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Form Approved
MAJOR REPAIR AND ALTERATION
OMB No. 2120-0020
US Department
(Airframe, Powerplant, Propeller, or Appliance)
For FAA Use OnlyJl,11.l -
of T ransportaticn
,
Federal Aviation
Office Identification
Administration
ACn
F.506
tr~
INSTRUCTIONS.: Print or type all entries. See FAR 43.9, FAR 43 Appendix B, and AC 43.9-1 _(or ~ubi.~quent revision tt,ere~f) __ ~orinstructions
and disposition of this form. This report is required by law ( 49 U.S. C. 1421 ). Failure to report can result in a civil pen~lty not to exceed $1,000
for each violation Section 901 of Federal Aviation Act of 1958). :
Make
Model
.
-,.
. .
..
..
.. -
..
BELL HELICOPTER TEXTRON
412EP.
1. Aircraft Serial No.
Nationality and Registration
Mark
36106 USA
N26NY
Name
(As shown on registration certificate)
Address (As shown on registration certificate)
UNITED AIR SURVEYS INC PO BOX 1195
2. Owner LAKEHURST NJ
08733-0695
3. For FAA Use Onlv
The data identified herein complies with applicable airworthiness requirements
and ;s •PA"'" abffibed a;n,-aft s,bject to a como,m;ty ;nspection
'te7;" tho ized in FAR 43, section 43.7
, ..
~
--- OCT 2 1 2002
Sign7ure AS'/JfSD0-03
Date
I
I
4. Unit Identification
5.Tvne
Unit Make Model
Serial No. Repair
Alteration
AIRFRAME
------- (As described in Item 1 above) -------
x
-
POWER PLANT
..
..
- - - ..
.. . ..
--
.. ..
. . ·~-
. .
--
PROPELLER.
..
- ..
.,
-
.
~
-:· ..
--
Type·
.. .·:.·
'.
.
~
. -· .
- ..
. ...... ·-
....
APPLIANCE
..
. ·-
Manufacturer
6. Conformity Statement
A. Agency's Name and Address
B. Kind of Agency C. Certificate No.
U.S. Certificated Mechanic
EDWARDS
& ASSOCIATES, INC
Foreign Certificated Mechanic
..
FKFR930D
PO BOX 3689
x Certified Recair Station
LIMITED AIRFRAME
BRISTOL TN 37625 Manufacturer
RADIO CLASS I
& II
D.
I certify that the repair and/or alteration made to the unit(s) identified in item 4 above and described on the reverse or attachments
hereto have been made in accordance with the requirements of Part 43 of the U.S. Federal Aviation Regulations and that the
information furnished herein is true and correct to the best of my knowledge.
Date
Signature of
Authori~~ .£7.. A,
OCT
2 3 2002
,JAMRC: .T R / ..., ../" ,... "~
· 7. Approval for Return To Serv'Jee"
/ ./ / /
-
Pursuant to the authority given persons specified below, the unit identified in item 4 was}nfpected in the manne(p~bed by the
Administrator of the Federal Aviation Administration and is
IX! APPROVED CJ REJECTED
FAA Flt. Standards
Inspector
Manufacturer Inspection Authorization
Other
(Specify)
BY
FAA Designee
Repair Station
Person Approved by
x
Transport Canada
Airworthiness Group
Date of Approval or Rejection
Certificate or
Signature of
Authorize:rc:::z.
~
A
OCT 2 3 2002
Designation No.
.TAM'C'C .T D · .,;--:., __.,,,--, ' ,/( 'C'V'C'D O ") n I"\
FAA Form 337 (12-88)
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