTLE ARM x BOXED FUEL SYSTEM P/N 2524791-7 MIXTURE ARM x S/N 70064304 FUEL PUMP x 2-90, 1-T FUEL PUMP P/N RG9570P/M FUEL INLET & ADAPTER x 1-STR SIN B-3076 CHT FITTING x PROP GOV. P/N NOT SUPPLIED CHT TYPE & LOCATION x S/N NOT SUPPLIED DIPSTICK x 12 QUART VACUUM PUM p P/N NOT SUPPLIED DIPSTICK TUBE x 77527 S/N NOT SUPPLIED EXHAUST STACKS x 10 COMPLETE

FILTER CONDENSERS x FLOW DIVIDER x FUEL INJ. NOZZLES & LINES x 6EACH NOTES ALTERNATOR x CRANKSHAFT P/N - LW17734-85 AL TERNA TOR BRACKET x S/N -V7043 AL TERNA TOR CONTROL ARM x HARNESS x DUAL BENDIX CASE M/N - 981 INT AKE PIPES x 6

INTER CYL. BAFFLES x 4

LIFTING EYES x 2 OIL PRESS. RELIEF VALVE -ADJUSTABLE LOG BOOKS ~ PY YELLOW

MAGNETOS x DUAL BENDIX

MAGNETOS DRIVE ADAPTER x CYLINDERS - BLUE I NITRIDE MANIFOLD PRESSURE FITTINGS x YELLOW I LONG REACH MOUNT LEGS x 4 BIG HOLE

NOSE SEAL RETAINING KIT x BOXED- MAG HARNESS CLAMP & TIE KIT, OIL COOLER x MISC ENG. GASKETS, 2 EXHAUST OIL COOLER FITTINGS x GAUGES, THROTTLE ARM W/ NUT, OIL FILTER x CH48103-1 2 RETAINER PLATES OIL FILTER ADAPTER x OIL SUMP x OIL TEMP FITTING x . OIL PRESSURE FITTING x "' PRIMER JETS & LINES x PROPGOV PADSTUD LENGTH x 4 @1 "

PROP GOV LINE .. x QUICK DRAIN x ROCK BOX DRAIN TUBES x 6

SPARK PLUGS x 12 RHB32E

STARTER x ST ARTER GEAR SUPPORT x SUMP PLUG x 2SQR

VACUUM PUMP DRIVE x VACUUM PUMP • '

x VERNA THERM .....

' x PYA FORM # PY-1 06 11/1/2005

THIS ENGINE WAS ASSEMBLED AS INDICATED. ORIGINAL CHECK IN ON FILE AT PENN YAN AERO

Engine Maintenance

Records

Log Number:

Aircraft Registration Number:

Serial Number: f\L- '7 ~OS'-tc I A Date Installed on Aircraft:

lTime Between_ Overhauls: I ~00 ~ rs Engine Position:

The Power of Experience

Penn Yan Aero 2499 Bath Road. Penn Yan. NewYork 14527 U.S.A.

315-536-2333

Repair Station Approval FAA: Y2GR396 Y EASA.145 5936

\\ ww. Penn YanAcro. com

Total Time Tach or Total Time Since Recording Descr iplion of Work Performed Page: 1

Date In Service Overhaul Meter Time Cert i ficate N umber & Signature of' Technician Performing Work

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I ,

This is to certify that the engine described I Our WO# Dated hereafter has been overhauled by Penn Yan 28597-09 7/9/2009 Aero to new parts tolerances and limits as specified by the manufacturer. Engine Engine Model Serial Number

disassembled, cleaned, inspected, repaired, TI0-540-S1AD RL-7805-61A

reassembled, and tested in accordance with .

data approved by and or acceptable to the -- . FAA. All applicable Airworthiness Directives are in compliance. See A.O. list supplied.

TIU-.... has bB rt11111111factund to Zero Time This engine has been dynamic balanced in Tlllllranl:la llJ Pinn Ylll Aero brvlca. h:.

accordance with FAA Approved Process

I Specification AMP-4302. Previous Time in Service

3367.91

I Installed new Lycoming PIN: 05K21108 cylinder kits at

~~~I this time. ' -.

Penn Yan Aero

2499 Bath Road, Penn Yan, New York 14527

~~~' . Telephone: 1-315-536-2333 -www.pennyanaero.com

"' -~ ,.q_ -- I

FAA Approved Repair Station: Y2GR396Y

I l ~thorized Signature EASA 145.5936

-

- --

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--Total Time Tach or

Total T ime Since Recording lks1.:r ip1 io11 orwor~ l\:r l'orrn1.:d Page: 2 Date In Service Overhaul Meter Timi.: ( \ :rt i licalc Nu111hcr & Sig11aturc 111' I cc.:h11 il·iu11 l'crfo1111i 11g Wnr~

!Julw1ce Fmward I --

I

' '· -

The accessories listed are either new or wore Right Magneto • Part# Right Magneto · SN# overhauled (as indicated) and supplied with this onglno: 10-682560-13 G071GN01 -

