PART OR MATERIAL CERTIFICATION FORM · 2019-04-03 · Page 1 of 2 PART OR MATERIAL CERTIFICATION...
Transcript of PART OR MATERIAL CERTIFICATION FORM · 2019-04-03 · Page 1 of 2 PART OR MATERIAL CERTIFICATION...
Page 1 of 2
PART OR MATERIAL CERTIFICATION FORM
& NON INCIDENT STATEMENT IN ACCORDANCE WITH ATA 106
2- Certificate reference MMRO1000008/19
1- Organization Magnetic MRO AS Väike-Sõjamäe 1A, 11415 Tallinn, Estonia 3- Organization's order #
MPO1004143
4- Date of issuance 22/Feb/2019
5- Internal ref PIN1000008
6-Item 7-P/N 8- S/N 9-Description 10-Qty 11-Status 12-Condition
10 28B545-9 333 STARTER/ GENERATOR 1ea AR As Removed
20 822-1604-101 16XXVV FLT CNTRL COMP 1ea AR As Removed
30 HG2050AC07 97110315 AIR DATA INERTIAL REFEREN 1ea AR As Removed
40 1152426-245 010C-0760 CONVERTR 1ea AR As Removed
50 6355C0001-01 3633 MOTOR 1ea AR As Removed
60 1151984-261 020C-0742 CONTROL 1ea AR As Removed
70 30128-03 0644 FUEL QTY PROCESSOR 1ea AR As Removed
80 1151952-6 049C-0792 CONTROL 1ea AR As Removed
90 622814-5 098C-1418 CONTROLLER 1ea AR As Removed
100 18-1738-10 5614 SENSOR 1ea AR As Removed
110 18-1738-12 0745 Flap Position xmitter Assy 1ea AR As Removed
120 45-0351-4 UNREDEABLE RET LANDING LIGHT 1ea AR As Removed
130 2340400-1 1745 SEPERATOR 1ea AR As Removed
140 1721F4 6415 SENSOR 1ea AR As Removed
150 2041683-7507 NSN ADF ANTENNA 1ea AR As Removed
13A- Statement The above referenced part(s) or material was (were) not obtained from any Government or Military Source and was (were) not subjected to severe stress or heat or immersed in salt water (as in a major accident, incident or fire).
13B- Trace To TRANSAERO, B737-800, MSN28621
13C- Last certifying agency n/a
14- New Parts/Material control The following signature attests that the part(s) or Material(s) identified above was (were) manufactured by an FAA or EASA Production Approval Holder (PAH) or under an industry or commercial standard. The following signature attests the «NON INCIDENT STATEMENT»
18- Used, Repaired or Overhauled Parts control The following signature attests that the information specified above are accurate. The following signature attests the «NON INCIDENT STATEMENT»
15- Signature 19- Signature
16- Name 17- Date 20- Name 21- Date
Mantas VERBUS 22/Feb/2019
Page 2 of 2
PART OR MATERIAL CERTIFICATION FORM
& NON INCIDENT STATEMENT IN ACCORDANCE WITH ATA 106
2- Certificate reference MMRO1000008/19
1- Organization Magnetic MRO AS Väike-Sõjamäe 1A, 11415 Tallinn, Estonia 3- Organization's order #
MPO1004143
4- Date of issuance 22/Feb/2019
5- Internal ref PIN1000008
6-Item 7-P/N 8- S/N 9-Description 10-Qty 11-Status 12-Condition
160 284A1801-3 740357001 RADOME 1ea AR As Removed
170 967-0212-002 1438 DFDAU 1ea AR As Removed
180 971-4193-001 9313 ACCELEROMETER 1ea AR As Removed
190 980-6116-001 03163 MICMONITOR,SSCVR 1ea AR As Removed
200 572757-1 8996 SWITCH 1ea AR As Removed
210 182820-3 33-136 HEAT EXCHANGER 1ea AR As Removed
220 233A3206-2 D00497 MDULE AY 1ea AR As Removed
13A- Statement The above referenced part(s) or material was (were) not obtained from any Government or Military Source and was (were) not subjected to severe stress or heat or immersed in salt water (as in a major accident, incident or fire).
