MAINTENANCE RECORD

DATE TOTAL TIME AUTHORIZED SIGNATURE,

IN SERVICE DESCRIPTION OF THE WORK PERFORMED CERTIFICATE TYPE
HOURS 10THS & NUMBER

JET AIR, INe ~

-
I COMPLIED WITH YEARLY AM-SAFE DIAGNOSTIC INSPECTION.
I CHANGEDB3-5-1 VACUUM FILTER - DUE AGAIN AT JUN-2013 OR T.T:1581.2
CENTRAL VACUUM FILTER DUE AT TACH: 1496.9
EL T SA TTERY GOOD Till NOV 2013 CIW FAR 91.207 EL T CONDITION/OPERATION.
REPLACEMENT OF PAPER INDUCTION FILTERS.
. NEXT REPLACEMENT DUE ATTACH:1981.2 HRS. HRS.
:$>e1W A.D. 29" 14~'jtiY INSPECTIO!:!,9F FUEL INJECTION LINES AND CLAMPS. DUE
I AGAIN AT NEXT ANNUAL 6-2014 ,;toli-;).<.,- ()~
I certify that the abOve stated maintenence and lor inspection was performed in accordance with
th~ current regulations of the Federal Aviation Administration and is airworthy for retum to
service.

Date0-s:&g13 Signed,~~
for Jet Air Inc. CRS # JAFR11() alesburg, IIlin 61401
i

-(€.~ L"l Jr{a3. <6. ,

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•••

MAINTENANCE RECORD j
DATE TOTAL TIME
.
AUTHORIZED SIGNATURE,
IN SERVICE DESCRIPTION OF THE WORK PERFORMED CERTIFICATE TYPE
HOURS 10THS & NUMBER
czf.//
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~~~ - ~~--=---_._------- -~-----.-~-.-

-
_--------"".-...,..- ..
Date: 9/21/2013
Tach/Hobbs: 1580 5
Total Time: 1580.5
~-=~
Blue Skie$ over Dub.l,lque Inc.
Airplane Maintenance
Repair Station # YQYR343B
10800 Airport Road
Dubuque, IA 52003
563·582·1293
AUTHORIZED SIGNATURE,
CERTIFICATE TYPE
& NUMBER
l.lnspected aircraft per FAR Part 43 appendix D checklist.
2.Replaced L&R tires, Aero Wheel WOn 221118 & 220544, greased wheel bearings.
3.Secured loose nose gear scissor link.bolts. 4.Replaced bent tow bar attach bolt on nose strut.
5.Rigged & adjusted aileron cables. 6.Replaced 2 tom rubber cowling shock mounts. 7.Charged up battery.
8.Replaced vacuum inlet & regulator filters.

certify this aircraft has been inspected in accordance with an 100 Hour inspection and was determined to be in
airworthy condition. See AD List in folder for compliance.
Work Order # 78440
Name: Paul M. Kaune

Signed: PaA).~r'Y\. ~~
Certified Repair Station # YQYR343B

~- , , -
I ., -.
"-

>

Date: 9/26/2013 ~ •. ~.", 10800 Airport Road .

(31 I
'" I;
TachIHobbs: 1590.7 Dubuque, Iowa 52003
I AUTHORIZED SIGNATURE,
Blu~ 5ki,es ov\!r DJl.bllque Inc. Repair station #YQYR343B
CERTIFICATE TYPE
Airplane Maintenance 1-563-582-1293
& NUMBER
---...
l.Replacedalternator field circuit relay inside J-box.
2.Rigged throttle cable arm on fuel servo for panel alignment.
Work Order #78454
Name: Paul M. Kaune

Signed: PQ,uQ Yh. ~,

Certified Repair Station # YQYR343B

---~~--
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- --~-- ~- ----- - -- -~----- _. --------.~-----------.----

 Date' 11/4/2013
Tach/Hobbs: 1632.2
D I I •
- 10800 Airport Road
Dubuque, Iowa 52003
Repair station #YQYR343B
Blu!!" ~ki,es ov~r Qubu,que lnc, AUTHORIZED SIGNATURE,
Aiiplane Maintenance 1-563-582-1293 9ERTIFICATE TYPE
& NUMBER

I.Replaced 7 ea. firewall forward oil & fuel hoses from Precision Hose Technologies Invoice #584748.
2 .C/W AD 2013-11: II Installed new oil pressure switch p/n-83278.
W ork Order #78533 -
NTame: Paul M. Kaune

