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~------------~--------------------~---'--------------,------------------~ 1. Approving Civil Avi:::tion
Authority/Country: AUTHORIZED RELEASE CERTIFICATE
FAA FORM 8130-3, AIRWORTHINESS APPROVAL TAG FANUNITED STATES
4. Organization Name and Address: TRIUMPH ACCESSORY SERVICES
411 North West Road
Wellington, Kansas 67152
6. Item: 7. Description: 8. Part Number:
1 TORQUE SENSOR
756158
12. Remarks:
Repaired per Sundstrand CMM 27-50-13 Rev.1 11/15/2001. TSN 35401.00, CSN 48029. No AD's applied.
9. Quantity:
Full details of work carried out per work order indentified in block 3
OB2R051L
10. Serial Number:
0299
3. Form Tracking Number:
17s0004897
5. Work Order/Contract/Invoice Number:
5016025047
11. Status/Work:
REPAIRED
Triumph Accessory Services 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 producUarticle is considered ready for release to service under EASA Part-14: Approval Number: EASA.145.4622.
14a. [g] 14 CFR 43.9 return to Service [8J Other regulation specified in Block 12
Certifies that unless otherwise specified in Block 12, the work indentified 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
14b. Authorized ·
14d. Name (Typed or Printed:)
Hare,Nancy
User/Installer Responsibilities
14c. Approval/Certificate No:
OB2R051L
14e. Date (dd/mmm/yyyy)
13/Dec/2016
It is important to understand that the existence of this Document alone does not automatically consitute 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 engine(s)/propeller(s)/article(s) from the airworthiness authority of the country specified in Block 1.
Statements in Block 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 8130-3 (02-14) NSN: 0052-00-012-9005
SERVICE REPORT
Customer: FOKKER SERV ICES BY Manufacturer: --------Customer No: 1949 Purchase Order: 501602504 7
P/N: 756 158 SIN: 0299 Date Received 12/8/2016
Corn~onent: Instructions: Received In:
TORQUE SENSOR R./\.N
Receiving_ lns[2_ection Remarks - Unit Received:
prel iminary inspection complicd with
Reason for Removal:
flap torque sensor inop maintenancc tag removal reason is failcd to test
Date Removed: Position: llNK
Form: 23
Rev: 5
Date: 10/6/14
SRO No. : l 7s0004897
AWB 653810831872 No.: ------Via:
Container Cond:
A/C
Customer Tag Attached: No TSO UNK TSN 35401.00
T.S.L.R. UNK lcso UNK jCSN 48029.00 C.S.L.R. UNK
Last O/H by: Date: SRO# UNK
Last RAN. by: Date: 3/26/20 15 12:00:00 SRO# 15s00068 12 /\M
Last F.T. by: Date: SRO# UNK
Disassembl'f. Findings: (Including_ [2_rimarx_ [2.art failure/malfunctionl
Malfunction of the unit is duc lO bcing out ofadjustmcnt, indicator light would only opcrale in one direction due to being out of
adjustment. and small parts were missing when recci ved in at T/\S.
Reason for Removal Confirmed: Yes I Foreman: John Mctz
Warranty: I Warranty Administrator:
Unit Has Been: SERYICEA£3LE Released to Service with T .S.O. CONTINUED T.T. CONTINUED
Tag Issued: FAA 8130-3 Date: 1 3 DEC 2016
Beyond Economical Repair: D Prior P/N or SIN:
F.A.A. APPROVED REPAIR STATION CERTIFICATE NO. OB2R051L
INSPECTION ANALYSIS WHERE POSSIBLE INCLUDE PROBABLY CAUSE OF MALFUNCTION
Form
Page
23 2
Reason for removal con fir med; Repair, indicator light would only operate in one direction due to being out of adjustment, and small parts were missing when received in at TAS.
