€¦ · tcca approval no.: 897-22 '" certifies that lhe items identified above -re...
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1 - OOWETD<t llllTHtRn'-,-,.. 2. 3. Fonn Tracking Number ---"' AUTHORISED RELEASE CERTIFICATE N'W A!plndJ Formulln
DIRECTION GENEAALE DE Certificat Libtiratoire Autoristi 115090
l'AVIATION CIVILE EASAFORM 1 FRANCE Formulaire 1 de l'EASA
,. OrganisatiOn Name and Address : Goodrieh ActuatJOn Systems SAS 13 Avenue de l'EguiUette, ZI du Vert Galant 95310 Saint Ouen l'Aum6ne (France) 5. WOik Oioer I Contract I Invoice Hom et Adu, ... d8 l'Organ/,me Ban m QJ11•1•11ii/Connt/ F.ct.n
43052525 f A:356987 6. llem/ Item 7. Descnplion I Ducrlptiotl 8. Part No. f N· de p/fJN ,. Otyf Otfi to. Senal No. I N" w1e tr. Status I WOik I Elat I r,.vaux
001 TAIMMASLE HORIZONTAL STABILIZER 47175-530 \ 0072 REPAIRED ACTUATOR
\2. Remarl(S{Remarque• The wcwk ldenbhed if! block 11 and descrt,ed hef1lin has been accomplished in accordance with 14 CFA CMM :27-44-57 REV:2 AMDTS: C TSN: 36644 Fhrs CSN: 5290 Fcys part 43 and in respect to that wcx1c. the ite1Tl$ are appro11ed fo, return to service i.n:ler ce111ficate See, in A.ppenclix ol tis A.ilWOOhinHs Certilicale, the Teardown Report rela\Ne to the Repair Sales Order n• 06SY947N. n• 6950927 , hlwig. if any, all the SeMce Buletins applied on !he Int and their corresponding A.iTWOrtNness Directives. RECOMMENDED SHELF LIFE 60 MONTHS Les travaux Kltlrltifils an case 11 er d8crits ici ont ete executes conformemertr 8 la partie 43 du 14 CFR et Passed test required by EASA. AD N" 2014-00n dans le cadre de ces rnweux. /es atticl6s sont ap,:x"OUVfl pour Ill remise Btl sBtVic:e an -111 du cer111icat Remaining life EASA. A.D 2017-0228 (A.LS PART 4-70000 Fhts/10000 Fcys) if fitted on an A340 senes A/C: n• 06SY947N. 33356 Fhrs 4710 Fcys Remaining fkghl cycles lo neXI NBB cisks regular maintenance (VSB 47175-27-10 I EASA. AD 2014- 02s1R11: 3291 F-- THSA A ........ ns-- 3$ -- EASA.A.D 2011-oo« I
"'' Certifies that the items dent.fied abcwe were manulactl.lred 111 cc:111ormoty to ; , ... "' Pan 145.A..50 Release to Serv,ce "' Other regulation specified 111 block 12 � � ,_ ..,,,_,,.. ldelrti#JN cklN:•uw ont ele r.brlquN conlomternlMI ..,. : Approbation pour ffflllu en MrVice Autre f991MNntatfon prec1.ee en callfl 12
0 approved design daia and are in a conditlOfl lot sate opeBIIOfl Sefori Partie 1"'5.A.50 donnM -� .,,,,,-o""'- flf IIOnt an MM lM �.,. IOulJ #Qlrllll Cartilies that unless Olhenwrse speahed in block 12, the work idenllliecl in block 11 and descnbed In block
0 � dn.grl data specified if! block 12 12, was accompllShed if! � with Part 145 and n respect 10 Iha! wcx1c !he items are considered donMN -� non .tpp'Oll"'-.,,.clfi4N "-'a &me:... 12 ready lor release to service.
Cffllfie que, .. ut Indication contra/re .,,.effiff en cue 12. Je• ITav•ux identifM• en UN 11 et dficri!s en callfl 12 ant fitll realiHs ��t j Ill ptl(fje 1"'5 e! qu"IIU vu de CH trav•ux, le• piecn sont conllideree• p,jte• i la,..,,. .. M Hfllke.
13b. A.IJthorised Signature tac. A.pproval/A.u!horisatioo Number 1'b. '"""""" s,g,,,,�, ,JIJi. t-: 14e. CerblicatelApproYal Rel. No -- M.lmtin, d..,,,.,_fld'autorluflon Signatu,.. autoriah w � N" clu c.rtificat/A!}l'ement
"'·: FR.145.0051
' 13d. Name I Hom "' Oate jdd mmm yyyy) I 0... OJ mmm ,,...) 14d. Name/ Nom , ... Oate (dd mmm yyyyy Dale OJ mmm aau)
BAPTISTE PATEAEA.U 26-A.pr-2019
USEMNSTAU.ER RESPOHSl81UTIES/�ds�- TNt Olrdclie -• nal -lk;l,IIJ- lll#IOrily- lO n1111 .. lfliln',(,� c.doe- ... �p.-�r..-..---rr•Jltem(9J
....-i.,. ................. perblftt wo,t.'" - - ........ ol ., .,_ ..a,oniy <111....W: llwl 11,e altwor1lints1 a!.Charlly "'*"'oed In - 1 M 11 e..-al - IN � .......,. - ,,..,.., ·-·•- ai..cr,o,IIJ � ........ lrom ..