S igned: {Javv£ m· ~
C ertified Repair Station # YQYR343B - -
------~ - - -
21- J3
1 b'1i"6 t.t 'K-e.pla£.ed I:~T k-tt-c.. .•.y, (c>~p),.-';f \..Qif)... 7="AR CI/.2D7 Cd). 107..# __. ~
. " "
~~. , .1 N~rl J l)C: 1)~c. 2D20 :4P3-627Cfcto '
I

•• ··M

Date: 12/13/2013
TachIHobbs: 1680.3
Total Time: 1680.3
.~~
iJlue Slciesover Dubuqu~Jn,c.
Airplane Maintenal\'ce
Repair Station # YQYR343B
10800 Airport Road
Dubuque, IA 52003 /
563-582-1293
AUTHORIZED SIGNATURE,
CERTIFICATE TYPE
& NUMBER

!.Inspected aircraft per FAR Part 43 appendix D checklist.

2.RepJaced right brake linings. 3.Secured loose tow bar attach bolt. 4.Replaced I cowling shock mount.
5.Repaired lower cowling crack with fiberglass. 6.Replaced vacuum regulator filter. 7.Charged up aircraft
battery. 8.Performed diagnostic test on Am-Safe restraint system.

certify this aircraft has been inspected in accordance with an 100 Hour inspection and was determined to be in
airworthy condition. See AD List in folder for compliance.
Work Order # 78606
Name: Paul M. Kaune

Signed: Podl ffi, ~

Certified Repair Station # YQYR343B

-----= ---~--~~-~ ---------------..~------

 Ate. Cessna 1725 REG: N5113J Tach: 1721.5 DATE:03/17/2014

'URE,
Complied with the following: 'E

I
Replaced Right Main Tire Tube with a new 6.00X6 Tube, Cleaned and repacked wheel bearings and installed wheel assy. on Aircraft.

All work performed was l/A/W Cessna Maintenance

airworthy condition for safe flight.. /J a. Manual and current Federal Aviation Regulations and was determined to be in an
A./)4
~(C ~ 2180688IA
YELVINGTON JET A VIA TlON, INC.
DA YTONA BEACH INTERNA TlONAL AIRPORT

/
I

Date: 04-30-2014 N5113J

Tach/hobbs: 1779.4
Aircraft Total time: 1779.4 AUTHORIZED SIGNATURE,
CERTIFICATE TYPE
& NUMBER
1. Inspected aircraft per FAR Part 43 appendix D checklist
2. Greased left, right and nose wheel bearings
3. Charged aircraft battery
4. CjW FAR 91.207(d) by inspection of ELToperation
5. Performed alternator over-voltage circuit protection test
6. Performed capacity test on standby battery for 55 minutes, battery passed at 23.4 volts
7. Performed diagnostics test on AMSafe restraint system
8. deaned under floor and around pedals
9. Secured left airframe fuel step hardware
19. ~eel:lFeEll99se ~aFEI\'I8re right fI Oilt seal I ecliAe aetl:latef ferliVerd mel:lAt (;I!J.
11. Replaced left brake linings/pads _. 'I'l"
12. Secured loose bulkhead nut on vacuum line 'at'firewall
13. Secured wire bundle anchor by top of left wing strut and in overhead right side
14. Replaced bonding strap left elevator

I certify this aircraft has been inspected in accordance with an annual inspection
and was determined to be in airworthy condition. See AD list in folder for compliance.

Name: James S. Jenkins, IA 301526=.;6=-- ...:.

Signed: F S· ~ ""C">~--------!
•••

I I I

--_._-- -~ -- --:----:::=:-::- -- -=.- --~~~--~-':..---;,., ------_ ----=-.---

.. --
 MAINTENANCE RECORD
DATE TOTAL TIME
IN SERVICE DESCRIPTION OF THE WORK PERFORMED
HOURS 10THS

c':'-~fn'id· ~;.fw Ab~o.bl-o(..-Il b"l. M~k~"'o .;)Jj<.t~t""~1. +0

~.I(e ;1.4 /Hnd",("t:.. ,A/e,e-l ;:>uC .;>-r -I.uh 18'1<8ID

Date: 9/4/2014 Repair Station # YQYR343B

&~n"'~~
TachIHobbs: 1879.3
Total Time: 1879.3 ".< _.}.>O>.b_"'"
~.~.~

Airplane Maintenan!=e
10800 Airport Road
Dubuque, IA 52003
563-582-1293

l.lnspected aircraft per FAR Part 43 appendix D checklist.