Work Scope Perfonned
Repaired per Sundstrand CMM 27-50- I 3 Rev. I 11 /15/200 I
Work Performed: Rt: PAIRCD ----------------------SER YI CE ABLE
SALVAGE SCHEMES EMBODIED IN THIS SERVICE
Scheme:
SRO Reference: l 7s0004897 \,
MAJOR PARTS REPLAC~D D l Z 2016
I D SEE ATTACHED PARTS LIST I f...../ __ -:=::::=--"7t51~;:c-"-.----+-- ---......"l:'T,.,,,,..""t'"'"t--- -----,,0,--81-e---
F.A.A. APPROVED REPAIR STATION CERTIFICATE NO. OB2R051L
SRO Work Order Report 17s0004897 12/ 12/2016
SRO: I 7s0004897
I IIIIII IIIII IIIIIII Ill lllll lllll lllll lllll 111111111111111111
Description: 756158 End Date:
-~~
,,. Triumph
Lead Partner:
904
Customer: 1949 Ship To: 11 FOKKER SERVICES INC. Ship Via: Scobee. Gretchen S.
Bill To: 1949 FOKKER SERVICES BY
Customer PO: 5016025047
Salesperson:
111111111111111
Line: Description: TORQUE SENSOR
Item: 756158
Operation: 140 O1>eration Code: 11 0- 100%
11111111111111111 IIII IIII Material
Trans Num Trans Date
I 12/9/20 16
2 12/9/20 16
Item
73502 1
CLAMP
NAS I 352C06I-14
SCREW
Operation: 150 Operation Code: 120-NRP
11111111111111111 IIII IIII
Unit: 0299
Qty:
100% Replacement Parts
1.00 UM: EA
Planned Labor Hours: 0.00
Qty UM
2.00 EA
4.00 EA
120-Non Routine Replacement Parts
Planned Labor Hours: 0.00
TACSV WE
jmetz
TRIUMPH ACCESSORY SERVICES Page I of I
I. App1ov:i~ Ci.va A,·ia:i,-,a ,\ u:horriy/Count1y
FAA/United Stat~
O t-[1., n a.tio.1 r t· !J · .rJ A j:'.J ~..: .• :~.
,;---
,-
2.
41~
AUTHORIZED RELEASE CERTIFICATE FAA Form SU0-3. AIR''WORTHINE.SS APPROVAL TAG
AERO lIVSTRUMllNTS & A H ONICS, INC. 7290 1VASH ROAD ,Y: :t: ·i. J"U.V:l.. 1i'.·1:\'VA. Ni1~~· './C·.0~-Y ! 4120-1596
!9 ',;. - - --- ---
(l\'CIRJ43.K) ·Juc:.rui t.'t'.
3. Form T ro~ing Numbc:r.
4594 - 412543
5. Vlork Ordc1lCo..,Lra.ct,'Tnvoit'-: Numb.:r.
9 - 90319
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t·. u-!:JAL l!OC ii D9 0 G- l\lOu J 1
, ~ th: ,iems id'1lt,f1ed abov~ wu~ rnat1Uf8.0!Ured in coofnrmit;r tc,,
I O .",f1X~ -~ oo· .• and fI!-:.. en • conditioe. for &.~fc -:,p<;r.Uion.
j""'""1 -, I • -.~•, • r _, • - t' j ,- - , , ..., ... ., C:..... r ----------..... ·-----
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0 i4 ~ 4 l.9 R,.., ·~11• l.<> -=:en ~:-<. w 0 th.er ro.g..ilatioo ~}-c=ified ,n Block 17
I. .....:.:.. J i ,~g .... ~.tt,or~~ ;:- ""._.;.3 .c t: .~ l --"t-, ..c ' .c~ wmk ... U!e.i.tern.~ 1.reappro\led Kl ·
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. ....___ Pl'd.'RICK 1'" CONNORS 0 9 / 0ct/20 1 5
----- - - - --- --1 I :it.1 l ,'u1t1: . J.~~r1ttu; : ____ .,,. -T, :le.
I z.7,,er/Installer Responsibilities
I JI ,. -··P- ''-'" -~ ........ ~'"' .. u --~- .; .• -~ .......... -.,. ;µ_ .t .-.!-.. . i. •• :v:, . ... . , ,.c.. ~L..:..,t,.iJ; c .i;'.y •;c~.:::i,·, "' -1.<::i::,· :c ir~1oll 1h~ air c-raft Oll~inei'p ,~1pellt<!/~rt,d e. . • ------
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e:.~} f::.>~ r:·.c; .::.ir.,· ..... '!th;:~e..'i!, ~:.r:itQrity of tDe CO'Jntry i,;po::ified j r.· B!,o:~ I
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I natic1ul 1i:g11 latic~~ by tM useo~nEtJrller before the aircraft m~y h:: t1own.