....._....� ll'IQfied In- I. Ov_l\ll:ll__,,,._,,........_,,_,51r ,r r .. ,,._--�di"*-""'�cr......,;g,bflfU-lfio,•!Hd_lt.,...1.lt-u--rvt#I�-·- ..... _....,......., ... �� IINllenOf .... PMr--"'ds,.,.... Tlhlwww-••-leeaw I.
Sii.i-in - 13- - ,..., oa - - .... ----.ion. In .. - e1ru.it............,. -• rni* cont•..,.., l.-.t111atkln cellltlcat.oo ltSUl(I In acoonance ,..., ,. fllbonll � t,y h ......,,,_ - ,. aorcran...., tie llown. l.ff ""'*'-,,,,,.... ., <:- f.J9 ., '"' ,. � - .,.,. - er. fflOflflpt. 0.... ....,. IH cu le _..,. ., • ...,,.,.,, ""' r_.,,,., - con- - � d� ....,...,.. -"'"',.,.,,.,., - ,..._"" ,,..,,,,,..,.,, Pl'" r11tt11u1e11t>1n111111MUr11V-- r.-,.._ .. --
EASA Form 1 lnue 2 / Fonnulaire 1 de l'EASA Edition 2
"
•
1 ....... """"'° COMO'ETDfl AUT>tOAITVICO.llffll• 2. 3. Form Tracking NUT1ber AU'TOIITE�AV5 AUTHORISED RELEASE CERTIFICATE N" di, l"llplftdl FamtMn,
DIRECTION GENERALE DE Cer1iflcat Liberato/re Autorise
EASAFORM 1 115091 L'AVIATION CIVILE
FRANCE Formulaire 1 de l'EASA
,. Organisation Name and Address · Goodrich Actuation Systems SAS 13 Avenue de l'Egu1llette. ZI du Vert Gatant 95310 Saini Oueo l'AirnOoe (France) s. Work Order I CQntract / lnvace Nom et Adre!lff de f'Organlsme 8cwl di, CCllllllWDI/Q:nrat/Far:IJQ
43052525 I R356987
6 Item/ Item 7 Description I Description e. Part No. I N" de pi9Ce 9 Oly f Qtli 10. Serial No. I W Hrie tt. Status (Work I Etat I Travaux
001 TRIMMABLE HORIZONTAL STABILIZER 47175-530 1 0072 REPAIRED ACTUATOR
12 RemarksfRernarques CMM :27-44-57 REV:2 AMDTS · C TSN: 36644 Fhrs CSN: 5290 Fcys See, m AppendiK ol lhis Airworthiness Certificate. !he Tean:lo>Ml Report relatNe to the Repair Sales Order n• 6950927 , listmg. If any. an the Service Bollelins apphed on lhe 1x111 and their corresponding Airworthiness Directives RECOMMENDED SHELF LIFE 60 MONTHS Passed test required by EASA AD N" 2014-00n Remaining life EASA AD 2017-0228 (ALS PART 4-70000 Fhrs/10000 Fcys) if lrtted on an A340 series A/C. 33356 Fhrs 4710 Fcys Remaining High! cycles lo neXI NBB clisks regiJar main1eoance (VSB 47175-27·10 I EASA AD 2014-0257R1 ): 3291 Fcys THSA passed inspection as per EASA AD 2017-0044 TCCA Approval No.: 897-22
'" Certifies that lhe items identified above -re manufactured in contormity to : '" "' Part 145.A.50 Release lo Service "' Other regulabOn specified in blodl 12 c«tJn. QW ,.. Ml,...,Q it#fltifiN � ont Mri fsbrlqutit, COtlformem«lt aux ; Approbation pour remlse en seosce Autra rliglementation priciHfl en case 12 a approved design data and are in a conclition for safe operaborl Se/on Partie 145.ASO
..... - conc.ptJott � ., ..,.,, "" ,kat - fonction,.,-"" toclte #CUrlfe ceneres lhat unless otherMSe spec;:lfied in block 12. lhe l!Ofk idenbfied m block 11 and descnbed 11'1 blocil a non-approved clesi� data spectfied in block 12 12, was accomplished ,n accordaoce with Part 145 and in respeci to that l!Ofk the items are considered dtmtNIN d9 conception non�� dan11 /a cae 12 ready for release to service
Certifie que, sauf Indication cont,aira spicifiH IHI case 12, ie. travaux identifies en case 11 et decrits en case 12 ont iti l"eali�s confortnement Ii Is partie 145 et qu·au vu de ces travaux, /es pikes sont conslderiea prites ii la nn ree •n sentif:L'
13b. Authorised Signature tac ApprovaVAU!horisation Number 14b. Aulhonsed Signature ® �
14c. CertrhcatefAppruvaJ Rel. No �IIUforie# NumtJro d'agrinwntld'autorlution Signature autoriHfl �clu CertificaVAgremerlt . FR.145.0051
13d Name/Nom 13'. Date (dd mmm yyyy) I 0.. OJ mmm aau) ,., Name/ Nom "' Date (dd rrwnm yyyyy Date (jj mmm aaaa)
BAPTISTE PATEREAU 26-Apr-2019
USE.A/INST ALLER RESPONSIBILITIES f Responsllbi/ltes di, l'ut1/isat-1ins/a/lateur This certificate does not aulomabealy constitlJ!e authorily lo instaU the �em(s). Ce document,. cons#tue pas torcoment l'autorisation d'lns/aller l'(u) item(s) Where the userli'lstaller performs work in accordance with regiAalions of an airworthiness aulhonty Olllereflt than the airworthi110Ss authority specjlied in block 1 � is esseolial that the user/installer ensures lhal his/her airworthiness au1hority accepts �ams lrom the airMllthiness authonly speciied in block 1. Ownd /'ut/lisataurlinsta/lllt,wr ir.vmHle Nlon lea ng1ementations d'una sutorile de navigabiliti clifflirente de /'autoriti de navigabilitf mentionnff <ans Ill c.H 1, ii NI euantiel que rutllisa1aurtfnstallllteur s'assu1" que son autoritf de navlgabltn. accapla /ff irems /ibtjrn par l'autorit9 de navigabilitli mentionflfNI dans la casa I. Statements 1n blocks 13a and 14a do not constJMe nstallalion cerllfocallon in au cases aircraft maintenance records mus! contain an Installation certlicabOn issued in aooon:lanca with lhe nallonal regulations by 11-.e user,1nstaler before the aircraft may be llown. Les indications portees en caNs 1311 et 14a ne constituent pas une certification de montage Dans tous las cas la do!ssier d'antretien de l'llflronef doif contenir Uflfl certificalion d·installation <UliVTH confcxmlimant aux r,jglemenrs natiooaux fNIF l'ut,/,ssteurlinstallaltNr s1111nt que /'HrOllflf puisH IIOIM.
