4Si5l(/37 luv.i t\lf) 3-6-/o W, 3Ac,l 1997.) A,'/ 9

Transcription

1 PART NAME Blade Assy, M/R RETIREMENT LIFE 10,000 Mrs DATE N#OR LOCATION MANUFACTURER Bell OVERHAUL LIFE N/A INSTALLATION TSN TSO A/C HRS ON COMPONENT HISTORY FORM INSTALLATI ON PART NUMBER SERIAL NUMBER A-FS340 NOTES Ref. Form DATE REMOVED A/C HRS ON REMOVAL HRS THIS INSTALLATIO N REMOVAL 7/ N/A l/oi "^011,5 6%,^ NIft 5/ai 13, h)lf\ fl/ni 767,9 993, 1 9//9- ' / 1- IM W3. / A P ^ , 0- <^3?, 3 /^3/ 7 'WA 4Si5l(/37 luv.i t\lf) 3-6-/o W, 3Ac,l 1997.) A,'/ 9 TSN TSO NOTES l)dy>,oi'cltl 61 i^ujorlky im, 1 Jj fj lo^m, L 7^^7-/3 1) 561,6 10^6,"] 30^7,,b j AJ/A nsgi..<7 l-l-l'i I1.6AJ6,0/)R- c>7/t> 9/f'^ 7?-ZIS^^ 308Z 'O Xj/9 ^S^/. 7 09/7%//</ YSS'/. & J/Z.7 339y.9 aju 61 -n^-rs,a)/1q U,632.S {\/is!/ 6 S~6"o. (d h^u-6'.s' R&mc u'cji 4/ru;L) AInY /^ mcx^4 A/^u^o/prN'i' Ui 0>c^ OTfi^

2 MODIFICATION MANDATORY SERVICE BULLETIN DATE MOD.# SIGNATURE & LICENSE DATE S/B NUMBER SIGNATURE & LICENSE OVERHAULS - REPAIRS -ADJUSTMENTS - REPLACEMENTS DATE TSN SIGNATURE & LICENSE

3 i fy3./ rr "form 1200 Rotorcraft Inc. Box 453 (Hwy 63 & 117) Black Rock, AR ;'f Work Order_i22 N 9 ^^1614 Date Received ^ Date Released Customer Name /// ^^ S ^ ^ Address ^7&///^oJi f' PoaA f /7IY ns Part name S IolJcS Part No. ^ OS- n/-3--/s >-/O/ Serial Number A-S^3VO 4 A-J^S.399 ^ Special Instructions a/^ Ae/^n hs /7 J>CL ia /7 ce Work Accqmpjished AS"/-2 3 hi/! /j ta ;>" >, / y9p?ss'/s^-s./0-z3-/

4 FORM 1200 i 306it. o " Rotorcraft Inc. Box 453 (Hwy 63 & 117) Black Rock, AR Work Order _ /3 N9^ Date Received Customer Name '-/3 ///in Of 3 /~ Date Released X/7C Address o^/^^d-, ^ ^ ^ ^ / Part name. Xe Part No. 2as~e>/3~/3o-Jol Serial Number Special Instructions (J Work Accomplished, jfjpi 4L ^/^/]-/4sr)A ^9'99 7Ai/^ns^/0 a L MA FUd,. /^o'a/ynfn^a 4/7 f 9' 04. -/w.^ f/tm 2io-Z3-\72J: tzc^/a'uy)4\ r//f3'/330-

5 1. Approving National Aviation Authority/Country: FAA/UNITED STATES 4. Organization Name and Address: RotorCraft Inc. Box 453 (Hwy 63 & 117) Black Rock, AR AUTHORIZED RELEASE CERTIFICATE FAA Form AIRWORTHINFXS APPROVAL TAG 3. Form Tracking Number: Work Order/Contract/Invoice Number: Item: 7. Description: 8. Part Number: 9. Eligibility: * 10. Quantity: 11. Serial/Batch Number: 12. Status/Work: 1 Main Rotor Blade Bell UH-1 series 1 A-FS 340 Inspected/Repaired 13. Remarks: Work Order # prescribing the actuai work performed is attached. The prescribed work was performed in accordance with FAA approved data. 14. Certifies the items identified above were manufactured in conformity to: [m Approved design data and are in condition for safe operation. CH Non-approved design data specified in Block Authorized Signature: 16. Approval/Authorization No.: ^ 14 CFR 43.9 Return to Service LJ Other regulation specified in Block 13 Certifies that unless otherwise specified in block 13, 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 approved for Authoriz^^ignature ^^^^^_^^^^^^^ return to service. 21. Approval/Certificate No.: 17. Name (Typed or Printed): 18. Date: 22. Naine'^(Typed or Printed): Jail's F. Propst 23. Date (m/d/y): User/Installer Resoonsibilities 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 Bl^kl'' s' ntial that the user/installer ensures that his/her airworthiness accepts parts/components/assemblies from the airworthiness authority of the countiy specified in Statements in Blocks 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 regulations by the user/installer before the aircraft may be flown. FAA Form (6-01) *Installer must cross-check eligibility with applicable technical data. NSN:

