Authorized Release Certificate printable pdf download

1. Approving National Aviation

3. Form Tracking Number.

Original

Authority/Country:

Z100310

AUTHORIZED RELEASE CERTIFICATE

FAA/UNITED STATES

FAA FORM 8130-3, AIRWORTHINESS APPROVAL TAG

4. Organization Name and Address.

5. Work Order, Contract or Invoice

Number:

1731 KETTNER BLVD

SAN DIEGO, CA 92101

Ph: 619-702-3112, Fax: 619-702-3522, Email:

Z100310

6. Item: 7. Description:

8. Part Number:

9. Eligibility: *

10. Quantity:

11. Serial/Batch Number:

12. Status/Work:

MASTER CYLINDER

010-06500

VAR

103413

New

13. REMARKS

See work order for details.

14. Certifies the items identified above were manufactured in conformity to:

19.

14 CFR 43.9 Return to Service

Other regulation specified in Block 13

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

Approved design data and are in a condition for safe operation.

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,

Non-approved design data specified in Block 13

the items are approved for return to service.

15. Authorized Signature:

16. Approval Authorization No:

20. Authorized Signature:

21. Approval/Certifcate No:

17. Name (Typed or Printed):

18. Date (m/d/y):

22. Name (Typed or Printed):

23. Date (m/d/y):

10/1/2002

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.

Where the user/installer 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 parts/components/assemblies from

the airworthiness authority of the country specified in Block 1.

Statement 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 eligibility with applicable technical data

NSN:0052-00-012-90005