EASA Form 1 luue 2 f Fonnu/aire 1 de l'EASA Edition 2
1 �" Country 2. <N!l l.\\l!l fi!l> .II. lol CAAC D��tt. Conformity 181:i!�tt. Airworthiness 3 iiE'll\11� Certificate Rel. No.
CHINA l!tllUI: ff iiE '!lllifil!tlllfi<'lt Al!THORIZED REL.EASE CERTlACATc/Al�ESSAPPROVAL TAG
115092
4 ${il Organization GOODRICH ACTIJATION SYSTEMS SAS 13, Av. de l'EgU1llette -Z.I du Vert Galant - 95310 Samt-OJen l'AumOne FRANCE 5 Ifti-i¥i/fH��J,\IJ'l WOiie Order/Coolractflrwoice D 43, rue des Pres - 27950 Saint-Marcel FRANCE 181 13, Av. de t'Egullette ·Z I du Vert Galant • 95310 Sa1nt-Ouen l'AUITl(ne FRANCE 43052525 I R356S87
6 /t--i} 7 �'!; 8 tt� 9 Jlillltt 10 ,!:• 11 :l.Jl:l-i}/ltt:-i} 12 r"��* Imm Pall No. Eh"DI',.:_ �No. -..WOO<
TRIM MABLE HORIZONTAL 47175-530 0072 REPAIRED 001 STABILIZER ACTUATOR A34C><OO 1
13 4it Remarks CMM :27-44-o? REV:2 AMOTS: C TSN: 36644 Fhrs CSN : 5290 Fqa RECOMMENDED SHELF LIFE &O MONTHS See, in Appendii of lhis Airworthiness Certiliciii., the Te11rdown Report relative to tt. Reiair Sain Order n' 69S0927 , listing, if ,ny, all the Sef'Yict. 8uHe1911 applied on the unit and !heir corrnponling Airworthsiet;1 Direeti\oet. Remaining lite EASA AD 201NIZ!8 (ALS PART 4-70000 Fhrsl10000 Fqa) ii fitted on an A340 aeriH AJC; 33356 fh11 4710 Fcys Remaining !light eycles to nut NBB di1kl regulM mainlerla'IQ (VSB 47175-27-101 EASA AD 2014-0257R1): 3291 Fey1 THSAR•uedin • · • EASAAD2017.oo44 Pauedtntr ired. EASAADN"2014-00n 14 1li r" 8:, New Parts 15 tl:Jtt.ct(Ar"iil. Used Parts tt/fl"ll:i!i""i.Ni:Jl. 13 JllfJjC;'t.:AflictH,., i2tfi�l:.i!Elit�M*.Millhtil4Jlfl: fi. ' , <lflni"'&.> Rft ttitr"ll:.i:£1"&,f.*:� 13 )Jl!tJ)(.'t:Al:ii:'.tl.*· i2��1:j:£���M*���nEl�ffli!tJ�A•*.a �ltt�����ITMM��n11•w.��ffl�*· IT 7 I tt,. �,"' &,ii: T:!c � PJ ffl �� iii ti. ffl:.lll!tfi ft:Jfl. Certifies that the Part(s) idercfied above excepl as · ee in bkx::k 13 was(were) manulacture<Vinspected in Certifies that the wort specified above excepl as specified l'I blodt 13 was carried out in eccooarce accordance wrth the airworttv.ness;:
� · , "' stated comtry ard'o, in the case ol parts !o be exported wJlh the wtlh the ailwo!thrless regtAations ol lhe stated cotmy and the nollfiecl special reqooements ot the approved de · n , .., special r · the � country. importing COIXltry and., respect to that work. the pa,t(s) IS {are) in condrtlon r« sale operabon and
I • ./ considered rAA..:· for reease to 5efVice rover\ 16 l!tllA:5:.f!'; tt3 \ l:,1j, 118 l!tllB»I 19 'Pl»!l;;M.e..liii"t.l Sqlature : I Date 26-Apr·2019 Issued by or on behalf of the CAAC : F03300551
17 l!tllAttt Ofijl�) Name{Printed) BAPTISTE PATEREAU
ftt1!l.ttffii:�IU:ltt11:54 AlJTHORIZED RELEASE CERTIFICATEIAIRWORTHlNESS APPROVAL TAG 0•1*••11.• USER/INSTALLER RESPONSIBILITTES
( 1) 0lllJIIII. -*3tfHt:::t-ltil:WfMll.f't-lSf't.aJJ;1.BfHJ�J",i.l:. ( 2) l!Uf.111./.ii:IHUIICJ._iifrttll:lUU!Ulfll>TtM, iH••&M 1 lJl'P;Ji'lill.lH'i�.ii9t;U!11 . lf.ffl4iit'Bt0ll-i;\iEiifrtt
llfll2S'i�····�MIIIJllS'i�·ltil:WOrl!Wm•msf't.. ( 3 l &'PM 1.( JJ. M 15 JJrl!-.J.t , #::t-il!.IJl-*3Ait!llltil:. ttiifr••� T , S'i!:!llftm� . S'i!:!lllf..lft4/.iiB* Sl!eii-*112'1
>TtM•.t:fll :fi:fllt»-lt.A !1 tfi2 ft 'P. (1) It is � to oodeistand lhal the existerc:e of this document alone does not automaocal)y oonstitu1e authonty to l'lstall the partlcomponentlasserrbly. {2) Where the userfnstallef works l'I accordarc:e with the national regulations of an Airworthiness Authorily drHeren1 than the Airworthiness Authonty ol the COllnl1y specified 11 bklck 1 ii is essential that the userfanstaler ensure