Engine Modol

I Left Magneto - Part# Left Magneto - SN# .-

TI0 -540·S1AD NIA NIA

Serial Number Our WO# lnvolco Dato ~1 lnjectorlCarb - Part# lnjectorlCarb • SN#

RL-7805-61A 28597-09 719/2009 2524791-7 70064304

I Fuel Pump - Part# Fuel Pump - SN#

h~!~ RG9570PIM B-3076

I

Starter • Part# Starter - SN# I

~ lo 149-NL (New) FN-190915

A horized Signature Turbo - Part# Turbo· SN#

r;mt7J21111 406610-9026 TER0210 I

Controller • 1 • Part# Controller • 1 • SN#

Penn Yan Aero NIA N/A -2499 Bath Road, Penn Yan, New York 14527 Controller - 2 • Part# Controller - 2 • SN#

Telephone: 1-315-536-2333 N/A NIA I www.pennyanaero.com

FAA Approved Repair Station: Y2GR396Y Wastegate - Part# Wastegate. SN#

EASA 145.5936 LW-16858 126836

Totals - Carry Forward I' 11

Total Time Tach or Total T ime Since Recording l)cscl'lplio11 nl Wn1" 111•!11111111·11

Date In Service Overhaul Meter Time Ccrli licalc Number & Signutilll' ot' I 1•rh 1111•l1111 111 1--__;::-=-o,::_~+-'=-=:...:..:...;...:..:...:--+__;:..____;---1-~~~~+-~~~~~~~~~~~~~~~~---

)

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BARTELT AVIATION, INC. 1301 WEST LAFAYETTE STURGIS, MI 49091

ENGINE LOG September 16, 2009 N8328D TI0-540-SlAD RL-7805-61 A Aircraft Tach Hours: 3837.02 Engine Total Hours: 3367.91 SMOH: 0.0

Installed this engine on N8328D, PA-32R-301T, SIN 32R-8129035, after Major Overhaul by Penn Yan Aero. New 2ea PIN J9613-19 & 2ea PIN J9613-55 Lord Mounts. Serviced engine with 12qts AerosheU 100 (50wt). Installed new PIN 73965-016 Alternator Drive Belt. Replaced worn engine compartment Scatt Hose. Installed new Tempest PIN AA3215CC'" Vacuum Pump SIN 58473. Installed Overhauled Vacuum Pump PIN 442CW-6, Serial No.106257. Installed new lea PIN 452-982, lea PIN 452-908, and lea PIN 452-907 Turbo Blankets. Tail Pipe Assembly repaired by Dawley Aviation, W.0. 98928. lnstalled new lea PIN 556-108 Tail Pipe Coupling Clamp. Complied per AD 91-21-0lRl Exhaust Inspection. Recur Inspection due at lOOhrs (Tach:3467.91). lnstaUed new PIN 763-427 EGT Probe. Installed the following new hos~. 124F003-4CR0224, 111F417-8D0210, 111F502-8D0266, 124F001-4CR0142, 124F001-3CR0146, 124F001-3CR0220, 111F504-8D0246, 193000-300072, from Precision Hose. Repaired misc baffling. P ropeller inspected and Governor Overhauled at this time by Tiffin Aire, Inc. See Prop Log for details. Oeaned and flushed Oil Cooler. Performed ground break in procedures per mfg guidelines. No leaks noted. Flight test to follow.

I CERTIFY THAT TlllS ENGINE HAS BEEN INSPECTED IN ACCORDANCE WITH AN ANNUAL INSPECTION AND WAS DETERMINED TO BE IN AIRWORTHY 0 ITION

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. ~ )!::>01q U! pa1Jpads A.J1uno::i a41 JO ~po41nv ssau

-!4lJOMJ!'v' a41 WOJJ sa!1qwasse1s1uauodwo::i /sµed s1da::i::ie ~po41nv ssau14µ0MJ!'v' Ja4/S!4 1e41 saJnsua Ja11e1su!JJasn a41 le41 1equassa

S! I! ~ )!::>01q U! pa!Jpads Aiiuno::i a4i JO ~!J041nv ssau14µ0MJ!V a4i ue41 1uaJaJJ!P Al!J04lnV ssau

-!4lJOMJ!'v' ue JO suo1le1n6aJ 1euo11eu a4l 41!M a::iuep1o::i::ie U! )!JOM 1a11elSU!J1asn a41 a1a4M

)

Date

• • Total T ime Tach or

Total Time Since l{ecordi 11g Description of Work Performed In Service Ovcrhau I Meter Time Certificate Number & Signature of Technician Performing Work

/Jalance Forward

'· B·\RT1~: 1 ,T AVIATION, INC. 1301 W11:ST LAFAYETTE STURGIS, MI 49091

1976

l r.NGINE LOG October 30, 2009 N83280 TT0-540-SJAD RL-7805-61A Ai1·crnft Tach Hours: 3841.70 ll.cmovcd and rcinstnlled Fuel Servo PIN 2524791-7R, Serial No. 7006304 and Engine Driven Fuel Pump after repairs by Pc11n Yan Aero. Sec From 8130-3dated10/28/2009, W.O. 29678. Performed ground run and flight test. Checks 1111tisfuctory. Aircrart.olt for return to service.

