I. Approving National Aviation Authority/Country

2· AUTHORIZED RELEASE CERTIFICATE 3· Form Tracking Number:

FAA/United States FAA Form 8130-3, AlRWORTHINESS APPROVAL TAG ' .

4. Organization Name and Address: Hamilton Sundstrand Worldwide Repair Windsor Locks Hamilton Sundstrand Division United Technologies Corporation I Hamil ton Road Windsor Locks, Cr 06096 S13R842L

6. lie 7. Descri lion

MOTOR ANO PUMP. AUXILIARY

13. Remarks Return to Service

8. Part Number 9. Eli ibili

NIA 782655-3

PART 4122-006009/782655-3 AND RECORDS WERE INSPECTED TO DETERMINE IT HAS NO TIME IN SERVICE SINCE MAINTENANCE AND/ OR ALTERATION. PART WAS MODIFIED AS DOCUMENTED ON 8130-3 TRACKING NUMBER 121017 ATTACHED. ALL RECORDS ARE ON FILE AT THIS REPAIR STATION . THIS INSPECTION IS IN ACCORDANCE WITH FAA ORDER 8130-21 AS AMENDED.

15973

5642885 1.000

5. Work Order/Contract/Invoice Number:

w.o. 7665658 Cust. P.O. 9-77874

atch Number: 12. Status ork

INSPECTED

TT TSO TSR TCSN

UNK 41364.50

0.00 UNK

Pertinent detail of the workscope identified in Block 12 are on file at this repair station under wor k order no.

~ork performed by Repair Station SI3R842L

7665658

Certifies work specified in Blocks I 2/13 was carried out in accordance with EASA Part 145, and with respect to that work, the component is considered ready for release to service under EASA Part 145 Approval Number: EASA 145-4983.

~ Other regulation specified in Block 13

Certifies that unless otherwise specified in Block 13, the work identified in Block 12 and described in Block 13 was accomplished in accordance with

Title 14, Code of Federal Regulations, part 43 and in respect to that work,

the items are approved for return to service.

Name (Typed or Printed :

Hampson,Robert

21. Approval/Certificate No.:

SI3R842L

23. Date (m/d/y): May212013

It is imponant to understand that the ex istence of this document alone does not automatically constitute authority to install the pan/component/assembly. Where the

user/installer perfonns work in accordance with the national regulations of an airwo1thiness authority difTercnt than the airwonhiness authority o f the country specified in

Block I . it is essential that the user/insta ller ensures that his/her airwonhiness authority accept.~ pans/components/assemblies from the airwo1thiness authority of the

country specified in block I. Statements in Block 14 and 19 do not constitute installation cenification. In all casl.'S aircraft maintenance records must contain an insta llation

cenification issued in accordance with the national regulations by the user/ installer before the aircraft may be flown.

FAA Fonn 8 I 30-3 (06/0 I) *Installer must cross check elig ibility with applicable technical data. NSN: 0052-00-012-9005

1. Approving National Aviation: 2. 3. Form Tracking Numbers:

Authority/Country: AUTHORIZED RELEASE CERTIFICATE 121017 FAA/UNITED STATES FAA Form 8130-3, AIRWORTHINESS APPROVAL TAG

4. Organization Name and Address: AeroControlex Group, Inc. 4223 Monticello Blvd., South Euclid, OH 44121 (FAA PMA PQ2093CE) A34O423J

5. Work Order/Contract/Invoice Number: 1052773/MR20260

6. ltemsj7. Description: !8. Part Number: !9. Eligibility:* !10. Quantity: Serial/Batch Number: f 12. Status/Work:

13. Remarks

AUXILIARY PROPELLER FEATHERING PUMP

4122-006009 / 782655-3 15973

N/A MODIFIED

PUMP ASSEMBLY WAS MODIFIED FROM P/N 4122-006009 S/N UNK TO P/N 4122-006009 S/N 15973 MAND RETROFIT PER SERVICE BULLETIN 14SF-61-A165 ORIGINAL ISSUE DATE: SEP 25112, MANUFACTURES APPROVED DATA AND C.M.M. 61-21 -28 REV. 3 DATED APRIL 20, 2007. REF. P/N 782655-3 P.O.# 6626194 TSN:UNK CSN:UNK

AeroControlex certifies that the work specified in blocks 12/13 was carried out in accordance with EASA 145 and with respect to that work the aircraft component is considered ready for release to service under EASA Certificate Number EASA.145.6259.