that his/her Airwortl*less Authority aa:epts partsloomponenWassembhes from the Airworthiness Authonty of the country specified in block 1. (3) Statements 14 and 15 do not constitute installabon cerbfication. In all cases the aircraft maintenance record must contain an installabon certJfication issued in accordance wi1h the nabonal regulation by 1he userflnstaller bel«e
the aircraft may be flown.
O UTC Aarospace Systems ALS PART 4 - Component movement Traceability Sheet COMPONENT DESCRIPTION: THSA 47175-530 , SN: 0072
DATE PART ASSY AIRCRAFT
On Off Reason PIN TSN LSN PIN I SIN I TSO I LSO M°"" MSN WV TSN LSN POS ENDORSEMENT
01 Aug 2005 47175-200 0 0 A340-541 685 0 0 tcs / 09 Sep 2010 Upg- 47175-200 ,..,. 3180 AJ.40-541 ,..,. 3180 -�
30 Jan 2011 47175-520 AJ.40-541 3!M 33590 "62T !CS X.I v "'""'
23Apr2014 Upg- 47175-520 36115 '''" A340-5'1 42831 6528 ' ,M;;-f
31 oct 2015 47898 T .... ics . 47175-530 A340-541 5T2
17 M.iy2016 AC dismantled 47175-530 366« 5290 A340-541 48427 7677
MAJOR REPAIRS REMARKS
Rldu� llfe limit Unit upgraded to PN 47175-530 with No-Bado: Brake (NBB) disks replacement in May-2014, as per EASA AO 2014-0257-Rl, Alrbu• repair N" Approval date Ne)(! NBB disks replacement before CSN = 8581 FC
TSN LSN Unit stored by AJW betweem May 2016 & Sept 2018 No major repairs
Life Limited Part
Issue date: 12/09/2018 Time: 16:58 Page: 1/1
NJMiiiltilt·HI 30331ss61
47175-530 AMOTSIN
SUB-ASSEMBLIES TRACEABILITY
43052525 0072
c PNOUT
6950927 47175-530 PNIN
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Goodrich Actuation Systems SAS 13 Avenue de t'Eguilfelte BP 7186 Saint Ouen l'Aum6ne F-95056 CERGY PONTOISE CEDEX Repair Station #06SY947N
TEARDOWN REPORT
O UTC Aerospace Systems
Customer A J WALTER AVIATION Cust PO R356967 Operator PO
Input Part 47175-530 Input Serial 0072 Qty 1.000
Output Part 47175-530 Output Serial 0072 Workscope REPAIR
Cust Part Cust Serial 0072 Status/Work REPAIRED
Description TRlt,O.IABi.E HORIZONTAL STA81LIZEA Removal Code IAAN Failure Date
Aircraft Engine Type Tail No A7-AGB
Incoming NSN NIA Outgoing NSN NIA
Date Rec'd 10.04.2019 Quote Date Accept Date
Ship Date DOM 01.04.2005 Last Order Date 09.10.2018
Sales Order 6950927 Work Order 43052525 Notification 303315567
Measuring Point: I Serial# I C�N I ·�N I I I I I I I I I I
OUTl0072 ' 5 136644.00 I I I I I I I I I I
Internal Traceability Trayabilite composants
INCOMING TRACEABILITY
PITCH TRIM ACTUATOR PN: 47148-122 SN: 1263
ELECTRONIC MODULE #1 PN: D90ST4209-100 [#1] SN: 5716
ELECTRONIC MODULE #2 PN: D90ST4209-1001#2] SN: 5750
ELECTRONIC MODULE #3 PN: D90ST4209·100 [#3) SN: 5767
ELECTRIC MOTOR #1 PN: 634163-200 [#1] SN: NIA
ELECTRIC MOTOR #2 PN : 634163·200 1#21 SN: NIA
ELECTRIC MOTOR #3 PN : 634163-200 [#31 SN: NIA
COMMAND DETECTION PACK PN: 450102SN: .0093
MONITORING DETECTION PACK PN: 450101 SN: .00097
RIGHT HYDRAULIC MOTOR PN: 3022017-001 IRJ SN : G0440661
LEFT HYDRAULIC MOTOR PN: 3022017-001 [LJ SN : G0440575
RIGHT HYDRAULIC BLOCK PN : 450092-200 [RJ SN: .00246
LEFT HYDRAULIC BLOCK PN : 450092·200 Ill SN: .00246 I
j Printed on 26.04.2019 09:49:38 Page 1 of 6
Goodrich Actuation Systems SAS 13 Avenue de l'Eguilrette BP 7186 Saint Ouen l'AumOne F-95056 CERGY PONTOISE CEDEX Repair Station #06SY94 7N
TEARDOWN REPORT
O UTC Aerospace Systems
Work Order 43052525
Input Part 47175-530
Cust Part
Description
Input Serial
Cust Serial
TAIMMABLE HORIZONTAL Date Rec'd STABILIZER ACTUATOR
0072
0072
10.04.2019
I RIGHT BRAKE PN: 450103 [RJ SN: .00172
LEFT BRAKE PN : 450103 [LJ SN : .00171
MANUAL CONTROL BOX PN: D90ST8006-100 SN: NIA
SCREWJACK ASSEMBLY PN : 5000C5094 SN : .0083
DIFFERENTIAL ASSEMBLY PN : 450091 SN : NIA
OVERRIDE ASSEMBLY PN: 450125-100 SN: NIA
FRONT CSP PN : 450664· 100 [FJ SN: 1429
REAR CSP PN: 450664-100 [RJ
OUTPUT TRACEABILITY
SN: 1430
PITCH TRIM ACTUATOR PN: 47148·122 SN: 1263
ELECTRONIC MODULE #1 PN: D90ST4209·100 [#1]