< ''"~ .1dn?;sc11~996IA "

HARTEtT AVIATION, INC. 1301 WEST LAFAYETTE STURGIS, MI 49091

1976

ENGINE LOG November 3, 2009 N8328D TI0-540-SlAD RL-7805-61A Aircraft Tach Hours: 3847.01 SMOH: 10.01

Changed Oil and Filter. Inspected filter for contamination, none noted. Installed new CH48103-1 Filter. Added llqts Aeroshell 100. Ru - no leaks noted.

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l. Approving National Aviation 2 . AUTHORIZED RELEASE CERTIFICATE 3. Fonn Tracking ~umber: Authority/Country: FAA/UNITED ST A TES FAA Form 8130-3, AIRWORTHINESS APPROVAL TAG 11352

' 4. Organization Name and Address: Repair Station# Y2GR396Y 5. Work Order/Contract/lnvoice Number

PENN YAN AERO 29678 I

2499 Bath Road, Penn Yan, New York 14527, 315/536-2333

6.Item: 7. Description: 8. Part Number: 9. Eligibility:* IO.Quantity 11. Serial/Batch No. 12. Status/Work:

1 SERVO, O/H 2524791-?R TBV by Installer 1 70064304 R epa ired

13. Remarks: *Work perform ed in block 12 was done in

*accordance with data approved by or

*acceptable to the FAA. Details on file

*under WO# in bJock 5 .

.

14. Certifies the items identified above were manufactured in conformity to: 19. m 14 CFR 43.9 Return to Service D Other regulation specified in Block 13

D Approved design data and are. in condition for safe operation. Certifies that unless otherwise specified in Block 13, t!Je work identified in Block

D Non-approved design data specified in Block 13. 12 and described in Block 13 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.

/) 15. Authorized Signature: 16. Approval/Authorization No.: ~~natur:-J 21. - Approval/Certificate No.:

(JrCLV..,, ,-,(/ Y2GR396Y

17. Name (Typed or Printed) 18. Date (m/d/y): '22. Nam() (Typed or Printed) 23. Date (m/d/y): TIMOTHY HANSEN Oct 28,2009

User/Installer Responsibilities It is important to understand that the existence of this Document alone does not automatically constitute authority to install the part/component/assembly. 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 essentiat that the user/installer ensures that his/her Airworthiness Authority accepts parts/components/assemblies from the Airworthiness Authority of the country sp.ecified in block I. :

Statements in block 14 and 19 do nol constitute insta llation certification. In all cases aircraft maintenance records must contain an installation certification issued in accordance with national regulations by the user/ installer before the aircraft may be flown.

FAA Form 8130-3 (6-01) *Installer must cr,oss-chcck eligibili ty with applicable technical data. NSN: 0052-00-0J2-9005

\

,, WORK ORDER FORM 100 lllllll lllll lllll lllll lllll llllllll / AERO

,(Oad

.A, New York 14527

,/536-2333 "'-'

FAA ID NO. Y2(;R396Y

WORK ORDER#29678-09

Dept #FUEL Page NO. 11 '•

Customer BAR13 I BARTELT AVIATION INC Location REC

Cust RO# Step AWAITING INSPECTION. Warranty Code 00 I 0

Work Req ffiAN Goodthru AD# 09-22

PIN 2524791-7R I SERVO, O/H SIN 70064304 Mfg PREOS ;::::=============================================== Reason/Rm IRAN

Date Reqrd 10/28/2009

Date Estmtd / /

PRELIMINARY INSPECTION :

No shipping damage .

PRE TEST (Yes/No) N

Not r equired.

I ~IDDEN DAMAGE:

'r'fo hidden damage .

TEARDOWN FINDINGS:

Manual# Rev . / / Rev#

ATA NO .,:

DATE: 10/26/2009 INSPECTOR: T.HANSEN

DATE: I I INSPECTOR:

Fuel servo and fuel pump sent for testing and repair if necessary .

TECHNICIAN: D. BERGSTRESSER DATE: 10/27/2009 INSPECTOR: T.HANSEN

FINAL INSPECTION BEFORE ASSEMBLY: DATE: 10/27/2009 INSPECTOR: T.HANSEN

CORRECTIVE ACTION:

Fuel servo and fuel pump P/N: RG9570P/M, S/N: B-3076 were installed on test bench and te

sted . Fuel pump pressures were all within manufacturer's limits. Adjusted fuel servo "0"

impact pressure to within manufacturer's limits. All other flows were within limits . Al

1 work done in accordance with data approved by or acceptable to the FAA. Fuel pump and f

uel servo are satisfactory for return to service.

TECHNICIAN : D.BERGSTRESSER ' DATE: 10/28/2009 INSPECTOR: T . HANSEN

MODIFICATION/SERVICE BULLETINES :

No AD ' s are applicable at this time.