Work Performed By: DAMON M.

P" 14 CFR 43.9 Return to Service P" Other regulation Specified in Block 13

Certifies that unless otherwise specified In Block 13, the work identified in Block 12

and described in Block 13 was accomplished in accordance with Title 14, Code of

Federal Regulations, part 43 and in respect to that work, the items are approved for

return to service.

21 .Approval/Certificate NO.:

A34D423J

23.Date(m/d/y):

APR/3/2013

User/Installer Responsibilities

It is important to understand that the existence of this document alone does not automatically constitute authority to install the part/component/assembly

When the user/installer performs work in accordance with the national regulations of an aiworthiness authority different than the airworthiness authority of the country specified

in Block 1, it is essential that the user/installer ensures that his/her airworthiness authority accepts parts/components/assemblies from the airworthiness authority of the country

specified in Block 1.

Statements in Blocks 14 and 19 do not constitute installation certification. In all cases, aircraft maintenance records must contain an installation certification issued in accordance

with the national regulations by the user/installer before the aircraft may be flown.

FAA FORM 8130-3(6-01) *Installer must cross-check eligibilty with applicable technical data. NSN :0052-00-012-9005

AERO coNrRoLEa L ~

4223 Monticello Blvd.

South Euclid, OH 44121

Repair Station A34D423J

PH:(216 )291-6025

FX:(216)291-6094

FORM NO. 11721/09

INSPECTION/CORRECTIVE ACTION REPORT

CUSTOMER:

PART NUMBER:

HAMILTON SUNDSTRAND

4122-006009 / 782655-3

SERIAL NUMBER: 15973

REPAIR WORK ORDER#:

PART DESCRIPTION:

DATE:

MR20260 AUXILIARY PROPELLER FEATHERING PUMP 4/3/2013

RECEIVING INSPECTION: n cHECK _____________________________ ...,!Lj:..., LIST

PRELIMINARY INSPECTION : MODIFY PER S/B 14SF-16-A165. Parts Needed: NAMEPLATE; MOTOR(PERM. MAGNET)ATP40-0105; GASKET; SEAL; SCREEN; TRANSFER TUBE; COUPLING; PACKING, PREFORMED, O-RING; SCREW. ~ R :;

INSP.STAMP: lv{:,,~ -:J;J HIDDEN DAMAGE: ./1h110 ( r;.,''".,"%\

INSP.STAMP:

PROGRESSIVE INSPECTION: D REQUIRED [Z]NOT REQUIRED (2]1D TAG ISSUED

INSP.STAMP: 6 ~ REPAIR TAG ISSUED O uNSERVICEABLE TAG..1ssuED

WORK PERFORMANCE/CORRECTIVE ACTION : PUMP ASSEMBLY WAS MODIFIED FROM P/N 4122-006009 S/N UNK TO P/N 4122-006009 S/N 15973 MAND RETROFIT PER SERVICE BULLETIN 14SF-61-A165 ORIGINAL ISSUE DATE: SEP 25/12, MANUFACTURES APPROVED DATA AND C.M.M. 61-21-28 REV. 3 DATED APRIL 20, 2007. REF. P/N 782655-3 P.O.# 6626194 TSN :UNK CSN:UNK

REPAIR TECHNICIAN SIGNATURE: ',,..~,,~~

0 27 5_.,. DATE WORK:

+ro r.'-'-<, APR O 3 2013

WORK ORDER REVIEWED AND COMPLETE: INSP.STAMP:

'09 ~ MAINTENANCE RELEASE ISSUED D FAA FORM #337 D RETURNED AS 1s (NOT REPAIRED) .... ~"-o

CZJFINAL ACCEPTANCE

4 i 5,., -:,,_ "

INSP.STAMP V'r·· · . C •

..J

:,

COMPONENT RETURN-TO-SERVICE RECORD -,

THIS SECTION TO BE COMPLETED BY PARTS ROOM ,,

"· THIS SECTION TO BE COMPLETED BY MECHp:NIC/TE~HNICIAN ~)'_ SHOP LOG WORK ORDER / '/ '2 0 I -. !NITIAL I REP AIR I r I OVERHAUL I I ASSEMBLY

NUMBER ~,,;, EVALUATION I MODIFICATION I I INSPECT I Ril y I I N

DISCREPANCY

'.