2.Secured loose tow bar attach bolt. 3.Replacedvacuum regulator filter. 4.Charged up battery.
5.Performed diagnostic test on Am-Safe restraint system.

I certify this aircraft has been inspected in accordance with an 100 Hour inspection and was determined to be in
airworthy condition. See AD List in folder for compliance.
Work Order # 79052
Name: Paul M. Kaune

Signed: __ I-.•.....••
~..:::::::.......£-'-"..L-.L...::~r-
Certified Repair Station # YQYR343B

MAINTENANCE RECORD
DATE TOTAL TIME AUTHORIZED SIGNATURE,
IN SERVICE DESCRIPTION OF THE WORK PERFORMED CERTIFICATE TYPE
HOURS 10THS & NUMBER
q -/6-1'1 18"(1" 0 Compiled V',;fl, AD 260/-06- ) 7 no adJ' uS+-h7~ +- n ecess C<.7, .n-£L-~
.#' /fPs!i"Z7C(crd
Date: 10-16-2014 N5113J
Tach/hobbs: 1978.5
Aircraft Total time: 19785 AUTHORIZED SIGNATURE
CERTIFICATE TYPE •
1. Inspected aircraft per FARPart 43 appendix D checklist & NUMBER

2. Greased left, right and nose wheel bearings

3. Charged aircraft battery
4. C!W FAR91.207(d) by inspection of ELToperation
5. Performed alternator over-voltage circuit protection test
6. Performed capacity test on standby battery for 55 minutes, battery passed at 28.5 volts
7. Performed diagnostics test on AM Safe restraint system
8. Cleaned under floor and around pedals
9. Secured loose wire bundle anchor in tail aft upper left side & back of aft tail bulkhead
10. Rotated 2-engine cowl shock mounts (4 & 5 o'dock)
11. Added chafe tape to left and right flap cove where flap and cove were rubbing
12. Replaced bonding strap left elevator with new /
13. Replaced one missing screw on muffler shroud

I certify this aircraft has been inspected in accordance with an annual inspection
and was determined to be in airworthy condition. SeeAD list in folder for compliance.

N.ame: ~~' JenkinSt!A 3015266

Signed:~ •• '2.,;6

MAINTENANCE RECORD
DATE TOTAL TIME AUTHORIZED SIGNATURE
IN SERVICE DESCRIPTION OF THE WORK PERFORMED
,.
HOURS, 10THS .- ' . CERrl~ICATE TYPE
&:NUMBER
•

IH3-1'f lD~I. :1 Re~ ••b I'll( i'r;rfro~e. Q7'j/

~7;P '7
)~
.AP362. 7Cflo

1/~'U~/4 2A2' .7
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, ',.
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l-&(~I. 2063 •G Re.hlCt.(ed Lef~ •••"d "R.o'C~/"+ +.'~S Q,hd l-~r c<cluJ 1.eA e..h d /1<. "f)' j, r ~8~ ___
W ~e( bc."o-r:/n~S. ;pf-p, '6279<10

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 "i;

.
FiT

'; .. :.
Date: 2118/20 15 a .. - . - Repair 5tation # YQYR343B
TachIHobbs: 2078.2 , 'I~"'.~-~ 10800 Airport Road AUTHORIZED SIGNATURE,
~
Blue Skies oV,erDubuque Int:. Dubuque, IA 52003 CERTIFICATE TYPE
Total Time: 2078.2
& NUMBER
Airplane Maintenance 563-582-1293

l.Inspected aircraft per FAR Part 43 appendix D checklist.

2.Secured loose tow bar attach bolt. 3.Secured loose Tanis heat plug. 4.Charged up aircraft battery.
5.Replaced vacuum system inlet & regulator filters. 6.Replaced 5 torn cowling shock mounts. Rotated other
mounts for longer wear. 7.Performed diagnostic test on Am-Safe restraint system.

I certify this aircraft has been inspected in accordance with an 100 Hour inspection and was determined to be in
airworthy condition. See AD List in folder for compliance.
Work Order # 79321
Name: Paul M. Kaune

Signed: _.L\.AIl<~=-IJ...!""'!!-~I",.1II,ir.61
Certified Repair Station # YQYR343B

)'L\<{_ (~ :1'""•..•s ~{(.(j 11e,..,v;'C3S..l - (;

