2. AUTHORIZED RELEASE CERTIFICATE 633264 CAA/The ... · This is to certify that within the...

. . 1. Approving Competent Authority / Country 2. AUTHORIZED RELEASE CERTIFICATE 3. Form Tracking Number

... 633264 CAA/The Netherlands EASA FORM 1

4. Organization

0 ~ponent Services, Amsterdam

Kruisweg 705, 2132 ND Hoofddorp, The Netherlands 5. Work Order/Contract/Invoice

Name and P.O. Box 2130 AB Hoofddorp, The Netherlands

Address: Tel: 31 (0)206552222 Fax: 31 (0)206534777 5017008642

I

6. Item 7. Description 8. Part No. 9. Qty 10. Serial No. 11 . Status/Work

1 CAB PRESS CONT 2117804-1 1 96-741 INSPECTED / TESTED

12. Remarks

Item maintained in accordance with Component Maint. Manual 21-31-70, Revision 2, dated 29-Jul-2011 . The work identified in block 11 and described herein has been

CSN: 27455, TSN: 24903 hours. accomplished in accordance with 14 CFR part 43 and in respect to that work, the items are approved for return to service under FAA certificate No. QT1Y438K.

-

Mod. status: Series 2.

138. Certifies the Items Identified above were manufactured In confonnlty to: 14a. 00 Part-145.A.50 Release to Service. 00 Other regulation specified in Block 12

D approved design data and are In a condition for safe operation Certifies that unless otherwise specified in block 12, the work identified in block 11 and described in block

D non-approved design data specified In block 12 12 was accomplished in accordance with Part 145 and in respect to that work the items are considered !Bady for release to service .

- ·' .. 13b. Authorized Signature 13c. ApprovaVAuthorlzatlan Ntmber 14b. Authorized Signature ilwa,,n! 14c. Certificate/Approval Ref. No.

NL. 145. 1133 ..

13d. Name 138. Date (dd mmm yyyy) 14d. Name ® 14e. Date (dd mmm yyyy)

F. P. de Waard 24 APR 2017 '

USER/INSTALLER RESPONSIBILITIES This certificate does not automatically constitute authority to install the item(s).

Where the user/installer performs work in accordance with regulations of an airworthiness authority different than the airworthiness authority specified in block 1,

it is essential that the user/installer ensures that his/her airworthiness authority accepts items from the airworthiness authority 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 be flown .

EASA Form 1 -MF/145 -issue 2

0 ~ponent Services, Amsterdam Shop Record

Customer: Fokker Services B. V

Partnumber: 2117804-1

Description : CAB PRESS CONT Type: NSN:

Manufacturer : Honeywell, formerly Allied Signal

Job ref : 633264

Serial number: 96-741

R/0 : 5017008642 Date R/0: Date in:

13-APR-17 18-APR-17

Complaint : Controller inoperative - trouble shoot defect.

Requested action : Repair

Incoming inspection :Item visually inspected and found ok. Complaint not confirmed.

Work performed:

Actual work :

Mod. status :

Remarks:

Temperature tested, hot and cold found ok. All functions found in normal condition.

Inspected/ Tested

Unit tested and found serviceable.

Note: If any parts were replaced, a record of parts used as replacements is being held at AAA. This record is available upon request.

Series 2.

Item maintained in accordance with Component Maint. Manual 21-31-70, Revision 2, dated 29-Jul-2011 .

CSN: 27455, TSN: 24903 hours.

Shop Manager: H.A. Pauw

24-Apr-2017

--------,-

I

Certificate of Conformance (only signed if released under non-civil aviation regulations)

This is to certify that the services to the component as described above conform in all A~thorized : respects to the specification(s) , drawings and order relative thereto and that the component Signature has been inspected and tested i.a.w the conditions and requirements of the order and was found airworthy for return to service.

I This is to certify that within the provisions of STANAG 4107, AQAP2070 and the agreed RGQA, the services identified above have been subject to Government QA and are

I considered to comply with the provisions of the applicable contract.

,--

Apr. 24, 2017 Docld:JSR001· 1013739

GOAR Signature

AAA Form No.~~Rev. Ju-;;0101

FAA Air Agency Certificate QT1 Y 438 K - EASA Approval Certificate NL.145.1133

I. Approving Competent Authority/Count!)' ,

CAA-NL / THE NETHERLANDS 2. AUTHORISED RELEASE CERTIFICATE·,

EASAFORM 1

3. Form Tracking Number

1316004030

4. Approved Organisation

Name and Address :

Fokker Services B.V. Hoeksteen 40 2132 MS Hoofddorp THE NETHERLANDS

Location Oude Meer

6. Item 7. Description 8. Part No

1 HIGH PRESSURE SHUTOFF VALVE 778686-3

12. Remarks - USED DOCUMENTATION: CMM 21-32-06 REV 9 DATE DEC 18/ 13 -Accompanying shopfinding report is part of this EASA Form I -


5. Work Order/ Contract/ Invoice

9. Quantity

I EA

9-94025

I 0. Serial No

840235

11 . Status/Work

REPAIRED

The work identified in Block 11 and described herein has been accomplished in accordance with 14 CFR part 43 and in respect to that work, the items are approved for return to serviae under certificate no. NQ I Y357K. Perti,1ent details of the repair are on file at this repair station under the order number referenced in block 3.