Test Data Used: Data approved or acceptable to the FAA

Test Technician: D. BERGSTRESSER

Inspector: T.HANSEN

'inal Inspection:T.HANSEN

Technician:

Inspector :

(ed Oct28.2009 11:16:12 PYAS00601

DATE : 10/28/2009

DATE: 10/28/2009

DATE: 10/28/2009

DATE: I I DATE : I I

Labor Task Control# lllfllllllll llllllllllll llllllll llllllllllllllJlll

I

I

/~RO WORK ORDER FORM 100 I lllllll lllll lllll lllll lll ll llll llll

/ .Koad ..tn, New York 14527

. . {/536-2333 " "-'-"'

Customer BAR13 I BARTELT AVIATION INC

FAA ID NO. Y2GR396Y

WORK ORDER #29678-09 Dept #FUEL P:age NO. 21

' I L1ocation REC

Cust RO# Step AWAITING INSPECTION. Warranty Code 00 I 0

Goodthru AD# 09-22 Work Req IRAN

PIN 2524791-7R I SERVO, O/H

I

ADDITIONAL COMMENTS:

(1)

(2)

SIN 70064304 Mfg PRE05

MAINTENANCE RELEASE RECORD THE COMPONENT IDENTIFIED ABOVE WAS REPAffiED AND SPECTED IN ACCORDANCE WITiiTHE CURRENT REGULATIONS OF THE FEDERAL AVIATION ADMINIS PERTINENT DETAILS OF THE REP AIR ARE 0 FIL

Approved return to Service By TIMOTHY

.~PSTM

.. ' '

'ted Oct 28,2009 11: 16: 13 PYAS00601

Oct 28,2009

Labor Task Control# l llll l llll ll l ll ll lll l ll l l l l llllll~~mD~ ID

Date

) 2.S I ~

Total Time In Serv ice

Total T ime Since

Overhaul

Tach or Recording

Meter Time Description of Work Performed

Certificate Number & Si •nature of Technician Performin Work

Balance F0tward

BARTELT AVIATION, INC. 1301 WEST LAFAYETTE STURGIS, MI 49091

1976

ENGINE LOG November 16, 2009 N8328D TI0-540-SlAD RL-7805-61A Aircraft Tach Hours: 3856.96 SMOH: 19.94 Changed Oil and Filter. Inspected filter for contamination, none noted. InstalJed new CH48103-1 Filter. Added llqts AeroshelJ 65 (30wt). Ground run-no leaks noted.

~Ys~IA Bartelt A via ti on, Inc. (269)-651-5431

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Total Time Tach or Total Timt: Since Recording In Service Overhaul Mt:ler T ime

Description of Work Performed Certificate Number & Si nature of Technician Performin' Work

Page: 6

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BARTELT AVIATION, INC.

Established. 1976

Date: 10/11/2010 N8328D Lycoming TI0-540-S1AD RL-7805-61A Engine TI: 3571 .53 Aircraft Tach: 4040.64 SMOH: 203.62

Complied per Lycoming Service Bulletin 480D, Oil and Filter Change and Filter Inspection. Installed new CH48103 Filter. Added 12 qts Aeroshell 15w50. Cleaned and inspected Oil Suction Screen, installed new gasket. Cleaned , gapped, and tested all Plugs. Checked Magneto to Engine Timing. Inspected Fuel Service Inlet Screen. C/W AD 2008-14-07 Fuel Injector Line Inspection per Textron Service Bulletin 342E (Due every 100hrs). C/W AD 91-21-01 Exhaust Inspection (Due every 100hrs). AD 2010-07-08 Kelly Turbo Charger Overhaul NIA. AD 2009-02-03 Fuel Servo Gasket N/A. Checked torque on Valve Cover hardware. Inspected engine controls for proper operation. Inspected Intake System for leaks and hardware torque. Inspected Fuel Injection Nozzle reference manifold hoses and clamp torque. Inspected engine compartment for fuel leaks. Compression Test: #1 79 #2 79 #3 79 #4 79 #5 79 #6 79 /80PSI. Performed ground performance operational run per mfg specs. No leaks noted. Checks satisfactory.

I CERTIFY THAT THIS ENGINE HAS BEEN INPECTED IN ACCORDANCE WITH AN ANNUAL INSPECTION AND WAS DETERMINED TO BE IN AIRWORTHY CONDITION.

c:~~ La ussell 35316091A Bartelt Aviation, Inc. (269)-65~-5431

Total Time Tach or Total Time Since Recording Description of Work Performed Page:7

Datt: In Service;: Overhaul Meter Time Certificate Number & Signature of Technician Pt:rfo nning Work

BARTELT AVIATION, INC. I-

Established. 1976 ~

Date: 01/13/2011 N8328D Lycoming TI0-540-S1AD RL-7805-61A I-

Aircraft Tach: 4066.56 -

Removed defective Alternator. Installed Overhauled Part No. EOFF10300AA, Serial No. H-K100848 Alternator from Kelly Aerospace Energy Systems. See Form 8130-3 dated 10/11/10, W.O. M601590. Performed op check. Ok for return to ......

service.