Flo.A To-m St lO-) (02-H ) .,..,:;r,~: D052--0D-e>1-;.9);6
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COMPONENT RSDORT
At:J·<O INSTRUMENTS & AVl0 N1CS, INC.
(:()!• ,~•,_IT~· ,n
2 4 1, \< AT, t ', t R (,A(l
72SJ N1'.SH ROAD N<j RT·-, 'i"'ONAWANDA, NY 14120 PHOt~E. 716-694-7060 FAX: 716-694-7594 ww.v.aP-n1i11st. com FAA P>r•x oved Repair Station# NC1 R343K [;A.SA ,l\pproved Maintenance Organisation EAS,A. 145 037
S . i?".!Rl,J\' ';TQN v-·, 05403
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Descr l 9t~0·1_··-··--- ·-s r;.LL '.·: .>,.:i.~ ~-,· ;c i:-:-- t .:!l
Rernov ~d Re o..;011 Wa s This Unit W:, s
And l s
': / l :, / ~ 1)1 ~
PA rt ~lumber. 9C 5 -1 'lf0 0- 4
Ve r. 1Ei ec Repa i r ed Co n t::. nu <?
----- - ·-------- - --
Shop Findi ngs :
9- 90319
Ti me
PO ·· -· · -····· ·- ---- ··· ::~ I:_~ ~:!:. . l0 t 9 / 2015
Ser~cd t 00 0/JOS !)Al;; S l S1'EMS
Aircraf t 11
N838CA
STI CK ; U c; HER l' . 3 . STIC~ ~ . ll~tK H 'I F. ~T;;; o 1n n ·-r . TP.ST I NG REVEIILEO R I GHT S':' ICK ?L S HE R :; . • , P l S HB U'iTON l N1'ERM I'l'l'l': tlTLY
STJ Cl<S . UNIT PEQll I RE S R:-:P/UR ,
De tai ls Of l'lo r k Ac ,,ompli s he d :
DISASS E MB LE D, f'LEl'.!JE D, AND INSPEC:-t: o UN J.r . l"!o Rl!"(ll'IMP:fl ( : Ll!'..)>N:CNC. A,rn J.NSPZCTI OI, OF C•Jb , 'ONE. I CARDS AND i\l.L M111' ING
CONtl 8C '.!' C R S . ,. : r1,~ CE O 2 LOWER PlJSHB Un'ONS . PEi'.FO?.ME:O A E'UNCTIO!II\ [, TE:31. tJNJ.'.l Mf_,f .'I'~ (< () lJ} , E l) Hi\N U r /\r TIJ RER • s TB.ST
S PE;CIFJ C!\TION', f.ERT I FJEO AI RWORT HY.
Mod Le v e : : NUNE
Compl,;c e ct By .
