Authorized Release Certificate printable pdf download

1. Approving Civil Aviation

3. Form Tracking Number:

AUTHORIZED RELEASE CERTIFICATE

Authority/Country

30ZPB0001001001

FAA/UNITED STATES

FAA Form 8130-3, AIRWORTHINESS APPROVAL TAG

4. Organization Name and Address:

5. Work Order/Contract/Invoice Number:

Duncan Aviation/3701 Aviation Road/Lincoln, NE 68524

JGVR194F

30ZPB

6. Item:

Description:

Part Number:

Quantity:

10. Serial Number

11. Status/Work:

RADIO ALT RT

7001840-922

89103200

Repaired

12. Remarks:

Customer: AAT AIRCRAFT MAINTENANCE

Discrepancy: False EGPWS call outs. Please check Aux Alt output, Pin x.

Preliminary findings: Bench checked and duplicated discrepancy. Evaluated and discovered defective connector receptacles

and suspect 0 ft adjustment pot on motherboard.

Corrective Actions: Replaced connectors and potentiometer, cleaned, aligned, and inspected. Function tested per HONEYWELL

RT-300 Radio Altimeter Receiver Transmitter Component Maintenance Manual with Illustrated Parts Catalog, Revision 8, dated

09/01/2010.

Duncan Aviation certifies that the work specified in Blocks 11 and 12 was performed IAW EASA Implementation Rule part 145

approval, and with respect to that work, the aircraft component is considered ready for release to service under EASA approval

number EASA.145.4392. Certificate Number JGVR194F.

All EASA/FAA Airworthiness Directives are the responsibility of the installer.

No current U.S. Airworthiness Directives apply.

Technician: Dennis C Smolik

This document constitutes a signed copy of the work order

Approval for return to service

See attached parts list

13a. Certifies the items identified above were manufactured in confirmity to:

14a.

14 CFR 43.9 Return to Service

Other regulations specified in Block 12

Approved design data and are in a condition for safe operation.

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

Non-approved design data specified in Block 12.

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.

13b. Authorized Signature:

13c. Approval Authorization No.:

14b. Authorized Signature:

14c. Approval/Certificate No.:

DUNCAN

JGVR194F

QI 1136

13d. Name (Type or Printed):

13e. Date (dd/mmm/yyyy):

14d. Name (Type or Printed):

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

Jathan J Saltzman

25 Jun 2014

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 engine(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 be flown.

FAA Form 8130-3 (02-14)

NSN-0052-00-012-9005

FAALNK

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