~c;;~~ ......

ussell 35316091A -Bartelt Aviation, Inc. Sturgis, Ml

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( ( (

(

1. Approving National Aviation Authority/Country:

2.

( (

3. Form Tracking Nmnber:

F AA/UNlTED ST ATES AUTHORIZED RELEASE CERTIFICATE H-K100848 FAA r:orrn 8130-3, AfllWORTHINESS APPROVAL TAG

4. Organization Na me and Address:

KELLY AEROSPACE ENERGY SYSTEMS, 2900 SELMA HWY., MONTGOMERY, AL. 36108 5. Wor k Order/Contract/Jnvoice Number: W/0: M601590

6. Item: ?. Description: 8. Part Number: 9. Eligibility: * 10. Qmmtity: 1 l. Serial/Batch Number : 12. Status/Work:

13. Remarks: COPY OF WORK ORDER AVAILABLE ON REQUEST FROM KELLY AEROSPACE ENERGY SYSTEMS

CERTIFIES THAT THE WORK SPECIFIED IN BLOCK 12/ 13 WAS CARRIED OUT IN ACCORDANCE

WITH EASA PART 145 AND WITH RESPECT TO TMAT WORK TllE AIRCR.AF1 COMPONENT IS

CONSIDERED READY FOR RELEASE TO SERVICE UNDER EASA APPROVAL CERTIFICATE NUMBER

H-Kl00848

EASA. 145.4418 AND BY THE FAA AIR AGENCY CERTIFICATE NUMBER UT2R226L. APPROVED FOR EXPORT

THE ORJG. EQUIP. MFG. DATA APPEARS ON THE DATA PLATE IN Tl IE LINES IDENTJFIED AS MOD/NO & ORIG. MFG. COMPLIES WITH PPS-900 1 LATEST REVISION.

OVERHAULED PER CESSNA MANUAL# D5064-13, REV I.

14 CFR 43.9 Return to Service

OVERHAULED

Other r egulation specified in Block 13

Certifies that unless otherwise specified in Block 1.3, the work identified in Block 12 and described in Block 13 was accomplished in accordance with Title 14, Code of Federal Regulations, part 43 and in respect to that work, the items are apvroved for return to service.

IS. 21. Approval/Certificate No:

UT2R226L

or Printed): 23. Date (m/d/y):

tacy Tolliver OCT i 1 2010

User/blstaller Res nsibilities Jt is important to understand that the existence of this document alone does not automatically constitute authority to install the part/component/assembly.

Where the user/installer )YCrfonns work in accordance with the national regulations of an airworthiness authority different than the airworthiness authority of the country S)YCcified in Block 1, it is essential that the user/installer ensures that his/her airworthiriess authority accepts parts/components/assemblies from the airworthiness authority of the country specified in Block 1.

Statements in Block 14 and 19 do not constitute installation certification. In all cases, aircraft maintenance records must contain an. installation certification issued in accordance with the national r egulations by the user/installer before the aircraft may be flown.

FAA Form 8130-3 (6-0 1) *Installer must cross-check e ligibility wilh appl icable technical data. NSN: 0052-00·012-9005

ESlCODE: 02407

( ( (

Total Time Tach or Total Time Since Record ing In Service Overhaul Meter Time

Description of Work Performed Certificate Number & Si nature of Technician Perfonnin ' Work

Page: 8 Date

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Date

I

Total Tirnc In Service

Tota l Tirnc Si n1.:e

O verhaul

T acll or Record ing

M eter Tirne

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BARTELT AVIATION, INC.

Established. 1976

Date: November 15, 2011

I >esnipt ion o l' Work Performed Cert ili cate Number & Signatu re o f Tcchni1.:ian l'crforming Work

N8328D Engine Model: TI0-540-S1AD Serial No. RL-7805-61A Engine Total Hours: 3715.44 SMOH: 347.53 Tach: 4184.55

Page: 9

Complied per Textron Lycoming Service Bulletin 480E, Part I Oil and Filter Change, and Part II Oil Filter Content Inspection. Installed new CH48103-1 Filter. Added 11 qts Aeroshell 15w50. Installed Rebuilt #2 Vacuum Pump PIN 442CW-6, Serial No. 147096. Checked Mag to Engine timing. Cleaned, gapped, and tested all Spark Plugs. Replaced 1 ea defective Plug PIN RHB37E. Complied per AD 2008-14-07 Fuel Injector Line inspection per Textron Service Bulletin342E (Due every 1 OOhrs). Complied per AD 91 -21-01 Exhaust Inspection (Due every 1 OOhrs). Complied per 1 OOhr Fuel Servo Inlet Screen Inspection and cleaning. AD 2011-13-03 Hartzell Technologies Turbocharger NIA. AD 2011-15-10 AVStar Fuel System Servo NIA. Installed new BA9005 Air Filter Element. Checked and Lubricated engine controls. Compression Test: #1 79 #2 79 #3 79 #4 79 #5 79 #679180 PSI. Performed ground run. Checks satisfactory, no leaks noted. I CERTIFY THAT THIS ENGINE HAS BEEN INSPECTED IN ACCORDANCE WITH AN ANNUAL INSPECTION AND WAS DETERMINED TO BE IN AIRWORTHY CONDITION.

