FAA-G-8082-19

INSPECTION AUTHORIZATION
INFORMATION GUIDE

Appendix 1
Sample Forms and Records

U.S. Department of Transportation

Federal Aviation Administration

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Doe, John J. A&P 12345678

1450 E Cheltenham Ave Meridian Aviation, Downtown Airpark

Cleveland County 5060 S Western Ave
Oklahoma City, OK 73098 Oklahoma City, OK 73452 (405) 555-1875




June 12, 20XX Meridian Aviation, Downtown Airpark Inspection, repair, and overhaul
5077 S Western Ave of single-engine and
Oklahoma City, OK 73458 multiengine aircraft

Endorsement expires in 30 days.

March 22, 20XX John J. Doe

March 22, 20XX John Milford John Milford ASW 25

Figure 1. FAA Form 8610-1, Mechanic’s Application for Inspection Authorization.

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UNITED STATES OF AMERICA

DEPARTMENT OF TRANSPORTATION

SIGNATURE OF AUTHORIZED MECHANIC

FEDERAL AVIATION ADMINISTRATION
INSPECTION AUTHORIZATION
This certifies that Robert D. Burge
holder of Mechanic Certificate No. 222442345

Robert D. Burge
has been authorized to exercise the privileges of Federal
Aviation Regulation 65.95.
This authority expires March 31, 20XX unless
sooner revoked by the Administrator of the Federal Aviation
Administration or extended by endorsement on the reverse
of this card.
DATE ISSUED SIGNATURE, FLT. STDS. INSPECTOR
3/16/20XX Mike Johnson Mike Johnson
FAA FORM 8310-5 (8-80) SUPERSEDES PREVIOUS EDITION

front

Authority to exercise the privileges of FAR 65.95 has been

endorsed or renewed to expire on the date shown below.
EXPIRATION DATE ENDORSED BY INSPECTOR FAA OFFICE

3/31/20XX Mike Johnson SW-FSDO-2

back

Figure 2. FAA Form 8310-5, Inspection Authorization.

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Form Approved Electronic Tracking Number

OMB No. 2120-0020
2/28/2011
US Department
MAJOR REPAIR AND ALTERATION For FAA Use Only
of Transportation (Airframe, Powerplant, Propeller, or Appliance)
Federal Aviation
Administration

INSTRUCTIONS: Print or type all entries. See Title 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 Registration Mark Serial No.
N12345J 721-43566
1. Aircraft Make Model Series
FleetWing FW200 80
Name (As shown on registration certificate) Address (As shown on registration certificate)
Address 2414 N. Lincoln
2. Owner Milltown OK
Mike J. Urbach City State

Zip 73122 Country

3. For FAA Use Only

The technical data identified herein has been found to comply with applicable airworthiness
requirements and is hereby approved for use only on the above aircraft, subject to
conformity inspection by a person authorized in 14 CFR part 43, section 43.7.

Maria Johnson Maria Johnson, ASI

4. Type 5. Unit Identification

Repair Alteration Unit Make Model Serial No.

 AIRFRAME (As described in Item 1 above)

POWERPLANT

PROPELLER
Type

APPLIANCE
Manufacturer

6. Conformity Statement
A. Agency's Name and Address B. Kind of Agency
Name Eugene Henson  U. S. Certificated Mechanic Manufacturer
Address 212 SW 66th Street Foreign Certificated Mechanic C. Certificate No. A&P 1709665
City Milltown State OK Certificated Repair Station
Zip 73122 Country Certificated Maintenance Organization

D. I certify that the repair and/or alteration made to the unit(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 Signature/Date of Authorized Individual

per 14 CFR Part 43
Eugene Henson March 2, 20XX
App. B Eugene Henson
7. Approval for Return to Service
Pursuant to the authority given persons specified below, the unit identified in item 5 was inspected in the manner prescribed by the
Administrator of the Federal Aviation Administration and is Approved  Rejected
FAA Flt. Standards Maintenance Organization
Persons Approved by Canadian
Manufacturer Department of Transport
Inspector
BY
Other (Specify)
FAA Designee Repair Station  Inspection Authorization

Certificate or Signature/Date of Authorized Individual

Designation No. Martin M. Sawyer April 2, 20XX
A&P 9486717 IA Martin M. Sawyer
FAA Form 337 (10-06)

Figure 3. FAA Form 337, Major Repair and Alteration (Airframe, Powerplant, Propeller, or Appliance)
(front view). Note the FAA inspector’s data approval for a major repair (block 3).