SPACE IS PROVIDED ON BACK Of FORM FOR CONTINUATION OF CORRECTIVE ACTION(S) AND PART(S) USED RECORD

MECH Ril INSP

I ~ I ,,

CORRECTIVE ACTION(S) INITIALSIEMP .#/DATE IN!TIALS/l!MP.#/DATE

,,,

1/r

.... ~ ... _ ---· ----- ---- ------------ - ---------+--------

PART(S) USED RECORD - . . QTY - NOMENCLATURE PIN SIN - !- • • ......

b ,

.... SECTION TO BE COMPLETED BY INSPECTOR TO REFLECT TCMES/CYCLES/DA TES AFTER COMPLETION OF WORK

(If Applicable) Enter time/cycle/day information below. YES D NO D

TSN

I CSN

I TSO

I cso

I TIS

I CIS

I TMI

I CMI

I DIS

(If Applicable) Enter currency date of component:

Manufacture Dale: Due Dale: Currency Date: Other:

Th e Compo~ent identijie~Lider~nd approved/or return to service.

Tech4~ ·,,. -" Type of Certificate and Number: S;i-7 ~ Date: C.po/7 Date: h / J ~ / / 1 lnspecl~r: ',:::: J-_ ~ - - J ~ Typeof CertificateandNumber: w 'llza fP?1

GMM / APPE DIX A-1,0RMS CA-7 COMPO ENET RETURN TO SERVICE RECORD REV 20 10/22/15 . PAGE I OF2

.,

COMPONENT RETURN-TO-SERVICE RECORD

THIS SECTION TO BE COMPLETED BY PARTS ROOM P.O. # I ~l~J r~ 1ssUEDTSf{op

REMOVED FROM A/C I DATE;r;f;~,~ i, 0~~1, ,. N2~1 PIA-

Nf~';lURE 8)rJ ~ f:Y::(u I Pm 11)-{o"x'f k b 15m 9'508~ - . THIS~ ECTION TO BE COMPLETED BY MECHANICffECHNICIAN

SHOP LOG WORK ORDER /o/9 I !NlTIAL I REPAIR !YI OVERHAUL I I ASSEMBLY I NUM BER EVALUATION I MODIFICATION I '- I INSPECT I ~ II y I IN IX

DISCREPANCY t/.JA-,~ I

P.A./ / .; k?.. ~ -- ,

: '

' SPACE IS PROVIDED ON BACK OF FORM FOR CONTlNUATION OF CORRECTIVE ACTION(S) AND PART(S) USED RECORD

CORRECTIVE ACTION(S) \

'· MECH RI! !NSP INTT!ALS/EMP.#IDATE IN!TIALS/EMP.#/DA TE

~ n_,.,J-:._ iA, "" , ,..L Al~ .J _, . ,;tn ..(/l,_ -.-.-1! /-../7-.

~;/ A,J, OJ\ -r.A-,w ., V ~~;rL:7 hf5'CM~H lo/-,:Jb -o-t) ....,..

. ,

~ . ,~ -

.. -.

- ' ,.,. '

~

.. '

.... ·'~

PART(S) USED RECORD ~

'

OTY NOMENCLA TIJRE PIN / SIN ,,.

1~ ~. _,. j /) ~ 7:3g//t/4 ~t.6.JcT V/,,+ .

~

SECTION TO BE COMPLETED BY INSPECTOR TO REFLECT TlMES/CYCLES/DA TES AFTER COMPLETION OF WORK

(If Applicable) Enter ume/cyclc/day infonnation below. YES 0 NO D

TSN

I CSN

I TSO

I cso

I TIS

I CIS

I TMI

I CMJ

I DIS

(If Applicable) En1cr currency date of component

Manufacture Date: Due Dale: Currency Date: Other:

The Con,pnnenr identifted · nside~e~ and approved for return to service. >N Date: '7/3/17 Tech cian: t'. -~ 1 Type of Certificaie and Number1V'~7JE?.

Inspector: .!.~/F -~j~';/. p lype of Certificate and Number-.l{,/!__Z..1>·1P~rt1--'l. Dale: Phfel/1'7

GMM / APPENDIX A-FORMS CA-7 COMPONENET RETURN TO SERVICE RECORD REV 20 10/22/JS . PAGE I OF 2