ELECTRONIC MODULE #2 PN: D90ST4209·100 [#2]
ELECTRONIC MODULE #3 PN: D90ST4209·100 [#3]
ELECTRIC MOTOR #1 PN: 634183-200 (#1] SN: NIA
ELECTRIC MOTOR #2 PN: 634183-200 [#21 SN: NIA
ELECTRIC MOTOR #3 PN: 634183-200 (#31 SN: NIA
COMMAND DETECTION PACK PN: 450102SN: .0093
MONITORING DETECTION PACK PN: 450101 SN: 11266
RIGHT HYDRAULIC MOTOR PN : 3022017-001 [RI SN : G0440881
LEFT HYDRAULIC MOTOR PN : 3022017-001 [L] SN : G0440575
RIGHT HYDRAULIC BLOCK PN : 450092·200 [RI SN : .00248
LEFT HYDRAULIC BLOCK PN : 450092-200 [LJ SN : .00246
RIGHT BRAKE PN: 450103 [RJ SN: .00172
LEFT BRAKE PN : 450103 ru SN : .00171
I Printed on 26.04.2019 09:49:38
\
Page 2 of 6
SN: 5767
SN: 5750
SN: 5716
Goodrich Actuation Systems SAS 13 Avenue de J'Eguilfette BP 7186 Saint Ouen l'AumOne F-95056 CERGY PONTOISE CEDEX Repair Station #06SY947N
TEARDOWN REPORT
O UTC Aerospace Systems
Work Order 43052525
Input Part 47175-530
Cust Part
Description
Input Serial
Cust Serial
TRIMMABLE HORIZONTAL STABILIZER ACTUATOR 0072
0072
Date Rec'd 10.04.2019
MANUAL CONTROL BOX PN: D90ST8006-100 SN: NIA
SCREWJACK ASSEMBLY PN : 5000C5094 SN : .0083
DIFFERENTIAL ASSEMBLY PN : 450091 SN : N/A
OVERRIDE ASSEMBLY PN: 450125-100 SN: N/A
FRONT CSP PN: 450664-100 (FJ SN: 1429
REAR CSP PN: 450664-100 (RJ
Discrepancies Teardown Report
SN: 1430
.................................•...............•.•• CMM REFERENCE : 27-44-57 CMM REVISION : 2 .................................................... PART NUMBER IN: 47175-530 PART NUMBER OUT: 47175-530 .................................................... AMENDMENTS IN : C AMENDMENTS OUT: C .................................................... WARRANTY STATUS: WARRANTY NOT REQUESTED .................................................... REMOVAL REASON : retour LAON
.•...........••••................................... CERTIFICATIONS : PART145
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Goodrich Actuation Systems SAS 13 Avenue de l'Eguilrette BFi 7186 Saint Ouen I' Aum6ne F-95056 CERGY PONTOISE CEDEX Repair Station #06SY947N
TEARDOWN REPORT
O UTC Aerospace SJstems
Work Order 43052525
Input Part 47175-530
Cust Part
FAR145 TCAC CCAA145
Description
Input Serial
Cust Serial
TRIMMABLE HORIZONTAL STABILIZER ACTUATOR
0072
0072
Date Rec'd 10.04.2019
.................................................... VISUAL INSPECTION : Shock : 450101
.................................................... DIAGNOSTIC FINDINGS : No defect observed :
.................................................... DISASSEMBLY FINDINGS: No defect observed :
.................................................... WORK PERFORMED : ALL SEALS REMOVED HAVE BEEN REPLACED ALL ASSEMBLIES FOUND MISADJUSTED HAVE BEEN ADJUSTED
A COMPLETE ACCEPTANCE TEST HAS BEEN PERFORMED THE FINISHING OPERATION HAS BEEN PERFORMED ON THE UNIT
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Goodrich Actuation Systems SAS 13 Avenue de l'Eguilrette BP 7186 Saint Ouen J'AumOne F-95056 CERGY PONTOISE CEDEX Repair Station #06SY947N
TEARDOWN REPORT
O UTC Aerospace Systems
Work Order 43052525
Input Part 47175-530
Cust Part
Description
Input Serial
Cust Serial
TRIMMABLE HORIZONTAL STABILIZER ACTUATOR
0072
0072
Date Rec'd 10.04.2019
I I
.................................................... SERVICE BULLETINS APPLIED : 47175-27·06 Rev· Dated 11 December 2009 (ALREADY APPLIED)
.................................................... AIRWORTHINESS DIRECTIVES :
.................................................... FAILURE CATEGORY: PRIMARY FAULT : Shock NO FAILURES FOUND DURING THE TEST PROCEDURE REPAIR CHARGEABLE TO CUSTOMER FAILURE OBSERVED BY THE CUSTOMER CONFIRMED
.....................................................