13B- Trace To TRANSAERO, B737-800, MSN28621
13C- Last certifying agency n/a
14- New Parts/Material control The following signature attests that the part(s) or Material(s) identified above was (were) manufactured by an FAA or EASA Production Approval Holder (PAH) or under an industry or commercial standard. The following signature attests the «NON INCIDENT STATEMENT»
18- Used, Repaired or Overhauled Parts control The following signature attests that the information specified above are accurate. The following signature attests the «NON INCIDENT STATEMENT»
15- Signature 19- Signature
16- Name 17- Date 20- Name 21- Date
Mantas VERBUS 22/Feb/2019
PACKING SLIP
Bill To: Ship To: ORIGINAL
No:
SITA
Part No. Description Cond Qty S/L Control # Cert No PO Number
Customer PO Ship Date Airway Bill Number
HONEYWELL AEROSPACE TRADINGHONEYWELL INTERNATIONAL INC1720 EAST GRANT STREET, PLANT 1013PHOENIX AZ 85034United States of America
HONEYWELL AEROSPACE TRADINGHONEYWELL INTERNATIONAL INC1720 EAST GRANT STREET, PLANT 1013PHOENIX AZ 85034United States of America
Magnetic MRO AS
PIN1000008
22/02/20194208308034
Original
28B545-9 STARTER/ GENERATOR, AC OU AR 1 1 7804-3 MPO1004143
Serial#:333822-1604-101 FLT CNTRL COMP AR 1 3 7806-18 MPO1004143
Serial#:16XXVVHG2050AC07 AIR DATA INERTIAL REFEREN AR 1 6 7806-25 MPO1004143
Serial#:971103151152426-245 CONVERTR AR 1 1 7804-2 MPO1004143
Serial#:010C-07606355C0001-01 MOTOR AR 1 4 7806-58 MPO1004143
Serial#:36331151984-261 CONTROL AR 1 1 7804-1 MPO1004143
Serial#:020C-074230128-03 FUEL QTY PROCESSOR AR 1 1 7806-45 MPO1004143
Serial#:06441151952-6 CONTROL AR 1 3 7806-5 MPO1004143
Serial#:049C-0792622814-5 CONTROLLER AR 1 3 7806-57 MPO1004143
Serial#:098C-141818-1738-10 SENSOR AR 1 4 7804-7 MPO1004143
Serial#:561418-1738-12 Flap Position Transmitter Assy AR 1 3 7806-33 MPO1004143
Serial#:074545-0351-4 RET LANDING LIGHT AR 1 1 7806-51 MPO1004143
Serial#:UNREDEABLE2340400-1 SEPERATOR AR 1 1 7806-39 MPO1004143
Serial#:17451721F4 SENSOR AR 1 5 7806-32 MPO1004143
Serial#:64152041683-7507 ADF ANTENNA AR 1 1 7806-7 MPO1004143
Inspectors StampFor and on behalf of Magnetic MRO AS
Signed:
We hereby certify that the parts in this shipment conform with applicable specifications and that documentation and/ordata is on file and available for examination. To the best of our knowledge, this part has not been subjected to conditionsof extreme stress, heat or environment, the part was not previously installed in a public aircraft, such as a government use aircraft or a military aircraft.
PACKING SLIP
Bill To: Ship To: ORIGINAL
No:
SITA
Part No. Description Cond Qty S/L Control # Cert No PO Number
Customer PO Ship Date Airway Bill Number
HONEYWELL AEROSPACE TRADINGHONEYWELL INTERNATIONAL INC1720 EAST GRANT STREET, PLANT 1013PHOENIX AZ 85034United States of America
HONEYWELL AEROSPACE TRADINGHONEYWELL INTERNATIONAL INC1720 EAST GRANT STREET, PLANT 1013PHOENIX AZ 85034United States of America
Magnetic MRO AS
PIN1000008
22/02/20194208308034
Original
Serial#:NSN284A1801-3 RADOME AR 1 1 7804-8 MPO1004143
Serial#:740357001967-0212-002 DIGITAL FLIGHT DATA ACQUISITION AR 1 5 7806-21 MPO1004143
Serial#:1438971-4193-001 ACCELEROMETER AR 1 4 7806-60 MPO1004143
Serial#:9313980-6116-001 MICMONITOR,SSCVR AR 1 1 7806-24 MPO1004143
Serial#:03163572757-1 SWITCH AR 1 82 7806-54 MPO1004143
Serial#:8996182820-3 HEAT EXCHANGER AR 1 2 7806-34 MPO1004143
Serial#:33-136233A3206-2 MDULE AY AR 1 1 7806-8 MPO1004143
Serial#:D00497
Inspectors StampFor and on behalf of Magnetic MRO AS
Signed:
We hereby certify that the parts in this shipment conform with applicable specifications and that documentation and/ordata is on file and available for examination. To the best of our knowledge, this part has not been subjected to conditionsof extreme stress, heat or environment, the part was not previously installed in a public aircraft, such as a government use aircraft or a military aircraft.
EASA CAMO | FR.MG.0346
ARW-ARD-F091 Issue B 11/15 © Regio Lease Non authorized photocopy and reproduction are forbidden – Copyright 2017– All rights reserved.
Airworthiness Department
Paris – 21/01/2019
To whom it may concern
Reference: 28621_NAS_1901_01 Tel : +331 80 45 00 45
NON ACCIDENT/INCIDENT CLEARANCE STATEMENT
Aircraft EI-RUK, details of which are specified below, has been operated by Regio Lease during the period from 26/10/2015 to 21/01/2019. Configuration details as of date of this statement;
Description Type/Part No. Serial No. TSN CSN
Aircraft B737-86N 28621 50503:19 26492
I hereby certify that, to the best of my knowledge, during the period stated above: 1. Neither the aircraft, nor any part installed have been;
a. damaged during, or identified as the root cause of, a reportable incident or accident as defined by Annex 13 to the Chicago Convention, or
b. subjected to severe stress or heat (such as in a major engine failure, accident, or fire) or has been submersed in salt water,
Unless its airworthiness status was re-established by an approved maintenance organisation in accordance with the applicable airworthiness regulations and instructions of the type certificate holder and/or supplemental type certificate holder and/or OEM of the part, and supported by an authorised airworthiness release certificate.
2. No part has been installed on the aircraft which was obtained from a military source or was previously fitted to a state aircraft as deemed by Article 3 of the Chicago Convention.
Emeric BLONDEAU
REGIO LEASE
Airworthiness Engineer