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NOTICE
Weight and balance or operating limitation changes shall be entered in the appropriate aircraft record. An alteration must be
compatible with all previous alterations to assure continued conformity with the applicable airworthiness requirements.

8. Description of Work Accomplished

(If more space is required, attach additional sheets. Identify with aircraft nationality and registration mark and date work completed.)

N12345J 03/02/20XX
Nationality and Registration Mark Date

Aircraft Total Time 6,210 hours

1. Removed horizontal stabilizer from aircraft and opened top and bottom skin at rear spar.
Removed cracked rear spar and replaced with new spar (part number FW10204-56) in
accordance with FleetWing structural repair manual No. 410, chapter 2, and figure 9-12.
Original rivet pattern and type (MS20470AD3-4) were maintained.

DATE: 02/25/20XX, inspected repair work to interior of horizontal stabilizer prior to closure of
top skin. Found repair to be in accordance with data indicated and ready for final closure. An
inspection of the complete interior of the stabilizer for hidden damage and condition at this time
revealed no damage and good structural condition.

Martin M. Sawyer
Martin M. Sawyer, A&P 9486717 IA

2. Primed interior of stabilizer and closed upper skin. Installed on aircraft, rigged elevator and
operationally checked in accordance with manufacturer’s maintenance manual (FW4490).

3. No change in weight and balance.

END

Additional Sheets Are Attached

FAA Form 337 (10-06)

Figure 3 (cont’d). FAA Form 337, Major Repair and Alteration

(Airframe, Powerplant, Propeller, or Appliance) (back view).

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March 22, 20XX

Total Aircraft Time 1,502.0 Hours

Tach Time 972.4 Hours

I certify that this aircraft has been inspected in accordance with

an annual inspection as per Air Tractor AT502 owner’s manual
and was determined to be in an airworthy condition.

Joseph P. Kline
A&P 123467899 IA

NOTE: This is an example of a record entry for an annual

inspection determining the aircraft to be in airworthy condition.
The date, aircraft total time, and tachometer (tach) or recorder
reading are included. The tach or recorder readings should
not be confused with the total time and should only be shown
in addition to the total time entry. The mechanic’s certificate
number is suffixed by the letters “IA” indicating that the mechanic
is the holder of an inspection authorization. Maintenance done in
conjuction with the inspection should be entered as a separate
entry.

Figure 4. Example of an airworthy annual inspection maintenance record entry.

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Page 1 of 1 Date 12/02/2000

Registration Number N937JM Aircraft Make/Model FleetWing FW-25-200 Serial Number 2842015
Aircraft Certification Date 07/12/2000
Engine Model Lycoming 0-320-D3G Serial Number L-7656-38A

Next Authorized

Recurring
One Time
Applicable Date and
Revision Method of Compliance Signature,
AD Number S.B. Number Hours at
Date Compliance at Type, and
and Subject Compliance
Hours/Date Number

2008-26-13 Inspect Oil 5/27/1996 Replaced hose NA Bill Jenkins

Cooler Hose 3,102 hours assembly with TSO A&P
53a, type D hose. 23453322 IA
100-hour recurrent
inspection or longer
required.
2005-20-R1 Oct. 10, Inspect fuel 12/14/2005 Inspected IAW No further Joe Kline
2005 cells IAW SB 2,823 hours FleetWing service action A&P
X
1134 bulletin 1134 sections required 123467899 IA
A and B.
2001-02-03 Fuel quantity 02/15/2001 Replaced right and left No further Jimmy Miller
indicators. 502 hours fuel quantity indicators X action A&P
per AD paragraph B2. required 23244411
2000-26-01 Inspect flap 02/15/2001 Inspected IAW Inspection Jimmy Miller
jackscrew 502 hours FleetWing SB 1002. required A&P
X
IAW SB 1002 each 3,000 23244411
hours

Figure 5. Airworthiness Directive Compliance Record (suggested format).