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Goodrich Actuation Systems SAS 13 Avenue de l'Eguitfette BP 7186 Saint Ouen l'AumOne F-95056 CERGY PONTOISE CEDEX Repair Station #06SY947N
TEARDOWN REPORT
O UTC Aerospace Systems
Work Order 43052525 Description TRIMMABLE HORIZONTAL Date Rec'd 10.04.2019 STABILIZER ACTUATOR
Input Part 47175-530 Input Serial 0072
Cust Part Cust Serial 0072
Components : Order Malena! ueecnpucn Heq uty , 1ssuea Neason Code Stor Loe
WAt>Hcn Kc, 0 0 FINISHING MAl>4
43052525 450101 MONITOR p.,..SITION 1 1 DAMAGE CHtN TRANSDUCER UNIT
Author: Print nam Signature: Date:
Authorized Approval : Print name: Signature: Date:
Page 6 of 6
O ITC..._,-,,-.. Restrictions ii !'exportation et utilisation Goodrich Actuation Systems SAS
finale PFC-ITC-010-DON-00 I Date d'application : voir repertoire documentaire I Page 1 sur 2
WARNING - EXPORT CONTROL RESTRICTIONS AND END-USE SPECIFICATIONS
As a US-controlled company, GOODRICH ACTUATION SYSTEMS SAS must comply with international sanctions edicted by the OFAC. Any transfer of its products to Cuba, lran, Libya, North Korea, Sudan and Syria, either in their original form or after being incorporated through an intermediate process into other end-items must be authorized under applicable expert control laws.
Also, these commodities:
1. will not be used for purposes associated with chemical, biological or nuclear weapons or missiles capable of delivering such weapons, nor will they be resold if there Is any suspicion that they are intended or likely to be used for such a purpose;
2. will not be re-exported or otherwise re-sold or transferred to a destination subject to UN, EU or OSCE embargo where that act would be in breach of the terms of that embargo;
3. will not be used in any nuclear explosive activity or unsafeguarded nuclear fuel cycle.
ATIENTION - RESTRICTIONS A l'EXPORTATION ET UTILISATION FINALE (Traduction de courtoisie)
En tant que soctete detenue par un groupe amertcafn. la soclete GOODRICH ACTUATION SYSTEMS SAS doit se conformer aux sanctions internationales prevues par l'OFAC. Le transfert de ses produits vers Cuba, l'lran, la Lybie, la Coree du Nord, le Soudan et la Syrie, que ce soit sous leur forme d'origine ou epres leur incorporation par un precede Intermediaire dans d'autres produits finaux, doit etre autorise en vertu des reglementations sur le contr61e des exportations qui leur sont applicables.
En outre, ces marchandises:
1. ne sauraient etre utlllsees a des fins Hees aux armes chimiques, biologiques ou nuclE!aires, ou a des missiles pouvant servir de vecteurs a de telles armes et ne sauraient etre revendues s'il existe des raisons de croire qu'elles sont destmees ou susceptibles d'etre ututsees a de telles fins;
2. ne sauraient etre reexoortees ou autrement revendues ou transferees vers une destination faisant l'objet d'un embargo des Nations Unies, l'Union EuropE!enne ou l'Organisation pour la Securtte et la Cooperation en Europe (OSCE) lorsque cette reexpcrtatton, revente ou retransfert se ferait en violation des termes de cet embargo;
3. ne sauraient etre utmsees dans des activites en rapport avec les explos[fs nucteelres ou des activitl!s non contr61E!es ltees au cycle du combustible nudE!aire.