5-, - 15" "8-el';)IQ.c.~ .nos« ~hec-l -h,~

=rr" VJtflt C~sno. S/3 /I-21.{-02 ~y ref'Q.un~ o.vrOY)J'c. S

rno..s-kr t>'c»l+ch •

Date: 5/28/2015
TachlHobbs: 2177.8
Total Time: 2177.8
. ~~-
Blue Skies ov"er Du!lyqu~ Inc.
AirpfamfMaintenance
Repair 5tation # YQYR343B
10800 Airport Road
Dubuque, IA 52003
563-582-1293
AUTHORIZED SIGNATURE,
CERTIFICATE TYPE
& NUMBER
l.lnspected aircraft per FAR Part 43 appendix D checklist.
2.Secured loose tow bar attach bolt. 3.Charged up aircraft battery. 4.Replaced vacuum regulator filter.
5.Replaced pin in left cabin door lower hinge. 6.Performed diagnostic test on Am-Safe restraint system,

I certify this aircraft has been inspected in accordance with an 100 Hour inspection and was determined to be in
airworthy condition. See AD List in folder for compliance.
Work Order # 79479
Name: Paul M. Kaune

Signed: faun ~
Certified Repair Station # YQYR343B

7-1..8-15" '1-2'(0 3 Rc,lCA. '-cPr J,~c. jcu:Js.

7-ZQ-/o ·U.l.i 0 '1 l?-cflt:u~J R/~f breJr.~ dlsc- 0",.,)

F-Cflaudk~ de,e,( my off f'1'YlC!r

, -, .,'

,-r-I'2, 253. ,
Oate: 09-03-2015 NSl13J
Tach/hobbs: ·2277.5 Aircraft Total time: 2277~5
JRE.
1. Inspected aircraft per FARPart 43 appendix D checklist 8. Secured wire bundle anchors; center belly main harness;
l. Greased left, right and nose wheel bearings upper baggage-right-between skin and radio rack
3. Charged aircraft battery 9. Secured loose visors
4. CjW FAR91.207(d) by inspection of ELToperation 10. Replaced missing screw right door handle (inside)
S. Performed alternator over-voltage circuit protection test
6. Performed capacity test on standby battery for 55 minutes,
battery passed at 23.5 volts
7. Performed diagnostics test on AMSafe restraint system

I Ciertifythis aircraft has been inspected in accordance with an annual inspection

and was determined to be in airworthy condition. See AD list in folder for compliance.

Name: James S. Jenkin~A 3015266

Signed: ~ S. ~ i

Date: 10/22/2015
TachlHobbs: 2376.9
Total Time: 2376.9
~~ •.
Bl~e S~I~.S
~
9'!~rP~buquelnc.
Airplal)~ Mainte-nance
Repair Station # YQYR343B
10800 Airport Road
Dubuque, IA 52003
563-582-1293
AUTHORIZED SIGNATURE.
CERTIFICATE TYPE
& NUMBER

l.Inspected aircraft per FAR Part 43 appendix D checklist.

2.Replaced broken bracket on left firewall for shock mount attachment. 3.Replaced 1 tom cowling shock .. ,.;;:.

mount. 4.Replaced clamps on engine drain lines at firewall. 5.Replaced vacuum regulator foam filter.
6.Charged up battery. 7.Perfonned diagnostic test on Am-Safe restraint.
,-.

I certify this aircraft has been inspected in accordance with an 100 Hour inspection and was determined to be in
airworthy condition. See AD List in folder for compliance.
Work Order # 79747
Name: Paul M. Kaune

Signed: P~ff\. ~
Certified Repair Station # YQYR343B

1{-2-d- l.f?1qO

1-/Y-/6 t.L( 7" 7

Date: 3/30/2016
Tach/Hobbs: 24763
Total Time: 2476.3
~.~
Blue Skie.s over Dubuque
Airplane Maintenance
Inc.
Repair Station # YQYR343B
10800 Airport Road
Dubuque, IA 52003
563-582-1293
AUTHORIZED SIGNATURE,
CERTIFICATE TYPE
& NUMBER

l.Inspected aircraft per FAR Part 43 appendix D checklist.

2.Replaced L&R tires. Greased wheel bearings. 3.Performed load test on standby battery for 55 minutes.
Battery passed by maintaining 22.3 v.Qlts. 4.C/W FAR 91.207(d) inspected ELT radio. 5.Replaced vacuum
regulator filter. 6.Charged up battery. 7.Installed Modification Kit MK 172-53-02 by adding reinforcement
angles on inside of firewall for battery box: support. 8.Replaced 2 cowling shock mounts. 9.Installed
serviceable propeller removed from aircraft N6319G.