[xi Part- t1S.A.S0 Release to Service [xi Other regulation specified in Block 12 Certifies that un1:ss otherwise specified in block 12, the work identified in block 11 and describ d in block 12, was~ ccomplished m accordance with Part-145 and in respect to that work the items are considered re:::dy for release to service.

14b. Authorised Signature

14d. Name Adnan Hanif

14c. Certificate/ Approval Ref. No NL.145.1174 14e. Date (dd MMM yyyy) 14 JUL 2016

Where the user/installer perfonns work in accordance with regulations of an airworthiness authority different that the airworthiness authority specified in block I, it is essential that the user/installer ensures that his/her airworthiness authority accepts items from the airworthiness authority specified in block I. Statements in blocks 13a and 14a do not constitute installation certification. 1n all cases aircraft maintenance records must con ain an installation certification issued in accordance with the national regulations by the user/installer before the aircraft may be flown.

-ASAFonn I-MF/ 1451ssue2

Fokker Services B.V. Location Oude Meer Hoeksteen 40 2132 MS Hoofddorp

..._ GKNAEROSPACE THE NETHERLANDS Internet: www.fokkerservices.com

Shop Finding Report Page: 1 of 2

Technician Deliverv: COMMUTAIR Attn: Mr. Craig Hatch, Records Manager 85 SICKER ROAD 12110 NY LATHAM USA Tel. : 518-690-9080 120 Fax : 518-690-9079

For Customer : COMMUTAIR 5.0. No. : 2516012043 Line No. :

Cust P.O. : 9-94025 P/N : 778686-3 Batch/Lot Our Ref# Desc : HIGH PRESSURE SHUTOFF VALVE Cust.Ref Contract# :AG-003477 S/N :840235 Work Perf. Vend Ref# : R0281316 MFG : HAMIL TON SUNDSTRAND Manual Project# : N837CA Qty : 1.00000 Cond As:sv Revision Completed P/N: 778686-3 S/N As : 840235 Into Bin Loe : l!:ompanv : 1 Division : 12 I Deoartment : 2400 Contract No. :AG-003477 Type : Exchanae / Repair/ Lease Stock Order Date : May-20-2016 Received Date: May-20-2016 Due Date : Jul-19-2016 I Print Date : Jul-14-2016

WORK ORDER No. 1316004030 Contract No. AG-0034 77 - Exchange I Repair/ Lease Stock Re~orted B:i Customer LH HP BLEED INOP

UNIT SUBMITTED FOR REPAIR AND RETURN TO SERVICE REPAIR TO LATEST MOD STATUS Receiving Condition UPON RECEIPT NO VISUAL DAMAGE lns~ection -INCOMING TEST FAILS:

-SOLENOID DEFECT NOT WORKING AT ALL. -SHUTOFF VALVE DIRTY. -SEALS DIRTY.

- LATEST MOD IS L3 ALREADY INCORPORATED.

Name: Date: Sign:

1 4 JUL 2016 (s1~2s) · /1.V"'"°

A, HANIF ,ov iS's i:iv1c~'<i ·

Continued on next page ...

Copyright (c) PENTAGON2000Software, Inc. Ser #:(2003.70129] Ver 9.00.03 Build 20

.

Fokker Services B.V. Location Oude Meer Hoeksteen 40 2132 MS Hoofddorp

.._ GKNAEROSPACE THE NETHERLANDS Internet: www.fokkerservices.com

Shop Finding Report WORK ORDER No. 1316004030

- USED INTERNAL INSTRUCTIONS: AWi H-01141 REV:B DATE 11 MAY 2016 Action Taken - SOLENOID AND SEALS REPLACED. - CLEANED UNIT. - NO FAILURES WERE FOUND DURING FINAL TEST.

Item Part Number/ Description

PARTS & MATERIALS- 1 17 747767-1

SOLENOID 3 69494J13

SEAL 18 69494J12

SEAL

,

.

.

Name:

Copyright (c) PENTAGON2000Software, Inc. Ser #:[2003. 70129] Ver 9.00.03 Build 20

Part Status

32 - Installed Compone 111

32 - Installed Compone 112

32 - Installed Compone it1

Date: Sign:

1 4 JUL 2016

Qty Cond

EA NE

EA NE

EA NE

Page : 2 of 2

Discrepancy / Disposition

Disc. : Disp. : Disc. : Disp.: Disc. : Disp. :

.------ ------ ----- ---r---------- -----------. --- '••---------- - -------,----------------------, I . Approving Competent Authority/Country

CAA-NL I THE NETHERLANDS 2. AUTHORISED RELEASE CERTIFICATE

EASAFORM l

3. Fonn Tracking Number

1316001807


Name and Address :

Fokker Services B.V. Hoeksteen 40 2132 MS Hoofddorp THE NETHERLANDS

Location Oude Meer

6. Item 7. Description 8. Part No

1 HIGH PRESSURE SHUTOFF VALVE 778686-3

12. Remarks -Accompanying shopfinding report is part of this EASA Fonn I -- USED DOCUMENTATION: CMM 21-32-06 REV 9 DATE DEC 18/ 13



9. Quantity

I EA

9-92698

10. Serial No 11. Status/Work

960513 INSPECTED/TESTED

The work identified in Block 11 and described herein has been accomplished in accordance with 14 CFR part 43 and in respect to that work, the items are approved for return to service under certificate no. NQ I Y357K. P•minent details of the repair are on file at this repair station under the order number referenced in block 3.

