0
us Oepar1ment
of Transporta1lon
FedBml Aviation
Admlnl&tmtlon
MAJOR REPAIR AND ALTERATION
(Airframe, Powerplant, Propeller, or Appliance)
Form Approved
IElec:tJonlc
0MB No. 2120-0020
11/30i2007
ngNumber
For FAA Uaa Only
INSTRUCTIONS: Print or type all entries. See TIUe 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 Registrauon Mark
Serial No.
USAN
1. Aircraft
Make
Model
I
Serles
Piper
PA46-310P
Name
(As shown on registration certificate)
Address (As
shown on registration certificate)
Addl'll88
2.0Wner
City
State
Zip
eoun11y USA
3. For FAA Use Onlv
4. Type
5. Unit Identification
Repair
Alteration
Unit
Make
Model
Serial No.
D
Ill
AIRFRAME
(As described In Item 1 above)
D
D
POWERPLANl
-·
�
-
-
"t]::-·-
r-co--
-
PROPELLER
0
- -----
----
---
----
-
-
- -
----
Type
D
D
APPLIANCE Manufacturer
6. Conformny Statement
A. Agency's Name and Address
B. Kind of Agency
Name
Mead Aircraft Sevices, Inc
1./
U. S. Certificated Mechanic
I
Manufacturer
AddJass
1180 � Aic1221l B�
Foreign Certificated Mechanic
C. Certificate No.
Clly
Hutchinson
Stale KS
Cettificated Repair Station
Zip
67501
Coumry
USA
Cettificaled Maintenance Organization
A&P 443641987
D. I certify that the repair and/or alteration made to the unlt(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
D
Kevin Mead 1-11-10
?/-
App.B
f
7. Annroval for Return to Service
Pursuant to the authority given persons specified below, the unit Identified in item 5 was inspected in the manner prescribed
Administrator of the Federal Aviation Administration and is
G2I
Approved
D
Rejected
FM Fil Standards
Manufacturer
Maintenance Organization
I PeJSons Approved by Canadian
Inspector
Department of Transport
BY
Other
(Specify)
FMDesignee
Repair Station
X
Inspection Authorization
Certificate or
·�"""'"IDateof AuU.orizoo lodl
�
Designation No.
Kevin Mead 1-11-10
?
IA 443641987
by the
Summary of Contents for Malibu PA-46-310P
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