~~-Ml 49091 (269)-651-5431

~t,~ I } 31-?CfS" 3t-1 .ii y.io¥.u' cir. 10A o.L,_c C:./lr . .IV\sfu'N

1_1

_1

-+--' ---1----1---1~{-;p~j V\u,._I (/ /-i ~'<:]OS :1 r t,1 W (,.o ~A A1n ((A,.._ - r.o ~J:... !M~1

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IJate Total Ti111e In Serv ice

Total Time Since

Overh au l

Tach or Recording

Meter Time Description of Work Pi.: rformed

Certili ca te N u111ber & Signature o l" l\:chnic ian Pcrf(irn1ing Work Page: 10

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6/ 15/12 Tach 42 14.36 TT 3745.46 SMOH 377.34 N8328D ENG IN E Per fo rmed an Annua l Inspect ion. Compress ion Check. # I 73 /80 #2 76/80 113 78/80 #4

74/80 #5 72/80 #6 75/80. Changed the oil and filteL 12 qt. 15W-50 Aeroshell was added. The plugs were replaced. The magneto timing checked. C/W AD 9 1-2 1-0 IR I I 00 Hr Exhaust inspection. Checked ok. Inspection is clue again at: 43 14.36 hrs. C/W AD I 1-26-04 rue I Injector L ine Inspection as instructed . Checked ok. Inspection is due aga in at: 43 14.36 Hrs. C leaned fuel sc reens and lubed controls. Realigned the tail pipe fl anges and torques the tai l pipe clamps. Rep laced the induction intake hose. Tightened and safetied all six engine preheat:er clamps. The engine was washed down, ran and checked for operat ion and leaks. Adjusted the idle and idle mi xture. AD 's were checked th rough 201 2- 11 . I certify that this engine has been inspected in accordance with an Annual Inspection and was determined to be in an Airworthy Condit ion .

s ;gnod ~ ZJ20(?t166Z3.:J.<> .:. hs la.

(/

.Jr

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Tota l Time Tach or Total Time Since RecorJing

Dat.:: In Service Overhaul Meter Time Description or Work l'crformcd

Ccrtili ca te Number & Si 'ilUtLire o!'Tcchnicia11 l'cr!'ormin ' Work Page: 11

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I. A11proving National Aviation 2. Authority/Country:

FAA/United States AUTHORIZED RELEASE CERTIFICATE FAA Form 8130-3, AIRWORTHINESS APPROVAL TAG

4. 01·ganization Name and Address:

6. Item: 7. Desc ription:

FUEL PUMP

13. Remarks:

Quality Aircraft Accessories Inc. (QYIR334V) 5746 East Apache Tulsa, OK 74115

8. P:1rt Number: 9. IWl(ibility: •

RG9570P/M NIA

RG9570 SERIES CMM DATED 4-22-81

Phone: l-877-833-6948 9'18-835-6948

Fax: 918-835-2804

IO. Quantity: 11. Serial/Batch Number:

B-3076 ':I"

. .'

....

3. Form Trackin g Number:

QAA# W01170009206

S. Work Order/Contract/ Invoice Number:

W01170009206

12. Status/Work:

REPAIRED

#. Certifies that the work spec ified in Block 12113 was carried out in acconh1nc'' with EASA Pv t 145 and iy respl'Ct to that work the component is considered rcll(ly for release to serv ice under l~ASA l':irt 145 approval no EASA 145.5982.

(M E H: MJH )

19. ~ 14 C FR 43.9 Return to Service ~ Other 1·cgul:ition specified in Block 13

D Approved ' : ·on data :iml :ire in :1 condition for s:ife ope ·

D ·1t:1 spl•cified in mock 13.

Certifies that unless othcnvise specified in Block 13, the work identified in Block 12 and described in Block 13 was acco1111Jlished in :1ccordance with Title 14, Code of Federal l~cgulations, 1rnrt 43 :111d in res11ect to that work, the items :11·e approved fo1· return to serv ice.

IS. 20. Authorized Signature: 21 . Ap1J1"m•al/Certificate No.:

QYIR334Y

22. N:tmc (Ty11ed or Printed): 23. Date (m/d/y):

OVETTE MITCHELL JUN 25, 2013

User/I nstallcr Responsibilities

It is important to understand that the ex istence of this document alone docs not automatically co nst itute authority to install the 11art/component/asscmbly.

Where the user /installer performs work in acco rdance with the national reguh1lio11s of au ainvorthiucss authority different 111:111 the airworthiness authority of the country specified in Block I , it is essential that the usc.r/ iustallcr ensures that his/her airworthiness authority accepts parts/components/assemblies from the ainvorthiness authority of the country s11ccific.d in Block I.