14a. [xi Part-145.A.50 Release to Service [xi Other regulation specified in Block 12

Certifies that unless otherwise specified in block 12, the work identified in block 11 and describ d in block 12, was accomplished in accordance with Part-145 and in respect to that work the items are considered ready for release to service.

14b. Authorised Signature

14d. Name

Adnan Hanif

14c. Certificate/ Approval Ref. No NL.145.1174 14e. Date (dd MMM yyyy)

03 MAR2016

Where the user/ installer performs work in accordance with regulations of an airworthiness authority different that the airworthiness authority specified in block I, it is essential that the user/ installer ensures that his/her airworthiness authority accepts items from the airworthiness authority 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 flown.

EASAFonn 1-MF/ 145 lssue2

Fokker Services B.V. Location Gude Meer Hoeksteen 40 2132 MS Hoofddorp

~ GKNAEROSPACE THE NETHERLANDS Internet: www.fokkerservices.com

\

Shop Finding Report Delivery: COMMUTAIR Attn: Mr. Craig Hatch, Records Manager 85 SICKER ROAD 12110 NY LATHAM USA Tel. : 518-690-9080 120 Fax: 518-690-9079

For Customer : COMMUTAIR 5.0. No. : 2516005286 Line No. :

Cust P.O. : 9-92698 P/N : 778686-3 Batch/Lot Our Ref# Desc: HIGH PRESSURE SHUTOFF VALVE Cust.Ref Contract# :AG-003477 S/N :960513 Work Pert. Vend Ref# MFG : HAMIL TON SUNDSTRAND Manual Project# : N361PH Qty : 1.00000 Cond As:sv Revision Completed P/N: 778686-3 S/N As : 960513 Into Bin Loe : Comoanv : 1 Division : 12 I Deoartment : 2400 Contr~ct No. :AG-003477 Tvoe : Exchanqe i Reoair / Lease Stock

· Order Date : Feb-29-2016 Received Date: Feb-29-2016 Due Date : Mar-13-2016 I Print Date It

. WORK ORDER No.1316001807 ..

Contract No. AG-003477 - Exchange/ Repair/ Lease Stock ReQorte.d B:t Customer 8 PSI ON DEICE PRESSURE GAUGE WHEN PERFORMING PROCEDURE PER MEL ~EPAIR TO LATEST MOD STATUS Receiving Condition ) ,:,ON RECEIPT NO VISUAL DAMAGE

3Qection -INCOMING TEST: NO FAILURE FOUND DURING THE TEST.

-USED INTERNAL INSTRUCTIONS: AWi H-01141 REV:A

Action Taken · NO FAILURE FOUND DURING THE FINAL TEST.

Name: Date:

A, HANIF 0 3 MAR 2016

Copyright (c) PENTAGON2000Software, Inc. Ser #: [2003.70129] Ver 9.00.03 Build 15

DATE 03-12-2012

Sign:

(s1~2s) ttW"I .~~~ -se,qv,c~c;i

Page: 1 of 1

: Mar-03-2016

I. Approving Competent Authority/Country

CAA-NL I THE NETHERLANDS 2. AUTHORISED REL~ASE C , RTIFICATE

EASAFORM 1

3. Form Tracking Number

1315004674


Name and Address :

6. Item 7. Description

Fokker Services B. V. Hoeksteen 40 2132 MS Hoofddorp THE NETHERLANDS

VALVE PACK TEMP CONT

Location Oude Meer

8. Part No

778727-7

12 . Remarks • Accompanying shopfmding report is part of this EASA Form I · USED DOC.

CMM : 21-61-47 REV.: 7 DATE: FEB 10/ 11

USER/INSTALLER RESPONSIBILITIES This certificate does not automatically constitute authoiity to install the item(s).


9. Quantity

I EA

9-88628

10. Serial No II. Status/Work

9610077 REPAlRED

Certifies that the work specified in block 11 / 12 was carried out in accordance with FAR part 43 and in respect to that work the part(s) is (are) approved for return to service for FAA Repair Station: Fokker Services B.V. under FAA Approval Number: NQ I Y357K Pertinent details of the repair are on file at this repair station under the order number referenced in block 3

Date: 15JUN2015 ,-:Ji}--Name: Albert van Dasler Signature: ~

14a. [xi Part-145.A.50 Release to Service [xi 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 work the items are considered ready for release to service.

14h. Authorised Signature

14d. Name

Albert van Dasler

14c. Certificate/ Approval Ref. No

NL.145.1174

14e. Date (dd MMM yyyy)

15 JUN 2015

Where the user/installer perfonns work in accordance with regulations of an airworthiness authority different that the ailworthiness authority specified in block I, it is essential that the user/installer ensures that his/her airworthiness authority accepts items from the airworthiness authority 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 flown.