GOOOIICIU,CTUATIOH MUMS· IOCICTt ,...,. ArnOM W..l'tlflU AU c.\11141. 01 M 000 000 C • ta/ WU.0,UU Ml If> Ul / IKGI IOCIM.: IOI, IIU[ _,..,...•fl UO IUC - fMIKKOl'VIIIGHT Cl 1011 I/TC M�OS,ACI S'ISTtMS. THII OOCUMUll II Tllll '1IOHIITV Of I/TC MIICJSNa IU[lllS- Y00J MAY NOT ,OUUS, 1111. COi"! Oft OIKlOs.l fNS
DOCl*l#TOft ....... NOIIM,l,TIOH III IT, fOft ....... -,.c)5(, •- Wl1llOIIT UMflATIDN. TO OU1GN. MNMlfACTUII[ Oft ....... PMTS. Oft OftTAIN ....... - ..,.,..,..41. TO DO to. WlfMOVf VIC MIIOS,..Q: JTfflMI lll ... US -Tltll HAMl$$00N. ,ofJfttU HCDl'T - l'OUUJIOII Of ,.., DOCUMUff 41.0NI,, f!IOM 4lff SOUIICl,
CONITHVTU WCN PPMIIIOII, l'OUUIION, UI(, -4 00 DIICUMUIOII IY .....,Ol<I WIT-, I/TC M!IOll',,,CI SYJTIMS lllNUI -ITTUrl -JNON Ill NOT ....,._D.....,MAYIIHULTIIOClt--��UUIUTV . •• _,., ..,UHCOHl�oum-v .. "_....,," ••
PFC-QI-OOO·OON·02
PACKING LIST I LISTE D'EXPEDITION Goodrich Actuation Systems SAS 13 Avenue de L' EguiHette ZI du Vert Galan! • 95310 Saini Ouen L' Aum6ne, France
C) UTC Aerospace Systems
Sold ToNendu A: 1624
A J WALTER AVIATION THE HEADQUARTERS MA YOWELL AVENUE SLINFOLD West Sussex RH13 OAS United Kingdom
Ship To/Expildl8 A: 1624 A J WALTER AVIATION THE HEADQUARTERS MA YOWELL AVENUE SUN FOLD West Sussex RH 13 OAS Uniled Kingdom
Transportation Oetailsl08tails de Transport
C arrierfT ransporteur· Wayb•1 #/Numero de L TA: lncoterms/lnc:oterms EXW: Factory Payment Termsflermes de Patement Net 30 Days
Package ID# Num8ro de Colis
Shipment Text:
1012069288 Dimensions 215 CM X 66 CM X 92 CM
Gross Weight 260.0 KG(s). Polds Brut
Net Weight 260.0 KG(s). Poids Net
Shipment# Numero d'Expedition
7045360 1111111111111111111
Item# Material Number Customer Material ga Description Batch Delivery# Artlcle Materiel Reference Client Designation Numero de Lot Numero de
Livraison P.O .I Item� 5.0. I Item i uo, Serial
Commande Client I Linne N• de commande I Post Unite de Mesur Num{!ro de seri
1 47175·530 1 TRIMMABLE HORIZONTAL 0023796521 3.,._;!�fJ2
llllllll 1111111111111111111 R356987
IHIIIIIIIIIIIIII I
6950927 / 1070
lllllllmllUIIIIIIIIIIIIIIIIII
1111111111 STABILIZER ACTUATOR
EA
11111111
Serial numbers: 0072
1111111111,IIIIIIIHIIU
Export Control# ECL99 Reference Contr61e Export
Export License# NLR Numero de Licence Export
N \))
� �
� J ...t <l: v-1- 0
L.-1.-- - 0
/ Non-incident I Accident Statement
Part 1
Component THSA Description
Part Number 47175-530 Serial Number 0072
Aircraft Regn/ A7-AGB I 715 Aircraft type A340-600 MSN
TSN & CSN at 36644 I 5290 Date of 13/01/2019 Installation Installation
TSN & CSN at 37482:49 & 5432 Date of Removal 02/04/2019 Removal ,,,.
��
Prepared by (Mansoor Ahmad) Checked by (Jinoy Jose) � ___ .> (Name/Signature) (S/No: 88989) (Name/Signature) (S/No: 6018�F1A,�/19
Part 2 It is certified that the above mentioned part was installed on aircraft operated by Qatar Airways during the period mentioned above, and based on our records, the part:
+ Has been installed and operated only on a civil aircraft on the civil register.
+ Has been operated, maintained, repaired and stored in accordance with the OEM Airframe and Engine
Manuals, Maintenance Schedules and within the defined operating limitations and environment.
+ Has not been subjected to any incident/accident as defined in ICAO Annex 13 Chapter 1.
+ Has not been exposed to corrosive agents, extreme stress or over-temperatures outside of normal
operation.
