.. 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