EASA Fonn I-MF/ 145 Issue 2

Fokker Services B.V. Location Oude Meer Hoeksteen 40 2132 MS Hoofddorp THE NETHERLANDS Internet: www.fokkerservices.com


Delivery : COMMUTAIR Attn: Mr. Craig Hatch, Records Manager 85 SICKER ROAD 12110 NY LATHAM USA Tel. : 518-690-9080 120 Fax : 518-690-9079

For Customer : COMMUTAIR S.O. No. : 2515014918 Line No. :

Cust P.O. : 9-88628 P/N : 778727-7 Batch/Lot Our Ref# Desc : VALVE PACK TEMP CONT Cust.Ref Contract# :AG-003477 S/N : 9610077 Work Perf. Vend Ref# MFG : HAMIL TON SUNDSTRAND Manual Project# : N379PH Qty : 1.00000 Cond As:sv Revision Completed P/N : 778727-7 S/N As : 9610077 Into Bin Loe :

C(~1';Janv : 1 Division :12 I Department : 2400 Contract No. :AG-003477 Type : Exchange / Repair i Lease Stock Orger Date : Jun-08-2015 Received Date: Jun-04-2015 Due Date : Jun-23-2015 I Print Date : Jun-15-2015 ,,.,,, <nn ' '.: ,,

+t W40RI( ORDER No~ 1315Q04~74 I

iii ' ' "''"; w,;;,' 0 Ji f,

-' Contr.act No. AG-003477 - Exchange/ Repair/ Lease Stock -ReQorted Bl Customer REMOVAL REASON REPORTED BY CUSTOMER: CABIN DOES NOT COOL DOWN DUCT TEMP OF 20 C IN FLIGHT

MAINTENANCE TAG REMOVAL REASON: TROUBLESHOOTING

BOX#46173

Receiving Condition SHIPPING CONTAINER CONDITION: OKAY lnsQection USED INTERNAL INSTRUCTIONS : AWi : H-01149 REV. : C DATE : 30 AUG 2010

INCOMING TEST FAULT : - POSITION OF THE LINK OF THE THROTTLE VALVE IS NOT CORRECT INSTALLED Action Taken

Name: Date: "'1(; G'i'Ok1r(', A ~

A.van Dasler .s>g1118 )

15 JUN 2015 '9111c1;.S

Continued on next page ...

Copyright (c) PENTAGON 2000 Software, Inc. Ser #:(2003.70129) Ver 9.00.02 Build 19

Fokker Services B.V. Location Oude Meer Hoeksteen 40 2132 MS Hoofddorp THE NETHERLANDS Internet: www.fokkerservices.com


WORK ORDER No. 1315004674 .

INSTALLED LINK OF THE THROTTLE VALVE CORRECT POSITION COMPLETE UNIT TESTED PERFORMED FINAL TEST; NO FAILURES WERE FOUND .

..

Name:

A. van Dasfer

Copynght (c) PENTAGON 2000 Software, Inc. Ser #:[2003.70129) Ver 9.00.02 Build 19

Date:

15 JUN 2015

.. _,

I. Cot1ntry 2 3. Certificate Re f" :'\o.

THE ~ETHERLAI\'DS CERTIFICATE OF C01'FORMITY 1215027017 / 14967430

4. Organization Fokker Services B.V. Location Oudc Meer 5. Work Order/ Contract/ Invoice Hoeksteen 40 Hoofddorp, 2132 MS 9-88628 THE NETHERLA DS

6. Item 7. Description 8. Part No 9. Eligibility* IO. Qty 11 . Serial No. 12. Purchase Condition

VALVE PACK TEMP CONT 778727-7 N/A I 9610077 SERVICEABLE EA

13 . Remarks

Maintenance Reference no: 1315004674 Maintenance document : EASA/FAR - PART 145 (DUAL RELEASE)

14. As an authorised representative of Fokker Services B. Y. for subject matter, I hereby certify that 18. As an au sed representative of Fokker Services B. V. for subject matter, we are a di stributor in compliance with ISO 9001 :2000 and AS 91 OOC, and are enclosing a copy I hereby certify tha are a distributor in compliance with ISO 900 I :2000 S 9100C. of the appli cab le airworthiness certifi cate from the PAHi OEM or Maintenance Station. The parts described above been maintained in a controlled envi ent throughout the duration The original is being maintained on file at Fokker Services B.V. 0f storage at the relevant Fokker Se s B. V. facility, and t C's received with the parts To the best of our knowledge. are on file at Fokker Services BY. based on the information provided by the supplier, the parts described above were not obtained from any government or military source nor were they incident or accident rel ated.

IS .Name 16. Signa1'?} {l 19. Name 20.S~

::,;0¥-Kf=A ,£, J~_"") Troy Tew (Fsf602J 17. Date (i MMMfYl>'YY 21 Date (dd/MMM/yyyy~ iS,E'RV10'i;: 17/J UN/ 15 --

COC Form - Issue I

1. Approving Civil Aviatior\ 2. Authority/Country

FAA/ UNITED STATES

4 . Organization Name and Address:

6 . Item: 7. Descri tion:

1 RECIRCULATION FAN

12. Remarks:

AUTHORIZED RELEASE CERTIFICATE FAA FORM 8130-3, AIRWORTHINESS APPROVAL TAG

NORTH BAY AVIATION 424 EXECUTIVE CT N S:E E FAIRFIELD, CA 94534-4019 (UYVR051J) Tel : 707-863-4970 / Fax: 707-863-4968

8. Part Number: 9 . Quantity :

778728-6 1

10. Serial Number:

850548

3. Form Tracking Number:

59108-15

5. Work Order/Contract/Invoice Number:

59108

11 . Status/Work:

INSPECTED

Serviced in accordance with CMM/DWG GEK 118268 revision 2_ issued FEB 03 2014 . No SB's or AD's were complied with .

Full details of work documented on Work Order No. 59108.

This repair station certifies that the work specified in Block 11/12 was carried out in accordance with EASA Part-145 and in respect to that work the

com anent is considered read for release to service under EASA Part-- 145 A roval Number: EASA.145.5308.

14a.~ 14 CFR 43.9 Return to Service ~ 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.

