CERTIFICATE OF RELEASE TO SERVICE

1. AIRCRAFT IDENTIFICATION
PK-GUA
MANUFACTURE MODEL SERIAL NO ENGINE #1 S/N
R
Unison Slick Magneto 1 93100119 LYCOMING 66K4A
TYPE NUMBER: MODEL NO: TORQUE:
M-1795 4301 13-15 Lbs
LH
COMPANY: ADDRESS: JOB ORDER NO:
SLICK SURABAYA,INDONESIA B-11
AIRCRAFT
PRODUCT
2. SUMMARY OF WORK ORDER AND WORK PERFORMED
(USE BACK OF PAGE IF MORE SPACE REQUIRED).
- Slick Magneto Removal
- Slick Magneto Installation

3. EXCEPTIONS OR CONCESSIONS
(USE BACK OF PAGE IF MORE SPACE REQUIRED).
Aircraft Magneto Service,Repair and Overhaul
Instal time 15 min
Removal time 5 min
Tools:
-WRENCH
13,19,14
4. CONFORMITY STATEMENT OF WORK ACCOMPLISHMENT
SIGNATUR DATE/TIME
CATEGORY AUTHORIZATION NO
E
REMOVE ATA 74 20-10-2022 09.30
INSTALLATION ATA 74 20-10-2022 10.30
5. CERTIFICATE OF RELEASE TO SERVICE
Certifies that the work specified except as otherwise specified was carried out in accordance with Part 145
and in respect to that work the aircraft in considered ready for release to service.
(AUTHORITY) DGCA APPROVAL NO: AME 1788

NAME (AUTHORIZE NAME): SIGNATURE AND STAMP:

ROSIANA HANTORO
DATE/TIME (GMT):
20-10-2022 /10.30 WIB

THE WORK SPECIFIED IN THIS CERTIFICATE REFLECTS THE SERVICES AS DEFINED UNDER THE AIRCRAFT MAINTENANCE
CONTRACT OR WORK ORDER BETWEEN GEN MAINTENANCE FACILITY. (GMF) AND AIRLINE CONCERNED. THE AIRLINE
CONCERNED HEREBY ACKNOWLEDGES THAT THE SERVICES PERFORMED BY ON THEIR AIRCRAFT HAVE CONFORMED FULLY
WITH THE TERMS AND CONDITIONS OF THE CONTRACT OR WORKS ORDER