I certify this aircraft has been inspected in accordance with an Annual inspection and was determined to be in
airworthy condition. See AD List in folder for compliance.
Work Order # 79976
Name: Paul M. Kaune

Signed: Po A & rY\ Kn II

Certified Repair Station # YQYR343B
M 0

10800 Airport Road

Date: 5/27/2016 Dubuque, Iowa 52003
T ac hIH 0 bb s: 2520 4 . #YQYR343B
Repair station
Blue Skies o'ver Dubuque Inc.
Airplane Maintenance 1-563-582-1293 AUTHORIZED SIGNATURE,
CERTIFICATE TYPE
& NUMBER
I.Repaired lower cowling by installing new channel & stiffener on left side.
Work Order #80020
Name: Paul M. Kaune

Signed:JO,V.Q m, Kol~
Certified Repair Station # YQYR343B

1,S67 \ Re-plCtuJ co D~tvv Su~ ~Q..v;'v.U

-$-16 A P -; -;rz..l <12~

-ZO-16 ZSqlj 6 rRepl&tcu.-\ and. bcvl~c~ "oc::.e.. wh.ee..l b;-(e.... '~cFll'\ 'r::A~\\.A1C.1
AI? ·sort. Iq z.~

- - --- . -~-
1. Approving Civil Aviation 2. 3. Form Tracking Number:
Authority/Country: 284
FAAIUnited States AUTHORIZED RELEASE CERTIFICATE
FAA Form 8130-3, AIRWORTHINESS APPROVAL TAG
4. Organization Name and Address: 5. Work Order/Contract/Invoice
Number:
CO Guardian LLC 1951 E. Airport Dr. Tucson AZ 85756 (pTl575NM)
4109
6. Item: I 7. Description: 8. Part Number: 9. Quantity: 10. Serial Number: 11. StatuslWork:

CO Detector 452-201-01ORX .85780 See Block 12

12. Remarks:
NS\\':>::)
z.~6t·!
Rebuilt (altered) to original CO Guardian LLC Specifications DWG 452-201 Rev. H

. .
Certifles the items identified above were manufactured in conformity to: }4a. 0~14 CFR 43.9 Return to Service ~ Other regulation specified in Block 12
Certifies that unless otherwise specified in Block 12, the work identified in Block 11
App sign data and are in a condition for safe operatio and described in Block 12 was accomplished in accordance with Title 14, Code of
Non-approve data spccified in Block 12. Federal Regulations, part 43 and in respect to that work, the items are approved for
• return to service.

14c. Approval/Certificate No.:

---_ ..
PTl575NM

14e. Date (dd/mmm/yyyy):

17106/2016

UserlInstaller Responsibilities

It is important to understand that the existence of this document alone does not automatically constitute authority to install the aircraft engine/propeller/article.
Where the user/installer performs work in accordance with the national regulations of an airworthiness authority different than the airworthiness authority of the country specified in
Block 1, it is essential that the user/installer ensures that his/her ainvorthiness authority accepts aircraft enginc(s)/propellcr(s)/articlc(s) from the airworthiness authority of the country
specified in Block 1.
Statements in Blocks 13a aOll14a do'not constitute installation certification. In all cases, aircraft maintenance records must contain 1111 installation certification issued in accordance with the
national regulations by the userlinstaller before the aircraft may be flown.

FAA Form 8130-3 (02-14) NSN: 0052-00-012-9005

1. Approving Civil Aviation 2. 3. Form Tracking Number:
Authority/Country:

FAAlUnited States AUTHORIZED RELEASE CERTIFICATE 111269-1-NW

FAA Form 8130-3. AIRWORTHINESS APPROVAL TAG
4. Organization Name and Address: 5. Work Order/Contract/Invoice
AMSAFE ~ Number:
1043 NORTH ~7 AVE 111269-1
PHOENIX, AZ. 85043 CERT NO. PQ1967NM o PAGES AIT ACHED
6. Item: I 7. Description: 8. Part Number: 9. Quantity: 10. Serial Number: 11. Status/Work:

1 I ELECTRONIC MODULE 508358-421 2 RA27APRI6-7,RA27APR1.9'"8

~ (~
I SEE BLOCK 12
""'\
IASSY DUAL/SINGLE SENSOR

12. Remarks: DRAWING: 508358 J1;l(13 '" \.1 5!,pT:f..L,)

REV: Y ';f-~\~' 't
"REBUILTTO ORIGINALPAH'S SPECIFICATIONS IN ACCORDANCE WITH 14 CFR43.3(J)" ..