Name (Typed or Printed):

JULIAN CEBALLOS

User/ Installer Responsibilities

14c. Approval/Certificate No.:

UYVR051J 14e. Date ( dd/mmm/yyyy):

02 I Sep/ 2015

It is important to understand that the existence of this documer.t alone does not automaticaliy constitute authority to install the aircraft engine/propeller/article.

Where the user/installer performs work in accordance with the national regulations of an airNorthiness 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 acc,~pts aircraft engine9s)/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 be flown .

FAA Form 8130-3 (02-14) NSN 0052-00-012-9005

NORTH BAY AVIATION 424 Executive Ct. N. Ste. E Fairfield, CA 94534-4019

TEL: (707) 863-4970 FAX: (707) 863-4968

FAA Repair Station UYVR051J

WOR K ORDER NO.: 59l08

CUSTOMER P.O. NO. : 5015014935AC19 I REV:l

CUSTOM ER :

DATE OPENED:

PART NO.:

M ODEL NO:

SERIAL NO:

MANUFACTURER :

DESCRIPTION :

MANUAL NO.:

A IRCRA FT NO:

FOKKER SERVICES INC

8/24/l015

778728-6

850548 GE AVIATION RECIRCULATION FAN

GEK 118268

CONDITION REPORT

POS. STA. REMOVED:

CUSTOMER COMPLAINT/INSTRUCTIONS: (Check appropriate box)

)(l INSPECT 0 REPAIR 0 TEST 0 OVERHAUL IAW MFR's SPECS

0 OTHER

MALFUNCTION REPORTED/ WORK REQUESTED

~_,,,,1u,L 7

FA 1 lu6_,i'

,., ,, i.""' ~

PRELIMINARY PHYSICAL INSPECTION: Ooed

WARRANTY REQUESTED: Ht YES D NO

PREVIOUS W.0. NO.: ~->30 I

/..

COMPLETE REPAI R RECORDS AN D RECEIPTS OF A NY SERVICE BULLETINS/

A .D.'s A RE ON FILE AT THIS STATION

MAl:FUNCTION CONFIRMED: 0 YES ~ NO 0 N/A

TROUBLE FOUND/ WORK PERFORMED:

0 PERFORM ED OVERHAU L; TESTED AND RETURNED TO SERVICE

~ INSPECTED AND SERVICED IAW THE REGULATION S

0 OTHER ________________ _

INSPECTION/FINDINGS AFTER TEARDOWN:

TEARDOWN REPORT SUMMARY

UN IT SERVICEABLE:

~ YES O NO

T IME SINCE OVERHAUL:

0 ZERO TSO 00.00 IJ( CONTIN UED

"

f ..c.,d!,l/1-,,-1) ~AM'~,. r f,.,~,,,,; AAJJ '&sl-,.~ ..z-;9w 6&"/ir II t!..26'8 ,

"'''"' Mi, p,,.,,J.f ;:i,~4).

DESCRIPTION OF CORRECTIVE ACTION AND WORK PERFORMED:

J._.11.f.,..,,t) r•',.,.,,, '- Tcsl- r,,4wl &.,nc lltf ..21',I,

/)#ll~..S A~L ~~-J~.

PARTS REPLACED: ~ .,t, ;--:,

C

I

~ /

,

T ECHNICIAN : ~/_>._.c/ __ ~_#,&~, ~--- --------+-(?m----lNSPECTOR: __ 1,..,,___._h.,,_,f&L""-"'-"~.-,e....--+--=<!-th~=~=(l,,v""-<-.,;:..,__----"'~~----

VN,· r

DATE: _ 9_·_--2_-_~_~_/._:,_-___ _

DATE: ~1_--_t?_z__ -_f_J __

I Country 2. . . 3. Ccn i ficate Ref. No.

THE NETHERLAI\'DS CERTIFICATE OF CO~FORNUTY 12150390 14 / 15177030

4. Organization Fokker Services In c. 5. Work Order/ Contract/ Invoice 5169 Southridge Parkway, Suite 100 Atlanta , GA 30349 9-89870 USA

6. Item 7. Description 8. Part No 9. Eligibility• 10. Qty 11 . Serial No. 12. Purchase Condition

REC IR ULATION FAN 778728-6 NIA I 850548 SERVICEABLE EA

13. Remarks

Maintenance Reference no: 59108-1 5 Maintenance document : EASA/FAR - PART 145 (DUAL RELEASE)

' 14. As an authorised representative of Fokker Services B. V for subject matter, I hereby certi fy that 18. As an au ·sed representative of Fokker Services B.Y. for subject matter, we a re a di stributor in compliance with ISO 900 I :2000 and AS 91 00C, and are enclosing a copy I hereby certify tha a re a di stributor in comp liance with ISO 900 l :2000 S 9l00C. of the app licable a irworthiness certificate from the PAHi OEM or Maintenance Station. T\1e parts described above been maintained in a controlled envi 11ent throughout the duration The orig inal is being mainta ined on file at Fokker Services B.V or torage a t the rel evant Fokker Ser s B.Y. facility, and t C's received with the parts To the best of our knowledge, a eon fil e at Fokker Services BY. based on the information provided by the suppli er, the parts described above were no t obtain ed ' from any government or military source nor were they incident or acc ident re lated. I

15.Name !IL.a: ':?.Pl- ~

20.S~ ~0KKE,9

Jimmy Bacon (Fsioo5J .S£RVlG~ 17 /)ate (cllflM MM/yyyy) 21 Date(dd/MMM/yyyy~

03/SEP/2015

COC Form - Issue I I

{gJ f-)009 e Cl\lo, ' - --1. Approving Civil Aviation 2.

