Cub Crafters CARBON CUB SS CC11-160 Maintenance Manual page 15

CONTINUED OPERATIONAL SAFETY REPORTING FORM
NAME (Last, First)
COMPANY/ORGANIZATION
ADDRESS
Number and Street
City
State/Province
Country
TELEPHONE NUMBER(S)
DESCRIPTION OF SAFETY OF FLIGHT ISSUE OR SIGNIFICANT SERVICE DIFFICULTY:
SIGNATURE
COS Log Number:
Manual number SSC10000AMM
Date: 04/18/2013
CUB CRAFTERS, INC.
CC11-160 MAINTENANCE MANUAL
Postal Code
DATE
FOR CUB CRAFTERS' USE ONLY
Date Received:
AIRCRAFT MODEL
CC11-_________________
AIRCRAFT SERIAL NUMBER
CC11-_________________
AIRCRAFT REGISTRATION NUMBER
1
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