Get 8310 3

FAA Form 8310-3 12-2011 Supersedes Previous Edition NSN 0052-00-686-1002 Record of Action Repair Station Inspection For FAA Use Only 6. The OMB control number associated with this collection is 2120-0682. You may submit any comments regarding the accuracy of this burden estimate or any suggestions for reducing the burden to the Federal Aviation Administration Aircraft Maintenance Division AFS-300 800 Independence Ave SW Washington DC 20591 Attention FAA Form 8310-3. OMB Approved 2120-0682 April 30 2012 If additional space is required for any item attach additional sheets of paper. U*S* Department of Transportation Federal Aviation Administration 1. Repair Station Name Number Location and Address Application for 2. Reasons for Submission Number a* Official Name of Station b. Location where business conducted c* Official Mailing Address of Repair Station Number Street City State ZIP Original Application for Certificate and Rating Change in Rating Change in Location or Housing and Facilities Change in Ownership Other Specify d. Doing Business As 3. Ratings Applied for Airframe Powerplant Propeller Radio Instrument Class 1 Accessories Limited Engine Landing Gear Float Rotor Blades Fabric Emergency Equip* Non-Dest. Test Specialized Services specify 4. List of Maintenance Functions Contracted to Outside Agencies 5. Applicant s Certification Name of Owner Include name s of individual owner all partners or corporation name giving state and date of incorporation I hereby certify that I have been authorize by the repair station identified in Item 1 above to make this application and that statements and attachments hereto are true and correct to the best of my knowledge. Date Authorized Signature Printed Name of Authorized Signer Title Paperwork Reduction Act Statement This form is used to apply for certification additional ratings or a change to a repair station in accordance with 14 CFR part 145. The FAA estimates that the average burden for this report form is 15 minutes per response. An agency may not conduct or sponsor and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Remarks identify by item number. Include deficiencies found ratings denied* 8. Date of Inspection 7. Findings - Recommendations A. Station was found to comply with requirements of FAR 145. C. Recommend certificate with rating applied for on application be issued* Office Signature s of Inspector s 10. Supervising or Assigned Inspector ACTION TAKEN APPROVED as shown on certificate issued on date shown* CERTIFICATE ISSUED Inspector s Signature Inspector s Printed Name. OMB Approved 2120-0682 April 30 2012 If additional space is required for any item attach additional sheets of paper. U*S* Department of Transportation Federal Aviation Administration 1. Repair Station Name Number Location and Address Application for 2. U*S* Department of Transportation Federal Aviation Administration 1. Repair Station Name Number Location and Address Application for 2. Reasons for Submission Number a* Official Name of Station b. Location where business conducted c* Official Mailing Address of Repair Station Number Street City State ZIP Original Application for Certificate and Rating Change in Rating Change in Location or Housing and Facilities Change in Ownership Other Specify d.