Authority/Country: AUTHORIZED RELEASE CERTJFICATE

3. Form Tracking Number:

58640-15 FM/ UNITED STATES FAA FORM 8130-3, AIRWORTHINESS APPROVAL TAG NORTH BAY AVIATION 5. Work Order/Contract/Invoice

Number:

4. Organization Name and Address: 424 EXECUTIVE CT N STE E FAIRFIELD, CA 94534-4019 (UYVR051J)

58640 Tel : 707-863-4970 / Fax: 707-863-4968 L---,--7-

0-s-c-:ri-.tio_n __ - -------r--:8;:;-_-;:;P=a=rt~N:-;-:u-:-:m:-;::-be=r-::: ------rng-_ ra~u-:-:a::n:.:ti:..ty-::: _;_~r.1::-0-. ::::S-e-:-ria-:1-:N-:-u-m--:-be_r_: ----1-- - - --,--1-1-. -S-ta_t_u-s/W--or_k_·_ -._J 6. Item: . e .

1 RECIRCULATION FAN 778728-6 1 890788 OVERHAULED

12. Remarks:

Serviced in accordance with CMM/DWG GEK 118268 revision i issued FEB 03 2014. No SB's or AD's were complied with. Full details of work documented on Work Order No. 58640.

This repair station certifies that the work specified !n Block 11 /12 was carried out in accordance with EASA Part-145 and in respect to that work the com onent is considered read for relea~e to service under EASA Part-145 A roval Number: EASA.145.5308. 14a.[8] 14 CFR 43.9 Return to Service [8J Other regulation specified in Block 12

Certifies that unless otherwise specified in Block 12, the work identified in Block 11 and described i~ 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.

EUGENE GOODMAN

14c. Approval/Certificate No.:

UYVR051J 14e. Date (dd/mmm/yyyy) :

13/Jul/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 w_ork in accordance with _the nat!onal r~gulations of_an airworthi~ess auth~rity different than the _airworthiness authority of the country specified in Block

1, it is essential that the user/installer ensures that his/her a1rworth1ness authority accepts aircraft engine9s)/propeller(s)/art1cle(s) from the airworth iness 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 be flown.

FM Form 81 30-3 (02-14) NSN: 0052-00-012-9005

'. 1. Approving Civil Aviation Authority / Country 2. 3. Form Tracking No.

- AUTHORIZED RELEASE CERTIFICATE Transport Canada W23274

Form One 4. Organization Name and Address 5. Work Order I Contract/ Invoice

GA C Global Aerospace Corporation, 7075 Fir Tree Drive PH: 905-678-6311

Mississauga, Ontario, Canada. FX: 905-678-6312 5017006434

L5S 1J7 www.globalaerosf!.ace.com

6. Item 7. Description 8. Part No. 9.Qty. 10. Serial / Batch No. 11 . Status I Work

1 Air Cycle Machine 782790-18 1 940394 Overhauled

12. Remarks:

* EASA Approval No. EASA.145.7031

* Overhauled in accordance with CMM # 21-51-53 Rev #16, dated 23 July 2014, and RDA# O-RA06-088/D, O-RA08-151 , O-RA05-037,

and O-RA05-260.

* Full details of work performed in work order W23274.

* For the replacement parts refer to Teardown Report.

- I~ the items identified above were manufactured in conformity to: 14a.

Approved design data and are in condition for safe aper · . [g] CAR 571 .10 Maintenance Release.

D Non a ved design data specified in blo ~ Other regulations specified in block 12.

Certifies that unless otherwise specified in block 12, the work identified in

block 11 and described in block 12, has been performed in compliance with the Canadian Aviation Regulations.

13b. Signature

~ 13~nization Number 14b. Signature

K·r:5~ }. 14c. Approved Organization Number

160-93

~ 13e. Date (dd/mmm/y~ 14d. Name

I~

14e. Date (dd/mmm/yyyy)

03/May/2017 Reza Bahra

(Previously form 24-0078) Important: See notes

Installer Responsibilities

This certificate does not constitute authority to install.

Installer working in accordance with the national regulations of a country other that that specified in block 1, must ensure that their regulations recognize certifications from the country specified .

Statements in blocks 13a and 14a do not constitute installation certification . In all cases, the technical record must contain an installation certification issued in accordance with the applicable

national regulations before the aircraft may be flown.

1. Approving Civil Aviation Authority I Country 2.

Transport Canada

4. Organization Name and Address

AUTHORIZED RELEASE CERTIFICATE

Form One

G Ac Global Aerospace Corporation, 7075 Fir Tree Drive Mississauga, Ontario, Canada.

L.5S 1J7

PH: 905-678-6311 FX: 905-678-6312 www.globalaerospace.com

6. Item 7. Description 8. Part No. 9.Qty. 10. Serial/ Batch No.

1 Air Cycle Machine 782790-18 1 940394

12. Remarks:


3. Form Tracking No. I I

W23274

5. Work Order I Contract/ Invoice I

I 50170064(34

I

11 . Status / Work

Overhauled

* Overhauled in accordance with CMM # 21-51-53 Rev #16, dated 23 July 2014, and RDA# O-RA06-088/D, O-RA08-151, O-RA05-037, and O-RA05-260. 1

* Full details of work performed in work order W2327 4.

