a la case 1 doit s'assurer que la reglementation en question reconnait la certification du pays ainsi specifie.

Transcription

1 1. Approving national aviation authority / country Form tracking No. / Numero de suivi du formulaire TRANSPORT CANADA AUTHORIZED RELEASE CERTIFICATE- BON DE SORTIE AUTORISE FORM ONE Approved organization name and address - Norn et adresse de l'organisme agree 5. Work Order/ContracUlnvoice - Bon de travail/contraufacture CASP Aerospace Inc., 98 Columbus St., Pointe Claire, QC, Canada H9R 4K llem 7. Description 8. Part No.-No. de piece 9. aty-ate 1 o. Serial/Batch No.-No. de serie/lot 11. Status/Work-EtaUtravail PORTABLE FIRE EXTINGUISHER 3.0 lb HALON H673 Y & Y INSPECTED/ TESTED 12. Remarks - Remarques FACTORY NEW UNIT INSPECTED IN ACCORDANCE WITH CASPAEROSPACE CMM 368-MM1211, DATED MFG. AMEREX CORPORATION. MFG. DATE: a. CAR O Maintenance release Certification a pres maintenance en vertu du RAC o D Other regulations specified in block 12. Autre regl1mentation precisee a la case 12 13b. Authorized signature/ Signature autorisee 13d. Name I Norn 13c. Certificate/Approval ref. No. Numero d'agremenud'autorisation N/A 13e. Date (dd/mmm/yyyy) Certifies tat, exc9 wijefe/9\fierwise specified in block 12, the work identified in block 11 and described in block 12 W<!J> ' Perform 'd m 1 apj.nce with-gaf 571. / Le present bon certifie que, a moins d'indications contraire apparaissant a a 1 s 7 1ft'? travail indiq a _Ii! c.i_se 11 a ete effectue conformement au RAC e. Date (ddlmmm/yyyy) Sebastien Krafft 1 0IAPRl2012 Installer must cross-check eligibility with approved data - Le monteur doit contre-verifier l'admissibilite avec les donnees approuvees. This certificate does not constitute authority to install. Installers working in accordance with the national regulations of a country other than the authority specified in block 1 must ensure that their regulations recognize certifications from the country specified. Statements in locks 13a or 14a do not constitute installation certification. In all cases, the technical record for the aircraft must contain an installation certification issued in accordance with the applicable national regulations before the aircraft may be flown. (Previously form ) Le present bon de sortie ne constitue pas une autorisation de montage. Le monteur qui travaille conformement a la reglementation d'un pays autre que celui specifie a la case 1 doit s'assurer que la reglementation en question reconnait la certification du pays ainsi specifie. Les declarations des cases 13a et 14a ne constituent pas une certification de montage. Dans tous les cas, le dossier technique de l'aeronef doit inclure une certification de montage delivree conformement a la reglementation nationale qui s'applique, avant que l'aeronef puisse voler.

2 r/9 s::o...., aerospace inc. 98 Columbus Street Pointe Claire, QC Canada H9R 4K4 T: F: CERTIFICATE OF CONFORMANCE Customer: Customer PO No: CASP Order No: AMERON GLOBAL PRODUCT SUPPORT Part No. Description 2 30H673 Fire Extinguisher, 3.0 lb Halon 1211 w/hose, 5-B:C Serial Number{s} Y & Y Date of Manufacture: 2012 This document certifies that the product(s) shipped on this order have been inspected and comply with all?licble requirements of the customer Purchase Order and of CASP Aerospace Inc. drawjng 30 3/,--3 Inspection and test records demonstrating product compliance with all ir -, an -ficable uiterhe r-e-0n file and are available for review upon request. / ( _ -,' I 10 Apr 2012 / / - ) Authorized Signature L/Sebastien Krafft, QC Inspector Date QF Rev N/A