,JOSl:;?H A J\l! Rl\MO
Rev : 0
Applic abl e 110· ~ NO
Tested Ely : l t\ Sp ,ic t ,,d ~'./ :
JOSE PH ,, /\l;IR_M)O PA! R TCK M :c~NQF~
•• s~e Invoice Fox full Pares Br e a ~do• n
Tl1e pumo~ -~ ot U11~ repc' I is •o f11misl1 ;n!orn1~io11 only. II is not l•J he use<1 or oc:r,epted ;;c tht l),1ai~ fcr ,:i··,L ~nco? or ~ Afr. ,or1hlnez~ ApprGval Tag. This repOlt must be ret;,ined with c mpone -t
8U'.-.:J 1:000/'=-·noc:J [, '.-1
Re v Da e , : 11 / 27 / 1989
s 0 COMMIJ"l Q IF
r··-- --- - -- ·--- ---- --- ··-- -- -·-······-- -· ····-- - ·--·1
! AERO INSTRUMENTS & PV!ON~CS~ ~NC. _J: . .. . .. .. , w, , ,__,_.._.. __ , ,. ______ J _ _ _ _ - ·-- - •• -- ---r • . ....... .,.., _
MA ".epo11r St.ttlon No. NCl.R3431( / f.A},,ilo. (.e•t . il( c>, l~ASA. :i.45.40::;;, 7290 NAS•rt R04 1J
NORTH TONAWAliOA, l~Y 1,i :LO PHONE: '16·694-7060 F.11.X: 7L~·594·7'594
Website; www.aerQlnst.com
s H COMMUTAIH
L 240 VALLl-:V ~ O Af"l I ,A.TIN MA 1 fR!AI.S D S. BURllt'd i"ur~ 1, f , 0540~1
T 0
P 8b .SICKEH ROAD 1.,; Ti-i(..:vl i~ r', : 2110
T 0
PAGE 1 OF 1
INVOICE 420771
Acc,1lin- t~0.T __ Order l\lo .. _ _]_Terms ~ h1~pV~i,~Cuyiomer Order Mo. - ~ _ Or_d_e_r D_at_e..__1_n_v_oi_ce_ D_a_te-1 45!;4 412543 1 ADV WI RE UPS GRND H·;,J0319 ! 9/14/2015 10/13/2015
- - -
E U Part Nurnber Description . ·--t---· Serial Number
906·1000Q·j_ STALL. WARN. COMPUTeR I 000005 -- - ---- -· - - ------ --~---- --------
ITEM NO.
B'l21SHZGE TCH 2
__ ~~·~-l~;~~ ; ER ~-- -~=~~-RIP~IO~ ;;.l •---+--------·----·----- ---· --· -·-- -
2 I C. CONSUMABLES 1 · -·--~-------·---- -·--- ·-----·· --- ---- - ·--·-- - - --- __ J
---- ·--- ·-- ----T hese commocl1 (1es, lechnok,gy, or ,;oflware are exported from the; United Status i,1 accorda,,ce .-,ith tne t= , p,rt Adr•1111istretio11 "le911J,.rhnB Divr.rs1or ~'{)r,lr;iry to U.S. law is proh,blt~d
·-- ----·----------------- - ------ - ·
PACKING SUP
10-20-' 115 l l : :3:2 FPOM- T - I Jl P0002./000tl F-278
Part A-Performed bv Mechanic
Receiving Drop Shipped Parts
·- - - --- ---]. Name of the Mechanii.: that will complete Pan A and E:
Station: _ //-1.D
Name: ~~ __ a._,..J~ ----,~,-/-a. __ v ___ (. '_/ _ __ Emp. # __ /;.....c_lJI_Z_~--=-3-=-t_4 _ _ _ _
Local Phone:_. 7 fl J .-{, I,, I -- /.,, 3 CZ., Local Fax: __ ~ -rc / @enn,,,11/f,,J:'a_;,,,
Aircraft the part or material will be used •.'!1: __ j// [ ; >.'? Pi1--
Date: /1,~/zo/401 J
Mechanic Date
2. Check the part 0f m11-te-r-·ia_J_fo_r_:----- - - -----~------ ·------- -·-----·----. - ------· ·
• Proper pacv. in&_, '!'he p·,rt or ma-.~?r .f.l is iJ,e>p·.~r\:1 packed, i.e. protected, separated, pb ced in bag:., caps and plugs installed, etc. if net!ded. ESDS parts are in appr0r,ride packing.
• Condition. Inspect tlle part or mate1ial to assure that it is free of obvious clefoci,;. The p,,rt or mal.e.rial wi.Jl l ,,,. remO',-:d fr,;m its packing to verify it." condition ifneeded. Desiccant indicators will 1Je :-,hecked for indication of moisture. ShocK inmcators wiil be che<:Kec! fv; ;nc.ication of shock.
• Any put 0r ma! P-rifJl tll a'. does not meet the above conditions will be rejected . >fotify n~ R':'c , ivi1'.~~ f-:- :.pector of the problem, see step 4 for contact information.
[nr, ·cdr Tl1i, :~r r \\ ·:: the par·,,~.; ·11 .'.r ' , · : ,.~"t':..
