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B
AIRCRAFT MAKE:
AIRCRAFT MODEL:
AIRCRAFT SERIAL NUMBER:
AIRCRAFT REGISTRATION NUMBER:
DATE WORK COMPLETED:
A. Installed the KMH 880/KTA 870 System in accordance with Unit Installation Manual
number 006-10609-000_, Revision ____, dated __________, and has been flight
tested in accordance with AC 20 ZZZ (draft), to verify proper operation and accuracy
for a follow-on IFR approval. Original IFR approval was accomplished by STC
____________, Master Drawing List number _________, specifications of TSO-C147
Class A and TSO-C151a Class B.
B. Ground and flight tests were conducted and determined that the KMH 880/KTA 870
System does not interfere with normal operation of other equipment installed in the
aircraft, and the KMH 880/KTA 870 System equipment is not a source of objection-
able electromagnetic interference. Proper operation and accuracy were verified, and
the unit functions properly and safely in accordance with the manufacturer's specifica-
tions.
C. The unit was mounted in rack location for avionics provided by the manufacturer and
is sufficient to ensure the restraint of the equipment when subjected to emergency
landing loads.
D. Installed an FAA Approved Flight Manual Supplement in the aircraft manual and a
Operator's Manual, part number 006-18265-000_, Revision _____, dated ________,
in the aircraft. Weight, balance and equipment list changes have been made in the
aircraft flight manual.
Rev 3, August/2002
SAMPLE CERTIFICATION CHECKLIST
10609I03.CDL
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
KMH 880/KTA 870
Page C-3
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