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OMB No. 2120-0003

08/31/2008

DESIGNATION
8. Comments (Describe the malfunction or defect and the circumstances under which it

OPERATOR
OPER. Control No.

DISTRICT
DEPARTMENT OF TRANSPORTATION

OFFICE
occurred. State probable cause and recommendations to prevent recurrence.)
FEDERAL AVIATION ADMINISTRATION
ATA Code 8120 Pilot reported loss in aircraft’s critical
1.
MALFUNCTION OR DEFECT REPORT A/C Reg. No. N- 6696J
altitude. Inspection revealed the left engine’s

OTHER
Enter pertinent data MANUFACTURER MODEL/SERIES SERIAL NUMBER
wastegate shaft warped and binding. The
2.

6219
shaft’s freedom of travel was also found to

COMMUTER
AIRCRAFT Cessna 421B 421B79485
3. be partially restricted due to carbon buildup
POWERPLANT Continental GTSIO520L C216977 in the bearings. This is possibly a

FAA
4.
PROPELLER McCauley 3AF34C92 42279 contributing factor in the warping.
Recommend lubricating wastegate valve

( 429 ) 555
Mike Merritt
MFG.
5. SPECIFIC PART (of component) CAUSING TROUBLE
Part Name MFG. Model or Part No. Serial No. Part/Defect Location. with approved lubricant such as Mouse Milk
or WD-40 when shaft is cool.

AIR TAXI
Wastegate shaft Garrett PN 4166952 NA left engine
wastegate
6. APPLIANCE/COMPONENT (Assembly that Includes part)

MECH.

X
Comp/Appl Name Manufacturer Model or Part No. Serial Number

TELEPHONE NUMBER
Wastegate Garrett 480164-10 1121

OPER.
Optional Information:

SUBMITTED BY:
Part TT Part TSO Part Condition 7. Date Sub. Check a box below, if this report is related to an aircraft

REP.STA.
1,222 hrs NA warped 1/22/20XX Accident; Date Incident; Date

FAA FORM 8010-4 (10-92) SUPERSEDES PREVIOUS EDITIONS

NOTE: This is a typical FAA Form 8010-4 (revised 10-92). The holder of an IA is urged to use this form for
all malfunctions or defects that cannot be attributed to poor maintenance procedures. Provide the information
requested on the form. Note that item 8 requests information concerning how the defect can be corrected. The
form may be obtained at the local Flight Standards District Office or online at the FAA’s web site (FAA.gov). At the
web site the form is found under the Aircraft tab and under the Advisories & Guidance—Service Difficulty Reports
(SDR) heading. The form may be e-mailed, faxed, or mailed to the addresses or telephone fax number noted
under Service Difficulty Reporting System (SDRS) Submissions on the web site.

Figure 6. FAA Form 8010-4, Malfunction or Defect Report.

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Operating Limitations: Zeph-Air 63-1A N40023

RPM Do not exceed 2,300
Oil temperature 212°F max.
Airspeed limits—do not exceed:
Level flight or climb 95 knots
Glide or dive 130 knots
Gross weight 1,200 lb
Empty CG 14.4 inches aft of datum
Useful load 453 lb
Kinds of operation VFR—day

Figure 7. Operating limitations placard.

March 22, 20XX

Total Aircraft Time 3,202.5 Hours

Hobbs Meter Reading 975.5 Hours

I certify that this aircraft has been inspected in accordance with

an annual inspection, and a list of discrepancies and unairworthy
items dated March 22, 20XX, have been provided for the aircraft
owner.

