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COMPANY NAME

PIREP/DEFECT CONTINUATUION SHEET NRWC REF. S/N________________ AIRCRAFT REG. ROUTINE TASK# DATE SHEET OF

ITEM

DEFECT/WORK REQUIRED

ACTION TAKEN

MECH SIGN

SIGNATURE AUTH/DATE

The work recorded above has been carried out in accordance with the requirements of BASR schedule 5.225 and 5.230 and inspection and determined to be in airworthy condition, in respect to aircraft/equipment and is deemed fit for release to service.

MAINTENANCE SUPERVISOR SIGNATURE____________________________________ No._________ DATE________________

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