Reviewed by:
Approved by:
Name
Designation
\J. \) , S, U «« t-ubef'oJ-\.. Name
Designation
Date
� Signature
Qatar Airways Tower, P.O. Box 22550, Doha, Qatar _),. - ..,._,.JI r r o o • . ..,.. . ._,,,�I(.>-! Tel. (+974) 44496000 Fax. (+974) 44621533 (+Wt) t n non-:._,.$\..., (+wt) tt t \ i · • • :....i;l.A
Qatar Airways (Q.C.S.C) ( f' ·f' .J . .j.) �I <.e�I .b_,h.;JI qatarairways.com
Technical Supply Chain Department
Hamad International Airport
Doha, Post Box 23947
State of Qatar TEL: 974 4022 8012
Email: [email protected]
Fax: 974 4462 2970
Return Loan NO: 41538855
Print Date: 03/04/2019 13:58 Page: 1 of 1
QATAR AIRWAYS GROUP Q.C.S.C
Return Of Loan
Location H IA Vendor: KB335 QATAR AIRWAYS AJ WALTER AVIATION LIMITED TECHNICAL STORES-RECEIVING Headquarters, The Business Park HAMAD INTERNATIONALAIRPORT Maydwell Avenue DOHA 23947 Slinfold, West Sussex RH13 OAS QATAR United Kingdom
TEL: 97433736629 Cell: 97440109102 TEL: 00441403798000 Cell:00447831583805 Fax: 00441403710936 Sita: LGWJWCR
Email: GI [email protected]. qa Email: enq u [email protected] ATTN: Simon Merriott
Ship Via Ship Via Account Currency Status Returned By USO 35979
Original Order: LO 21670711 Line: 1 Batch: 7177380 S/N: 0072
P/N: 47175-530 Condition QTY U.O.M Unit Cost Total
Desc: THSA SERV 1 EA .00 .00
Return Amount: Totals I 0.00
PRINTED BY & DATE 53644 03/04/2019
SERVICEABLE PART LABEL {TPM-04-03-08)
LABEL SEQ NO. 42263
11111111111111111 IIIII IIIII IIIII IIIII IIII IIII 7177380
PART NUMBER
47175-530 !SERIAL NONENDOR LOT
0072 P/N CATEGORY SER
SUB CATEGORY ROT
UOM QTY GRB DESCRIPTION
THSA 7177380 1 EA t";ssiTi;A;rTuus sflN"iwco:iiR�K<l°i:MMOXD� IFFI ICCAATn 100NN-;N;o;: .-------------TooRRDDE ERRNNico� . -----fl� iiiiiiiiJII TOOL LIFE EXPIRY
SERV AMDT: C AD2014-0077+AD2017-0044 21670711 1' I-R_E_L_E_A_S_E_C_E_R_T_ IFJ IC_A_T_E--,l�F-O_R_M_TRA_C_K_ I_N_G_N_O_ .----------+--------D -..i...,;..;....a;,ri"1
D D LIMITATION YES NO � NFF EX-HOLD - CRS/CREDIT NOTE LSN#41492 ----
INSPECTOR
53644
STAMP
QTR/S/129
DATE
03/04/2019
TSN
CSN
37482:49
5432 TSO
cso
37482:49
5432
TSV
CSV
838:49
142
INSTALLATION DATA INSTALLED ON A/C INSTALLED DATE INSTALLED BY
REASON FOR RETURN DRETURNED UNUSED
D LOAN RETURN OTHERS/REMARKS
D ROBBERY
D TROUBLESHOOT
D MODIFICATION/EC/SB D REMOVED AS SERVICEABLE
REMOVED FROM /VC
NHA PIN & S/N
CERTIFICATE OF RELEASE TO SERVICE D INSPfTESTED
D REPAIR D MOD D O.H.
CERTIFIES THAT THE WORK SPECIFIED EXCEPT OTHERWISE SPECIFIED WAS CARRIED OUT IN ACCORDANCE WITH CURRENT AVIATION REGULATIONS· PART 145 AND IN RESPECT TO THAT WORK THE AIRCRAFT COMPONENT IS CONSIDERED READY FOR RELEASE TO SERVICE. D EASAAPPROVAL REFERENCE NO. EASA.145.0115 D QCAA APPROVAL REFERENCE NO. QCAA.AM0.03
APPROVED SIGNATORY STAMP DATE {DD-MM-VY)
UNSERVICEABLE PART DETAILS {TPM-04-03-09)
OFF P/N QTY PHYSICAL DAMAGE DvEs 0No
DESCRIPTION TYPE OF REMOVAL DEFECT NOTED DURING
SERIAL NONENDOR LOT OscHEDULED D1NSPECTION D RUN-UP D INFLIGHT
POSITION PFR/BITE TESTfTSD ATTACHED DYES 0No
D UNSCHEDULED D OTHER (PLS. SPECIFY\
WORK PACKAGEfTECH LOG REF ACCIDENT/ INCIDENT/ SAFETY REPORT/TOR/ASR/CSR {IF YES, ENSURE TO ATTACH INCIDENT INVESTIGATION LABEL) D YES D NO REFERENCE I DATE
PART NUMBER OF NHA SERIAL NUMBF.R OF NHA
REMOVED AT STN I I I REMOVED FROM REG. I I 1-1 I I DATE REMOVED 1 1 1-1 I \- \ \ \ REASON FOR REMOVAL (MANDATORY)
PN ON PHYSICAUACTUAL UNIT D NOT READABLE DMISSING
APPROVED SIGNATORY STAMP DATE
SUPPLY CHAIN (STORES\ USE ONLY INSPECTION PARAMETERS YES NO RTS BATCH NUMBER {STORES)
LABEL CORRECTLY FILLED BIN (STORES)
PROTECTIVE BLANKS IN PLACE REMARKS
PHYSICAL CONDITION OK
CONTAINER/PACKAGING OK
VERIFIED BY STORES (STAFF NO, SIGNATURE, DATE)
QTR/MAT/038 ISSUE03 AUG 2018
:E w 1- - z < 0 ...J
:J 0 0 Q. Q. s -IC
Q�11ltr *IATP POOL/*LOAN ITEM REMOVAL LABEL 1
(TPM-04-02-05)
IATP Pool No. Manufacturer Part No. Description Serial No.
4,y1s-- -.r;'<>o ll-1S .,&.cJv,'\f � Oo7 '2... Hrs Run Engine No. Unit Location Unit Position
NC Type NC Regn Date Fitted Station Fitted
J-<-1 --- AG� Return to (Airline Name): At (Shipping Address)
LOAN CHARGED ITEM RETURN WITHOUT DELAY
ATTACH THIS LABEL TO LOANED ITEM ON REMOVAL • Delete as necessary OTR/MNT/006 ISSUE 3 JAN 2010