4. Contact Rec.:.iv •• 1g ~rL;pl: ·li <.,n to de.tc:rmi.tic if .irlc.iti(1nal infonm.tion is needed. Record any addit'.ona.l ;;, :0,1,iaiLn in the space tek,\\ . if no additional information is needed sign thi:; step off as :.:1:>~ :.p)!ica.ble.
Receiv'.ng ).,1, p t'c l\lr con1,idtfa!: Name: -~T~·.;,:_ ,;,. _f)l e' ( t . . . e,_ Fq,. 1, 'rnber: / CC!.]5 -J....
Additi<m 'll fofr,,.. ,· · · •i:-,1~ ,·; ~ r.r1plicn~)lc) . _ _ . .. . ____ ....... _ _ _
·Lt ' / !/ I~,/ / ii O'l16 I r 7 /')
I
..... ------·-------·-· --- -- ·-- - ··-·--- - ------- ~---~·- --- - ~
-· ----- ---- ----- ·- · ·- - ----------- ~- .... _._ .. _____ ____ - -- - - -- ---------·---- - --- -- ----.·--- ---- - ---, - - ---i
3/ I / t/ / I 5. Forwaru i.h.i~ lon11 <1Jh, all IMPeI work ncc1ved wnh the drop shipped parts to Stores. l ' .,, / ,?./·;.i;-/1'1 / CJ,;;}"" ./
-·--·---- ---- ·--· - - --- - -----------· · · ·····-·- - · I
1::;, 7.' l 1, :-:c,· ·::,'.;;:-!{OP SHlJ·Y.rm P,lRTS l -. .·,i;; I OF4
(FORl\1 CA-75)
Rl':V 19 Oo/. (llj_ <
10-20-' 15 11 : 33 FFi0M- l --1:3'1 P0003/0009 F-278
Receiving Drop Shippe.d Parts
Station : /t/.J? _ Date: _/Pft1$~ Part B-Performed __ ~~~u;.~s Perso-;;·;1--·= =-- __ ________ _ _ r -·stor~ -Date
1. Complete the Stores Receiving Process pe: the ,Jppropriate section of the GMM. I ~ / 1
, . /
· I, I 11 ~~:r I Forward this fonn and all paperwork to •J1e Receivmg Inspector identified in Part A, ! · · .z,r..,o/Si
1 / h
S~ 4. - ----- · • Part C-Performed hy Re1.:ci-ving Insp~tor __ _________________ _ Rec. Insp. Date
1. Assure Farts A and B are complete. I <I /\ i<Jr;· ·'
,It/,,~/ I / v I · 11,·-
1------ - --- ---- - - - --- - ----------------~-2. Receive the pcrrt er ~I!~ct:t~~~! per the :.:.pp1 Jpriatc fed!On of the OMM. The steps in th.i~
·L _tct'31; ,---·
forr,1 w 1i: a\A-u::.iµLsh ti·,G p;1ysic,s.l iJt.:,pc::,dor. 1.,f Ll • .:. p.l.rt, ve-rifica"iion of" the J,•at, number and serial number (C applicable) on the part, and completion of the yellow iag CA-70. (if ap(.lli..,abi ·,).
If aci.:i:~;c.,·,,,l : .. ,for:,1,;i.L) .. ; uecod k 1 ;;,~c.ivc' th:., ~&rt, contact the Mechruifo identified In Part A , Step }
If a part cam1ot be rece1vd , state the reason in tne space below and sign tne entry:
·1/J c.7111·· / k · ;,) J .1;_1 , .
:/ !;I
";Ji'!/?.,,··· •• / I
i I I I
I I
3. Shelf Lifo reouirP.I'ltnt~:.~)'e;- _g,No :7fus-ace 110t apply to Calendar Life Limitea i'ort:. ,
·-----'----,
. ,, >,J) ,,,J,1 JC,., I l-/tf'· 'o/"f '.:;1 ; / -f~'J'iJ ' I
---- - -- ------ ---· - - --------1 If yes> Record the fo]losit,g !
If yes wl.a.t is the t.!J.,ii::atiu:i Jate: I 4.
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