OLD SERIAL NUMBER: 26JAN09-29,16AUG07-42

EXPIRATION DATE: 0423 ,

tifies the items identified above were manufactured in conformity to: 14a. 0 14 CFR 43.9 Return to Service ~ Other regulation specified in Block 12
Certifies that unless otherwise specified in Block 12, the work identified in Block 11
o Approv esign data and are in a condition for safe op and described in Block 12 was accomplished in accordance with Title 14, Code of
o Non-approved . n data specified in Block 12. Federal Regulations, part 43 and in respect to that work, the items are approved for
return to service.

13~ Authorized ...,..~"",,,, • ...,w tloa No., . 14b. Autho rize ...,.tuR' , 14c. Approval/Certificate No.:

. ~U/~~ PQ1967NM

13d. Name~rlnted):

~
. ---lt3<. nate (~ 14<1. N.~ '?" er Prlnt ed):

NANCY WILLIAMSON
14e. Date (ddlmnunlyyyy):

27/APRl2016

UserlInstaller Responsibilities

It Is important to understand that the existence of this document alone does not automatically constitute authority to Install the aircraft engine/propeller/article.
Where the user/installer performs work in accordance with the national regulations of an airworthiness 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 aircraft engine(s)/propeUer(s)/artic1e(s) from the airworthiness authority of the country
specified in Block 1. .

Statements In Blocks 13a and 14a 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.

FAAFonn8l30-3 (02-14) NSN: OOS2'()0'() 12-900'1

 AmSafe , CUSTOMER CRO No: 111269
Aviation REBUILD/ALTERATION ORDER Date: 04/26/16
TEAR DOWN REPORT
Cust: UNIVERSITY OF DUBUQUE Cust PO: N5107N/N5113J SO#£.\~~~.{i'~'ri~~~~.
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.·.~:1I,"!IJf~~~]g:-i~l~~~;tt#IW~~~
Part: 508358-421 Pt Name: ELECTRONIC MODULE ASSY
Quantity: 2.0 Drawing: 508358 Rev: Y

:::_:::/t1AZ!tt~lf:-_l_%t;_t_1J!!It}l!-)~~;::-:::~-:~~:~_
REASON FOR RETURN (Customer's Stmt) S'~ Llo AU&Ol-<1.'2.
EMA EXCHANGE L ~ .3 3"3 S?~I 2-D
__________________________
~~_~3YS~~ ~L~q------------------- _
INVESTIGATIQN BY: REBECCA Date: 04/26/16
Confirmed:--.kL Other: S~ ,*~.Id~Dq-J/j' Top Aasy .
------------------------------------------------------------------------------
,
Disposition: REBUILD Freight: CUST
Service Bulletins: Responsibility: CUST

WORK INSTRUCTIONS BY: Qk~.~~----------_ Date: 'i/2-1/L(p

~ Disassemble Hdwr/Non-Serv(red tag) Scrap
~ Inspect for Serviceability
FIRST PIECE ACTUAL
~ Record Hardware Lot# of MFG date code PIMENSION·
Reweb Required
Relabel to include R in date code
,
_._ Clean compo~ent/~y. per print
~ RePl~~~f~~re7Ref~ p/n/qty/lot(BOM)
~ Manufacture First Piece per print / SiB
,uild remaining units per print / SiB
Q:o 1,"" c

t-'\ nal Y Inspection :<'7!11'~/~oIG

ttrJ~ to Service Tag# &£,6<1- -& 1

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------------------------------------------------------------------------------
Am-Safe Aviation Form No. A-013 (REV 02/19/14)
 -"'"II

Date: 09-01-2016 NSl13J

Tach/hobbs: 2575.6 Aircraft Total time: 2575.6

1. Inspected aircraft per FARPart 43 appendix D checklist 8. Lubed right door handle cable and latch system ~ED SIGNATURE,
9. Secured fuel selector handle ~ICATE TYPE
2. Greased left, right and nose wheel bearings \lUMBER
3. Charged aircraft battery 10. Secured loose screw on dash
4. C/W FAR91.207(d) by inspection of ELToperation
5. Performed alternator over-voltage circuit protection test
6. Performed capacity test on standby battery for S5 minutes,
battery passed at 22.3 volts
7. Performed diagnostics test on AMSafe restraint system

I certify this aircraft has been inspected in accordance with an annual inspection
and was determined to be in airworthy condition. SeeAD list in folder for compliance.