6 I. Approving Civil Aviation Authority/Country: FAA/United States 4. Organization Name and Address: Rotorcraft Inc. Box 453 Black Rock, AR AUTHORIZED RELEASE CERTIFICATE FAA Form , AIRWORTHINESS APPROVAL TAG 3. Form Tracking Number: Work Ordcr/Contract/Invoice Number: Item: 7. Description: 8. Part Number: 9. Quantity: 10. Serial Number: 11. StatusAVork: 1 Main Rotor Blade A-FS 340 Inspected/Repaired 12. Remarks: A general description of the work performed is attached as form 1200; Under the part description listed in blocks 6,7,8,10 and 11 as applicable. A complete description of work performed is on file at the above referenced organization under the work order and system tracking reference number indicated in blocks 3 and 5. NOTICE: An Airworthiness Directive may apply to the article(s) described hereon. The installer is responsible for ensuring complete compliance with any applicable Airworthiness Directives.. Part Total Time (As supplied by owner) Hrs 13a. Certifies the items identified above were manufactured in conformity to: II] Approved design data and are in a condition for safe operation. Q Non-approved design data specified in Block a. izi 14 CFR 43.9 Return to Service Q 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 Title 14, Code of Federal Regulations, part 43 and in respect to that work, the items are approved for return to service. 13h. Authorized Signature: 13c. ApprovaFAuthorization No.: 14b. Authopz^ Signature: 14e. Approval/Certificate No.: 13d. Name (Typed or Printed): 13e. Date (dd/mmm/yyyy): Ijt^Name (Typed or Printra): James F. Propst ]4e. Date (dd/mmm/yyyy): User/Installer Responsibilities 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 1, it is essential that the user/installer ensures that his/her airworthiness authority accepts aircraft engiue(s)/propeller(s)/article(s) from the airworthiness authority of the country specified in Block 1. 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 he flown. FAA Form (02-14) NSN:

7 o \ SERVICEABLE MAINTENANCE RELEASE THE AIRCRAFT AND/OR COMPONENT IDENTIFIED ON REVERSE SIDE WAS REPAIRED AND INSPECTED IN ACCORDANCE WITH CURRENT REGULATIONS OF THE FEDERAL AVIATION ADMINISTRATION AND IS APPROVED FOR RETURN TO SERVICE. PERTINENT DETAILS OF THE REPAIRS ARE ON FILE AT THIS REPAIR STATION UNDER Work Order No. QT-Q^-I ft l U Dated Inspected By James F. Propst Remarks Inspected/Repaired spx per Work Order. ROTORCRAFT INC. Box 453 (Hwy 63 & 117) BLACK ROCK, AR 72415

8 SERVICEABLE Manufacturer Bell Helicopter O Part Name Main Rotor Blade Part No , Serial No. A-FS 340 Owner Billings Flying Service, Inc. Total Time Inspector TSO Date Additional Remarks On Reverse Side

9 o SERVICEABLE MAINTENANCE RELEASE THE AIRCRAFT AND/OR COMPONENT IDENTIFIED ON REVERSE SIDE WAS REPAIRED AND INSPECTED IN ACCORDANCE WITH CURRENT REGULATIONS OF THE FEDERAL AVIATION ADMINISTRATION AND IS APPROVED FOR RETURN TO SERVICE. PERTINENT DETAILS OF THE REPAIRS ARE ON FILE AT THIS REPAIR STATION UNDER Work Order No Dated S-8-13 Inspected By Jsmes F. Propst Remarks I^ispected/Repaired per 'fajork order. ROTORCRAFT INC. BOX 453 (HWY 63 & 117) BLACK ROCK, AR 72415

10 SERVICEABLE Manufacturer ^ell Fgligppter Part Name Wain Rn-Hnr- -nl aho o Part Mffg Serial No.. A-FS 340 Owner Billings Flying Service, Inc. Total Time = ISO..0^ Inspectoc Pete 4 ~ ^ Additional Remarks On Reverse Side