Statements in Block.~ 14 and 19 do not constitute. installation certification. In all cases, aircraft mai ntenance records must co11t:1i11 :111 installation certifica tion issued iu aecordance with the nation:1I r ei:-nlatious by the user /installer before the aircr:1ft may be nowu. ' '1

FAA Form 8 130-3 (10/08) * Installer must cross-check eligibil \ty wi th appl icable technica l data.

• NSN: 0052-00-0 12-9005 ,.

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Total T ime 'J'ach or Total T ime Since Recordi ng In Service.: Overhaul M eter T ime

Description or Work l'crJ'ormed Ccrti licatc.: Number & Si · nature.: ol" Tcchnician l'er fonnin ' Work

Page: 12 Date

2 9t:" 7 Balance Forward

1-----"~_L.L____j..---l------l---l-'c.=-=-··lu-=· :__'#?.:_:_·=--~--=-~f!Af@ g) ua~n~t2- ,<,t..:hrrv~v- c tR(.,,ld~dt.-~ 12.11 s ;t/eJ._· f&buu?Z~~/: 6 ;k~ cbt?J4 _· -1

1------+-----+----,1-----1-----------------------'-- ------

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Total Time Tach or

Dale Total Time Sim:e Recording In Se1·vice Overhau l Meter Time

IJescription or Work Pcrforn1ed Certilicalc Nulllber & Si •nalurc ol"' l't.:chnician l'erformin • Work

Page: 13

Blll llnce Forward

{' CV /~ft~_ LJ..Ja// ~d;-1~-krh- /)~ ./..ILJ!..j~~~~~___k,~~ee:.~~/;~~~~~~:::..1~~~ff/~ d/?94-P>;- -r::u»IJ cil41/-~~ -~Vn2 ~~ ~..k/Q~~""__LL:~~~~~ '-l-L-'-~tr---~'-.af' Odr/-d a/- ¢'~ . ~kd? ~,r:rLJo!d~PZ? ~ ·

/ /,'/.e Oh/t?/C A~~;FkuffeL/cv:,,-w'x:/PYe_-A/ -ehfd? ~/~~~J? /

... &-~-/'/ d .... .']/3?12 - ¢

1----+-----+---1----1------------- ........... -.,.-.. au rcz:•~'!t:• ~ l~ ta loeDrtaae ~. ~/J/~

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Total T ime Taeh or Total T ime Since R..:cording

Date In Scrvic..: Ov..:rhaul M <.:tcr Time

(

Engine - Completed all routine items for an annual/100 hr. lnsp. IAW guidlines set forth in FAR 43 Appendix D. Lubed all lube pts . as required,- _.Cyl. ~omp. N as follows. 11~/80 2i2'180 Y C/80 47>/80 51(180 s1~80. Drained oil. Removed oil filter. Drained, cut open & inspected. No contaminants found at this time. Removed, inspected & cleaned all fuel & oil screens.

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nncd Han Performing Work

Page: 14

- -----

Date: 4-3-1 5 CA:_.--s-- )'---------------Reg: N8328D '189 f

Total Time:3861.18 (493.27 smoh] Phone: (508) 339~636 ~----------------! Tach Time: 4330.29 Email: caseyaviation@comcast.net

Added 10 qts 20w50 phillips xc and installed 48103-2; Turbo disassembled and inspected; no defects noted at this time; Reassembled after surfaces cleaned; retorqued and resafetied; Cleaned lower spark plug holes; Lubed controls; Added camguard; Washed engine and cowl; Ran engine, op ck ok ; No fuel or oil leaks noted at this time; Adjusted idle speed and mixture;CW AD2011-26-04 on injector lines and clamps; no defects noted at this time; ,Recowl; Ads reseached thru 2015-06

_,,.... -rach T"1me .L./?. :Z/'J~. a 9 Date 4--3·-h •· ,~v'-·

I certify that this AireMftlEngine has been in~cted in Accordance with a !inn ve-~ inspection and has been

found to be in Airworthy Condition

Mechani~1

Lie# T)JJ- 1Yh.t?.J

J 7 '

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T otal Ti m..: T ach or Total Tim..: Sine..: R..:corJ ing

Dal..: In Servic..: Overhaul M eter Tim..:

,;/-/-lb ;;P . 31f_,, .c/3-5'3 3 Balance Forward

Totals - Carry Forward

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Des..:ripl ion o f"Work l'..:rforn11.;d Ccrtilicat..: Number & Siirnalllrc n!"T1~ .. ·hni1· i"n P1•rli1nn ino Wtwl·

Page: 15

Enqine .. ,_:<'mpleted a.I rout~ne items for ~r. a!lnual/100 hr. lnsp. IAW guidlines set fortli in :.__ _______ _

FAR 43 Appendix iJ. Lubed all lu,be pts as re_guired. Cy!. Comp. N as tollows. 17f /80 2~80 ~me; ~~ao slJ!dO &''1Jso. Drained o~I. Removed oil filter. Orajm~d, cut Ofien & inspected. No co<rta:-P. i r.ants found at this time. RemoveJ, inspected & cleaned all fuel & o!C screens.