* For the replacement parts refer to Teardown Report.

l~if~t the items identified above were manufactured in conformity to:

I 7'----J_ Approved design data and are in condition for safe oper · . -------D Nona ved design data specified in blo

14a.

~ CAR 571 .10 Maintenance Release.

~ Other regulations specified in block 12.

Certifies that unless otherwise specified in block 12, the work identified in 1

block 11 and described in block 12, has been performed in compliance with the Canadian Aviation Regulations. '

13b. Signature ~ 13~proved Organization Number 14b. Signature ;'(: 1

£ _ / " 14c. Approved Organization Number

A..J~ 160-93 , I

(Previously form 24-0078)

This certificate does not constitute authority to install .

13e. Date (dd/mmm/y~ 14d. Name ~ 14e. Date (dd/mmm/yyyy) 1

~ Reza Bahra~i ~-·, ) 03/May/2017

Installer Responsibilities

Important: See notes

I

I Installer working in accordance with the national regulations of a country other that that specified in block 1, must ensure that their regulations recognize certifications from the country specified.

I

Statements in blocks 13a and 14a do not constitute installation certification. In all cases, the technical record must contain an installation certification issued in accordance with the applicable national regulations before the aircraft may be flown .

Global Aerospace Corp. 7075 Fir Tree Drive Mississauga, ON L5S 1J7 Canada Ph: 905-678-6311 , Fax : 905-678-6312

Ship To: Fokker Services Inc 456 Aerotron Parkway LaGrange,GA 30240 United States o

Ref#: 5017006434

Code:Ml2

Phone#: 770-991-4356

Site:

Fax#:

PN : 782790-18

Make: Qty: 1

TSN : 0

Oat~ Released

Day$ Last Part

Serial Numbers: 940394;

Symptoms:

For Repair

Station:

TSO: 0

Buyer

Customer Note

TSR: 0

Date Can Quote

Delay

CSN: 0

Tear Downtlnsoection1

Work Order#: W23274

Date Printed: 4/26/17

Time: 11 :45 :29 AM

Page: 1

Email: Robert [email protected]

Descr: AIR CYCLE MACHINE

Model: Mfg: HAMIL TON

CSO: 0 CSR: 0

Engine Number:

Tail Number:

" Early failure - failed before reaching 1500 hours/cycles after installation . Investigate failure and advise root failure. Please perform repair under warranty. END."

Faults:

Snag Confirmed

1. Please refer report prepared by Quality Department & e-ailed by Debby. 2. Sump cover pin 782166-1 found damaged. 3. Drive shaft p/n 753385-2 damaged. 4. Turbine housing p/n 758073-111 cracked , dish repair required . 5. Turbine rotor p/n 785733-5 damaged. 6. Bearings damaged. 7. Other parts reauired as listed below.

PN Description Qty Needed Disposition .,·

094-0500MCP PIN, SPRING-SPIRAL 2 Consumable

094-0625MCP PIN.SPRING-SPIRAL 2 Consumable

540628 WIRE, SPRING 1 Consumable

570057-8 PIN, STRAIGHT HEADED 2 Consumable

6925384 IDENTIFICATION PLATE 1 Consumable

69494J111 PACKING 1 Consumable

69494J139 PACKING 1 Consumable

69494J154 PACKING, PREFORMED 1 Consumable

69494J262 PACKING, PREFORMED 1 Consumable I

69494J262 PACKING, PREFORMED 1 Consumable

69494K113 PACKING, PREFORMED 1 Consumable

69494K151 PACKING 1 Consumable

727455-11 BUSHING, WICK 2 Consumable t

738612-3 WASHER, TAB 1 Consumable

Form created with Quantum Con/rol(/m) technology. Product Licensed to: Global Aerospace Corp.

- =--Global Aerospace Corp. Tear Downllasoection 7075 Fir Tree Drive Work Order#: W23274 Mississauga, ON L5S 1J7 Date Printed: 4/26/17 Canada Ph: 905-678-6311, Fax: 905-678-6312 Time: 11 :45:34 AM

Page: 2

753385-2 SHAFT, DRIVE 1 Consumable

753389-4 SPRING, COMPRESSION 1 Consumable

753391-1 RING, SEAL 1 Consumable

753391-1 RING, SEAL 1 Consumable -

753392-1 SPACER, FAN 1 Consumable

753443-2 GASKET OUTLET 1 Consumable

753443-2 GASKET OUTLET 1 Consumable

782166-1 COVER, SUMP ITEM 1 Consumable

785733-5 ROTOR, TURBINE 1 Consumable

808519-3 WICK, NONMETALIC 2 Consumable

89803 - 10-32 KEYSERTS, THINWALL UNF 1 Repair

AN814-3DL FITTING 3 Consumable

AN960PD10 WASHER 2 Consumable

BALANCING BALANCING 1 Repair

D04008-1 CARBON RING 1 Consumable

D04008-1 CARBON RING 1 Consumable

D04008-2 WAVE SPRING 1 Consumable

D04008-2 WAVE SPRING 1 Consumable

D05023-2 THROAT INSERT 1 Consumable

j. D05023-3 MAIN BORE INSERT 1 Consumable

D071 123-1 Dish, Turbine Chamber, ACM 1 Consumable

M202HX67REVC BEARING,BALL 2 Consumable , M83248-1-021 PACKING 1 Consumable

M83248-1-021 PACKING 1 Consumable



MS21043-3 LOCK NUT 10 Consumable

MS9245-28 PIN 2 Consumable

NAS 1802-08-16 SCREW 9 Consumable

NAS 1802-3-10 SCREWS 6 Consumable

NAS620C10L WASHER 6 Consumable




NAS620C10L WASHER 10 Consumable I





NOT Non Destructive Testing 14 Repair

Form created with Quantum Control(tm) technology. Product Licensed to: Global Aerospace Corp.