Joseph P. Kline
A&P 1123456789 IA

Figure 8. Example of an unairworthy annual inspection maintenance record entry.

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Academy Aviation
Hangar 4
North Philadelphia Airport
Philadelphia, PA 19114

Mr. Morris McCall

1450 W. Cheltenham Ave.
Philadelphia, PA 19125

Mr. McCall:

This is to certify that on March 22, 20XX, I completed an annual

inspection on your aircraft, Condor 191B, S/N 3945, N1234, and
found the following unairworthy items:

Compression in No. 3 cylinder read 30 over 80, which is below the

manufacturer’s recommended limits.

The muffler has a broken baffle plate which is blocking the engine
exhaust outlet.

There is a 6-inch crack on bottom of the left wing just aft of the
main landing gear attach point.

Joseph P. Kline
A&P 123456789 IA

Figure 9. Discrepancy list to be provided to an aircraft owner when reporting

an aircraft with unairworthy items after completing an annual inspection.

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Weight and Balance Revision Date: 05/06/20XX

N44933 Cessna 182L Supersedes Computations

found on FAA Form 337,
Serial Number 18234329 dated 10/22/20XX

Removed the following equipment: Weight Arm Moment

1. Turn coordinator P/N C661003-0211 2.50 lb 15.0 37.50
2. Directional gyro P/N 0760099 +3.12 13.5 +42.12
Total 5.62 79.62

1,709.60 35.26 60,282.20

–5.62 –79.62
Aircraft after removal 1,703.98 35.20 60,202.58

Installed the following equipment: Weight Arm Moment

1. Vector2 Autopilot system including 13.0 lb 32.7 425.13
turn coordinator and directional gyro.

1,703.98 60,202.20
+13.00 +425.13
*REVISED LICENSED EMPTY WEIGHT 1,716.98 60,627.71

*NEW USEFUL LOAD: 1,083.02

Forward Limit Check (Limit +38.4) Rearward Limit Check (Limit +47.4)
Wt Arm Moment Wt Arm Moment
A/C Empty 1,716.98 35.31 60,627.21 A/C Empty 1,716.98 35.31 60,627.21
Fwd Seats 170.00 36.00 6,120.00 Fwd Seats 170.00 36.00 6,120.00
Aft Seats Aft Seats 340.00 71.00 24,140.00
Fuel (min.) 115.00 48.00 5,520.00 Fuel (max.) 360.00 48.00 17,280.00
Oil 22.00 –15.00 –330.00 Oil 22.00 –15.00 –330.00
Baggage Baggage 120.00 97.00 11,640.00

2,023.98 35.50 71,937.71 2,728.98 43.78 119,477.71

Joseph P Kline
Joseph P Kline
A&P 123456789 IA

NOTE: Computations are shown. Form is signed, dated, and identifies the computations or
figures it supersedes. It is recommended that the manufacturer’s weight and balance data
forms be used for specific aircraft.

Figure 10. Weight and balance revision for a typical light, single-engine aircraft.

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July 12, 20XX

Aircraft Total Time: 1,566 hours

Complied with Airworthiness Directive (AD) 20XX-12-10R1,

effective date June 30, 20XX. Modified the airplane by
compliance with paragraph 2(b) of AD. Installed FleetWing
Service Kit SK 1910 as required by AD. No recurring action
required.

Bill Quinlan
A&P 143298671

Figure 11. One-time Airworthiness Directive compliance entry.

May 23, 20XX

Engine Total Time: 720 hours

Complied with Airworthiness Directive (AD) 20XX-10-12, Alcon

Turbo Chargers by inspection as required by paragraphs (b)
through (g) of AD. Turbine housing found satisfactory, next
inspection due at 920 hours.

Joe Knight
A&P 279387792

Figure 12. Recurrent Airworthiness Directive compliance entry.

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