3 I. WORK ORDER: II. PART NUMBER: REGNALVE P/N :N/A Ill. Work to be Performed: ASSEMBLY S/N:001046C REGNALVE S/N:N/A =--feverhaul FUNCTIONAL TEST Ameron Global Product Support LINCOLN AVE. HOLBROOK, NY Work Order # CUSTOMER: MAGELLAN GROUP SALES (MGS) DESC:FIRE EXTINGUISHER CYLINDER S/N : OD I O 4 lo l REPAIR fispect WEIGHT CHECK RECHARGE CRS# OWR461 N 04/05/12 CUSTOMER'S ORDER: MFG:FLAG FIRE EQUIPMENT HYDROTEST IV. Data Used: V. Other Data Used: Revision : 05/08/07 SBs/ADs: VI. Corrective Action: Instructions: Initial numbered and lettered entries that apply. Initials indicate step was complied with. All other entries to be completed as they apply. 1. _ Disassembled (Required for Overhaul). 2. _ Cleaned and Inspected (Required for Overhaul). 3. _ Repaired as necessary (Required for Overhaul). 4. jj?e'placed all required parts Pi\G Description Qty Serial/Lot P/N Description Qty Serial/Lot PLUNGERASSEMBLY ORING NYLON SEAL N FIRE EXTINGUISHER 1387 TAMPER SEAL HOSE ASSY 30H673 FIRE EXTINGUISHER 3604 DECAL-HALON 3605 DECAL PRESSURE GAUGE NYLON TIE LEAF SPRING RIVET PULL PIN.ANTI-VIBRATION I qs-jo&, F WARNING LABEL NOZZLE OPERATING LABEL A247650F B F1211 OA DECAL, NAMEPLATE SC1 PULL-TITE II SEAL/FX 1211 HALON COLLAR A DATAPLATE BRACKET ASSY RCVD FULL ( COLLAR 5. Reassembled (Required for Overhaul). "8. Hydrostatically Tested: a. Date tested : 9. o wor.l< cc;omplished: - ' 6. Recharged. 7. Tested (Required for Overhaul). b. Next Hydrostatic Test due: a. Beyond Economical Repair c. Cylinder service life expires: b. jf_4iffsalvageable PART c. Returned to customer "AS-IS" d. isposed of at A.G.P.S. 10.Fire extinguisher service data: Empty weight: _ Returning Less: (per customer's instruction) Agent weight: Cartridge(s), N2 Weight/Pressure: si Less cartridge(s) Outlet(s), 11.Additional comments: -'-''--'-J:..L::!.>'-"--"''-O--'<...;'-'--;..._::; --''----'-""-':.._.:_,...,_=---"-'-_;;;_o ;_H.:...: Less outlet(s) &>c ;3;..._..J--5,q N;..._--1- :_.,. _, ;... _ W'. D d-jt Work performed by: Certificated Technician: Authorized Inspector: Date: Date: Date: Form Rev 1s

4 PART OR MATERIAL TRACEABILITY FORM 2. Seller's Name: 3. Reference # Magellan Group Organization: Phone#: Magellan Group Address: Fax#: B TOWNSHI P ROAD CHARLOTTE, NC SITA/Wire Code: USA Status: 5A. Seller's Contract#: P B. Buyer's PO #: ltem 7. Description 8. Manufacturer & Part Number 9.Eligibility 10.Qty 11. Serial/Batch # 12.Status 5 FIRE EXTINGUISHER 30H673 CRJ 1 SN: Y NE CASP 13A. Remarks: ON THE BASIS OF INFORMATION OBTAINED FROM THE SUPPLIER IN BLOCK 13B, THE ABOVE REFERENCED PART(S) OR MATERIAL WAS/WERE NOT OBTAINED FROM AN Y US GOVERNMENT OR MILITARY SOURCE AND WAS/WERE NOT SUBJECTED TO SEVERE STRESS OR HEAT OR IMMERSED IN SALT WATER. 13B. Traceable To: 13C. Last Certificated Agency: OEM c.sp Jle 1 " :c.. ro CASP AEROSPACE 14. New/SV/OH/Reifaired Parts:. 18. Uose;cable Parts Vecmcatioo / THE PART(S) DETAILED ABOVE WAS RECEIVED IN THE CONDITION STATED ABOVE THE FOLLOWING SIGNATURE ATTESTS THAT THE PART SPECIFIED ABOVE IS UNDER APPROVED CERTIFICATE ATTACHED AND ISSUED IN THE SAME CONDITION AS TRACEABLE TO THE SOURCE IN BLOCK 138. RECEIVED AND IS TRACEABLE TO THE SOURCE IN BLOCK 138. ) Signature Name 17. Date 4/27/2012 Cc,:.,.,. PL 21. Date 4/2 7/2012 1' , c:.: I ne IIOve s1gnture omds the se11er ana m,u1 lt:.k 10 me accuracy or me 1mora_uon provtoea m me t-ukm. ;:jnou1a me mrormauon prov1aea in mis t- orm contain 1naccurac1es or misrepresentations, the signer and SELLER may be liable for damages and be subject to cnm,nal prosecution under state and federal law.

5 . ' PIN QTY NOTE: If the mechanic filling out this form is contracted maintenance, they must or AME # in place of employee number. GMM / APPEN DI X A -FORMS CA-49 MAINTENANCE DISCREPANCY RECORD PAGE I OF I REV 19 06/20.'JS