Micro Computer Systems

Work Order Request

and

11/28/18

DISCREPANCY COVER SHEET

Customer:

Bilbo Baggins

Address:

515 Kim Drive

Aircraft Type:

BELL 407

Address:

Aircraft Reg.

N123BB

City, St Zip:

Fort Collins, CO 80524

Aircraft S/N:

53249

Country

USA

Tach Time:

1092

Total Time:

14856

MAINTENANCE REQUIREMENT:

15,000 Hr Inspection

I, as the owner, or representative of the owner, of the above described aircraft, request that MyCompany, Inc.

Perform the above described maintenance and install the necessary parts required for accomplishment.

Signature:

Date

Mechanic

Preliminary Inspection Complied With

11/23/16

JJ Wilson

Date

Mechanic Certificate No

Inspector

Hidden Damage Inspection Complied With

11/23/16

JJ Wilson

Discrepancy

Date

Mechanic

406-010-115-127 / Upper Plate Sn Az1452 / [Retire]

11/23/16

JJ Wilson

A

Action

Box Up Retired Parts 406-010-115-127 Ms28775-211

Date

Mechanic Certificate No

Inspector

Discrepancy

Date

Mechanic

406-010-117-125 / Lower Plate Sn Az1455 / [Retire]

11/23/16

JJ Wilson

B

Action

406-010-117-125

Date

Mechanic Certificate No

Inspector

Discrepancy

Date

Mechanic

406-010-108-131 / Grip Sn Lp 816 / [Retire]

11/23/16

JJ Wilson

C

Action

406-010-108-131

Date

Mechanic Certificate No

Inspector

Form CTK-201

Sheet No:

1

Aircraft:

BELL 407

Rev.C

Work Order No:

11632

Registration No:

N123BB

1/5/07