Name: James S.Jen~lS266

Signed' p;.; ~ ; --- -:r~ tct.~'-<.-Ic-I
q-2-2--\6 Z-SC(1, 6 fe.pla.ceJ. t~ e.lev~ 6o,",eL~ &~
~f'~=1-vqz..~

Date: 10/25/2016
Tach/Hobbs: 2674.9
Total Time: 2674.9
~'-
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r.fiJ.1iI'ft-~-:- __-"P.- ,<
"_- __6 -

'BI~e SR,-_~qlt~r~ubU~I!::i-!l~c.,
AlrplaneMaintenance
~
- _
---

Dubuque, IA 52003
563-582-1293
._ _. '.
Repair Station # VQVR343B
10800 Airport Road
AUTHORIZED SIGNATURE,
CERTIFICATE TYPE
& NUMBER

d ai ft FAR Part 43 appendix D checklist. . .

~:~:~~:~:d ~~c~~1eefinings. 3.Replaced vacuum system inlet & regula~r ~lte~s. 4.R~Pl~C~~:;~ :;n:a~~~~
on L&R cabin doors. 5_Replacedlower left cowl mount attach bracket s oc moun. .

i':e~~;7~~ ~;;:a~s~~t~~e~~:;~~t:~ i~~~~~~~~~~~ith an 100 Hour inspection and was determined to be in

~
airworthy condition. See AD List in folder for compliance.
Work Order # 80250
Name: Paul M. Kaune
--+------- ~j
Signed: &.A a1. J<,o.~
Certified Repair Station # YQYR343B
d~
"S"c.>~ ta,,~\. __ __
i
~il'\pli€l;\ w;Q,.. ~SS,,~SUv;'-- e, '&\.Illd,;-V\. 1\- Vi-O"Z b~ r~tttCj~ A-f~1Z____lqz..~
Qvil.>l"\iC> t"Y\c<<£tv <;;v>;-k-I..

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5c>~ ~V\\..Lt--(

\ 'L-O'L-1-h Z.b~1f, 5" Q.

 D a te 1112/2017 , 10800 Airport Road
"(:2' . 'P. I ~
Dubuque, Iowa 52003
Tach/Hobbs: 2696.3 AUTHORIZED SIGNATURE.
Blue Ski;,sol'~rDilbuque'lnc, Repair station #YQYR343B CERTIFICATE TYPE
Airplane Maintenance 1-563-582-1293 & NUMBER

l.Balanced nose wheel assy. 2.Replaced bolts & spacers in nose gear scissor links.
VVorkOrder#80356
Name: Paul M. Kaune ..

Signed:
fcwg M. ~
Certified Repair Station # YQYR343B

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s hll l.J ae-» I/~c-uu"".,
IA.o ..••'of 5. ( "
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ALi
AP·n·LI9.'2..~

-------------------- - _ .. ---.--
Date: 03-21-2017 N5113J
Tach/hobbs: 2774.3 Aircraft Total time: 2774.3
IRE.
1. Inspected aircraft per FAR Part 43 appendix D checklist 8. Secured loose wire bundle anchor: belly center panel main
2. Greased left, right and nose wheel bearings wire bundle
3. Charged aircraft battery 9. Replaced 8 o'clock cowl shock mount
4. C/W FAR 91.207(d) by inspection of ELT operation 10. Replaced right brake pads
5. Performed alternator over-voltage circuit protection test 11. Secured right door inside handle
6. Performed capacity test on standby battery for 55 minutes,
battery passed at 23.1 volts
7. Performed diagnostics test on AMSafe restraint system

I certify this aircraft has been inspected in accordance with an annual inspection
and was determined to be in airworthy condition. See AD list in folder for compliance.

Name: James S. Jenkins IA3015266

Signed:
It. :5 ,'-..J", 1. --
-- ._- ---- --- --.._--- --- --.
 f.l5 If ;wJ
1.Approving Civil Aviation
Authority / Country :
I 2 AUTHORIZED RELEASE CERTIFICATE \13 FoonTrackingNumber

FAA / UNITED STATES FAA FORM 8130-3, AIRWORTHINESS APPROVAL TA AA IOBBN-OOOO

4. Organization / Name and Address FAA-PMA PQ1206CE 5. Wor!<Order / Contract /Invoice Number:
Aero Accessories, Inc. 1240 Springwood Church Road, Gibsonville, NC ... IOB8N-0000
o. Item I 7. Descrioton I 8. Part Number 9. Quantitv I 10.Serial Number: 11. Status / Work
1 I Dry Air Pump I AA3215CC
I 1 I OB8N08 I OVERHAUL
12. Remark!OVERHAULED IN ACCORDANCEWITH THE FOLLOWINGFAA APPROVEDPROCESS(ES):203-0-1009Rev. B DATED
05l2312OO6CERTIFIES
THAT THE WORKSPECIFIEDIN BLOCK11112WAS CARRIEDOUT IN ACCORDANCEWITH EASA PART
14!LIlNDIN RESPECTTO THAT WORKTHE COMPONENTIS CONSIDEREDREADYFORRELEASETO SERVICEUNDEREASA