Global Aerospace Corp. 7075 Fir Tree Drive Mississauga, ON L5S 1J7 Canada Ph: 905-678-6311, Fax: 905-678-6312

NOT Non Destructive Testing

RR137S RING.RETAINER




RR325S RING, RETAINER

RR87S RING, RETAINER-INT.

S750493-14 SEAL

5

1

2

Work Order#: W23274

Date Printed: 4/26/1 7

Time: 11 :45:46 AM

Page: 3

Repair

Consumable

Consumable

Consumable

Consumable

Consumable

Consumable

Consumable

Form created with Quantum Control(tm) technology. Product Licensed to.· Global Aerospace Corp.

1. Approving Civil Aviation Authority/ Country 2. 3. F.orm Tracking No.

AUTHORIZED RELEASE CERTIFICATE Transport Canada W22912

For.m One 4. Organization Name and Address 5. Work Order / Contract/ Invoice

GA C Global Aerospace Corporation, 7075 Fir Tree Drive PH: 905-678-6311 Mississauga, Ontario, Canada. FX: 905-678-6312 5016015237 L5S 1J7 www.globalaeros~ace.com

6. Item 7. Description 8. Part No. I 9.Qty. 10. Serial / Batch No. 11 . Status / Work '

1 Air Cycle Machine 782790-18 1 HSM0111A Repaired

12. Remarks:


* Repaired in accordance with CMM # 21-51-53 Rev #16, dated 23 July 2014. * Full details of work performed in work order W22912.

* For the replacement parts refer to Teardown Report. * TSO- 2,162.60; CSO- 2,498.

•.

Certifies that the items identified above were manufactured in conformity to: 14a . • ~ Approved design data and are in condition for safe aper CAR 571.10 Maintenance Release.

·o Non a ved design data specified in blo ~ Other regulations specified in block 12.

Certifies that unless otherwise specified in block 12, the work identified in block 11 and described in block 12, has been performed in compl iance with the Canadian Aviation Regulations .

13b. Signature

~ 13~nization Number 14b. Signature

/ .IS~ 14c. Approved Organization Number

l 160-93

~ 13e. Date (dd/mmm/y~ 14d{ Name

CID 14e. Date (dd/mmm/yyyy)

Reza Bahrami 15/Sep/2016 C

(Previously form 24-0078) - Important: See notes

Installer Responsibilities This certificate does not constitute authority to install.

Installer working in accordance with the national regulations of a country other that that specified in block 1, must ensure that their regulations recognize certifications from the country specified.

Statements in blocks 13a and 14a do not constitute installation certification . In all cases , the technical record must contain an installation certification issued in accordance with the appl icable national regulations before the aircraft may be flown .

.. ,

Global Aerospace Corp. 7075 Fir Tree Drive Mississauga, ON L5S 1J7 Canada Ph: 905-678-6311 , Fax: 905-678-6312

Ship To: Fokker Services Inc 5169 Southridge Parkway Suite 100 Atlanta,GA 30349 United States o

Ref#:5016015237

Code: AAl2

Phone #: 770-991-4356

Site:

Fax#:

PN : 782790-18

Make: Qty: 1

TSN: 0

Dat ! Released

Day;; Last Part

Station:

TSO: 0

Buyer

Customer Note

Serial Numbers: HSM011 1A;

Symptoms:

For Repair

TSR: 0

Date Can Quote

Delay

CSN: 0

Tear Down/lnsoectlon Work Order #: W22912

Date Printed: 9/15/16

Time: 11:45:47 AM

Page: 1

Email: [email protected]

Descr: AIR CYCLE MACHINE

Model: Mfg: HAMIL TON

CSO: 0 CSR: 0

Engine Number:

Tail Number:

" Cabin temp duct (Bleed air) over 60 degrees celcius when #2 engine started . Could not cool our plane down. Warranty check requested . END."

Faults:

Note

•• Unit previously overhauled in March 2015 •• 1. Screen/ mesh of containment housing damaged due to stones of air intake. 2. Stone marks on fan blades .

••• No fault found during testing ••• 1. Option 1 : Repair screen & unit tested & re-certified : Quote $ 1320.00 USD. 2. Ootion 2: Reoair screen , reolace fan o/n 762049-1 , retest & certifv: : Quote $ 2540.00 USD.

PN · Description " Qty Needed 69494J111 PACKING 1

69494J139 PACKING 1

69494J154 PACKING, PREFORMED 1

69494J262 PACKING, PREFORMED 1

69494K11 PACKING, PREFORMED 3

69494K151 PACKING 1

753443-2 GASKET OUTLET 1

753443-2 GASKET OUTLR 1

753453-40 SCREEN INLET 1

762049-1 FAN, COOLING 1

808519-3 WICK, NONMETALIC 2

89803 10-32 KEYSERTS, THINWALL UNF 1

Dispo~ition

Consumable

Consumable

Consumable

Consumable

Consumable

Consumable

Consumable

Consumable

Consumable

Consumable

Consumable

Repair

Form created with Quantum Control(tm) technology. Product Licensed to: Global Aerospace Corp.

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