Lla.te~ ·V - 16 C-A·~-:5::: Reg: N6328D 1B">i Total Time: 38&4.19 [516.28 SW.OH] Phone: (508) 339-5636 Tach lime: 4353.3 Email: caseyav:aoon@comcast.net

Added 1 C qts Phillips 20w50xc ..Jii and install~d new 48103-2 filter; CW A02015-19-07 on injedor lines and ._ clamps- rm uef~cts noted at this time per 51=3342; Inspected Turbo wh&:I and end play- ok at tllis time; • --------" Reto!fqued and safetierl rum~ clamps anrl het shielcis; Resealed heat shi~ld ma~nal at top fire"Nall Jrec'\; Lubed all controls; Retorq1.<ed exhaust stacks; Replaced air filter; Washed enumc ;ind cowl; Ran engine- op ck ok ~t t~is time- No fuicl .:>roil leaks ~oteri at this time; ACls r<!scached thru 2016-08 END

Date_±-1-/6

I

I '--------

I certify that this Aiecaaft/Engine has been in50JPcterl in Accordance with a AnAt1~ inspection ~nd has been ,,____ _____ _

found to be in Airworthy Condition I ,r----------

Mechanic~~ I / I

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(

Total Tim <:: Tuch or Total Ti m<:: Sine<:: Recording

Dale In Service Overhaul M elt:r Time

3 . 7-11

\

(

Descriolion or Work Perl(m11ed

Engine - Completed all routine items for an annual/100 hr. lnsp. IAW guidlines set forth in FAR 43 Appendix 0. Lubed all lube pts as

. ian Per forming Work

(

Page: 16

req~ired. Cyl. C_?!Y"P· N -~s follows. 17~ .... /80 2n 1ao 1

37Jfao 411/ao 5"'J/80 67"180. Drained 011. Removed 1t------------

oil filter. Drained, cut open & inspected. No contaminants found at this time. Removed, inspected & cleaned all fuel & oil screens.

Date: 3-7-17 ~>·=~~ Reg:N83280 189 Total Time: 3889.49 [521 .58SMOH] Phone: (508) 339-9636 Tach Time: 4358.6 Email: caseyaviation@comcast.net

I I

Added 10 qts Phillips 20w50XV 1 camguard and installed new filter 48103-2. CW AD2015-19-07 on injector lines and clamps- no defects noted at this time; Inspected turbo wheel end play and found ok at this

1 time; Lubed controls; cleaned air box and replaced filter; >--------------------·

Dressed and painted prop; Washed engine and cowl--Ran engine- op ck ok at this time. No fuel or oil leaks noted at this time. Recowl. ADs reseached thru 2017-06 END

DateJ_ ... Z· / 7 Tach Time 4 J5? '-·

I cartify that this Ail eta:ft/Engine has been insQected in Accordance with a I

/-Jr1,1 l/d inspection arad has been r--------------1

found to be in Airworthy Cond~tion I lc----------------j

Mechani~~#_.iffe-?~Y'-11

. ~ <-------------

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Tota l Tirn..: Tuch or Total Time Since R..:cording

Engine - Completed all routine items for an I

Dali: In Serv ice Overhaul Meter Time annual/100 hr. lnsp. IAW guidlines set forth in Page: 17

W-.::2 - /rf 39.1/ . J'f ~ Bafllnce F'urward FAR 43 Appendix D. Lubed all lu!fa pts as

~.33- 4.37J. ~ required. Cyl. Comp. N as follows. 17 /80 # 180 31J/80 47~80 s)f/80 s7~80. Drained oil. Removed

oil filter. Drained, cut open & inspected. No

contaminants found at this time. Removed, I

inspected & cleaned all fuel & oil screens. r=-A:--L:.=~=, I

Date: 4-2-18 Reg:N8328D

1B9 -

Total Time: 3901.89 [533.98 SMOH] Phone: (508) 339-S636

Tach Time: 4371 .0 Email: caseyaviation@comcast.net I-

Added 1 O qts 20w50 Phillips xc, 1 camguard and new filter; Cleaned air box and replaced filter; CW AD91-21 -01R1 on \

- -

exhaust shield- ok at this time; CW AD2017-17-04 by replacement of oil cooler hoses w/ Type 0 - reassemb~ed ~ub- I

~ assys; Inspected turbo wheel end play- ok at this time-reassembled, torqued and resafetied; cleaned low~r spark

-

plug holes; Replaced #4 CHT ~ro~e ; Washed eng1~e and cowl; ran engine- op ck ok at this time- no fuel or Oil leaks r noted at this time- recowl . ADs reseached thru 2018-08. END

I I

Date +~-/{ Tach Time -4/ 3 1 /: IJI'- .... I

I I certify that this A;fCraftlEngine has I -

I be~nT~ed in ~ccordance with a 'lnt'i mspect1on and has been

l found to be in Airworthy Condition

1

MechanicAC--1 I

Lie# .7/frYJUEP ~ I

·oJ /

~ Totals Carry Forward

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