Piper Malibu PA-46-310P Pilot Operating Handbook page 187

0
us Oepar1ment
of Transporta1ln
(Airframe, Powerplant, Propeller, or Appliance)
FedBml Aviation
Admlnl&tmtlon
INSTRUCTIONS: Print or type all entries. See TIUe 14 CFR §43.9, Part 43 Appendix B, and AC 43.9-1 (or subsequent revision thereof) for
instructions and disposition of this form. This report is required by law (49 U.S.C. §44701}. Failure to report can result in a civil penalty for each
such violation. (49 U.S.C. §46301(a)}
Nationality and Registrauon Mark
USAN
1. Aircraft
Make
Piper
Name
(As shown on registration certificate)
2.0Wner
4 . Type
Alteration
Repair
D
Ill AIRFRAME
D
D POWERPLANl
-·
-
�
-
r - c
- -
PROPELLER
"t]::-·-
o
APPLIANCE
D D
A. Agency's Name and Address
Mead Aircraft Sevices, Inc
Name
AddJass
1180 � Aic1221l B�
Hutchinson
Clly
USA
67501
Coumry
Zip
D. I certify that the repair and/or alteration made to the unlt(s} Identified in item 5 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.
Extended range fuel
per 14 CFR Part 43
D
App.B
Pursuant to the authority given persons specified below, the unit Identified in item 5 was inspected in the manner prescribed
Administrator of the Federal Aviation Administration and is
FM Fil Standards
Inspector
BY
FMDesignee
Certificate or
Designation No.
IA 443641987
MAJOR REPAIR AND ALTERATION
3. For FAA Use Onlv
5. Unit Identification
Unit Make
-
- -----
0
Type
Manufacturer
6. Conformny Statement
B. Kind of Agency
1./
Stale KS
Signature/Date of Authorized Individual
?/-
Kevin Mead 1-11-10
7 . Annroval for Return to Service
Maintenance Organization
Manufacturer
X
Inspection Authorization
Repair Station
·�"""'"IDateof AuU.orizoo lodl
Kevin Mead 1-11-10
Serial No.
Model
PA46-310P
Address (As
shown on registration certificate)
Addl'll88
City
Zip
Model
(As described In Item 1 above)
----
U. S. Certific Mechanic
Foreign Certificated Mechanic
Cettificated Repair Station
Cettificaled Maintenance Organization
f
G2I
Approved D
Other
?
�
Form Approved
ngNumber
0MB No. 2120-0020
IElec:tJon
11/30i2007
For FAA Uaa Only
Serles
I
State
eoun11y USA
Serial No.
-- -
----
-
- -
-
----
Manufacturer
I
C. Certificate No.
A&P 443641987
Rejected
I PeJSons Approved by Canadian
Department of Transport
(Specify)
by the