..~..,""" .. PART 145APPROVALNUMBEREASA.145.5682 -

;,~~"'-

~..,.. :~.• 14a. [21:

14 CFR 43.9 Return To Service
[X
Other Regulation Specified in BloCk 12
&.-~ Certifies that unless otherwise specified in block 12. the work identified in block 11 and -
.~ll'ii>S:,~7 described in block 12 was accomplished in accordance with Title 14. Code of Federal
, ·~·f Regulations. part 43 and in respect to that work, the iteni~'are:8pproVed for return to service.
14b. Authorized ~Ignature 14cApproval/Certlficate No:
~~ YV4R688M
f ,
14d. Name (Typed or Printed) 14e. Date (dd/mmmlyyyy)
. Mitch Murphy 031 Aug/2016
User I Installer Resoonsibilities I
It is impor1antto understand that the existence of this document alone does not automatically constitute authority to install
the aircraft engine/propeller/article.
Where the user/installer performs work in accordance with the national regulations of an airworthiness authority different than the
airworthiness authority of the country specified in Block t.it is essential that the user/installer ensures that his/her airworthiness authority
accepts aircraft engine(s)/propeller(s)/article(s) from the airworthiness authority of the country specified in Block 1.
Statements in Blocks 13a and 14a 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 I installer before the aircraft may be flown.

FAA FORM 8130-3 (2-14) NSN 0052'{)Q.012-900~

 1. Approving Civil Aviation 2. 3. f

Authority/Country:

AUTHORIZED RELEASE CERTIFICATE

FAA/United States FAA Form 8130-3,AIRWORTHINESS APPROVAL TAG
4. Organization Name and Address:
. 5.1

tP MidContinent'" I NSTRU MENTS+AVION rc s

;
. 9400 E. 34th Street N.
Wichita KS 67226
FAA CRS OL2R061L

6. Item: 7. Description: 8. Part number: 9. Quantity: 10. Soria I numbor: 11

1U 149-015-15 Nn/'J:)

1 Attitude Gyro 5000B-75/ S3326-2 1 T98144Q

3-1- r» .;< 7S«.1-
12. Remarks:

THE WORK ORDER REFERENCED DESCRIBES THE ACTUAL WORK PERFORME

ALL WORK WAS PERFORMED REF. MANUAL # 86M024! CHANGE 1 ! 4 Nov 2011
- ,

. .

138. Cert(fles the items Identified aboll(fWere manufactured In conformity to:

q
~1;; ::-.; 1P"W ~.;. 14a. 00 14 CFR 43.9 Return to service o Other regul.tic
Block 12
0' Approve.d design dat~ a,ndare in a condition
o Noni-approYed design data specifled In Block 12.
for safe operation.
"
I
• ill'
Certifies that unless otherwise specified in Block 12. the work idenlifi
aCC~;t:ished in accordance with Title 14. Code of Federal Regulatic
items rejPproved for return to service,
- .. W' 1[1
13b. Authorized signature: l3c. ApprovallAulhorlz~tion No.: 1/
'w:,: Jt~ ,,~ ;w~.ture:
:1 ,
'" .1'f,;;'
:.;t;'
';, ",''ii,!,,!, &1'1 '" ,.,diII B! 1Ii~ w
,I

:A ~ ~
fi'''' 'i I
~,~<
l3d. Name (Types or Printed): '" 13e. Date (dd/mmm'yyyy): " ,m 14d. Na~ypos or Printed): 1,

r
M
if;

- Nicholas Ryan Howe

User/Installer Responsibilities

It is important to understand that the existence of this document alone does not automatically constitute authority to ins:
engine/propeller/article.

Where the userlinstaller performs work in accordance with the national regulations of an airworthiness authority differen
authority of the country specified in Block 1, it is essential that the user/installer ensures that his/her airworthiness authc
(s)/propeller(s)/article(s) from the airworthiness authority of the country specified in Block 1.

Statements in Blocks 13a and 14a do not constitute installation certification. In all cases, aircraft maintenance records m
certification issued in accordance with the national regulations by userlinstaller before the aircraft may be flown.
FAA Form 8130-3 (02-14)