I. Approving national aviation authority/country 2. AUTHORIZED RELEASE CERTIFICATE 3. Form tracking No.

Transport Canada FORM ONE 1114153604

4. Organization name and address 5. Work order/contract/invoice

Canadian Aero Accessories Ltd. 170 George Craig Blvd. N.E. Calgary, AB, Canada T2E 7H2 153604

6. ltem 7. Description 8. Part No. 9. Qty. 10. Serial/batch No. 11. Status/work

1 NITROGEN CYLINDER 410870-5 1 411 OVERHAULED

12. Remarks I

The unit identified above was: OVERHAULED/MODIFIED IAW CMM 35-31-18, REV. 22/MAR/13. Full details held on Work Order 153604 Unit modified from P/N 410870-3 TO P/N 410870-5. Cylinder DoM 01/01, passed Hydrostatic Retest and All Required Inspections. This HST: 11/14. CYLINDER EMPTY .. The aircraft component is considered ready for release to service under EASA Part 145 Approval Certificate Number: EASA.145.7019.

I tifies that the items identified above were manufactured in conformity to· 14a.

~ CAR 571.10 Maintenance release. D Approved design data re in condition for s eration. ITi D Non approved design data s

Other regulations specified in block 12. in bloc

~ Certifies that, except where otherwise specified in block 12, the work identified in block 11 and described in block 12 was performed in accordance with Canadian Aviation Regulations.

13b. Signature 13c. Approved Organization Number 14b. Signature ~r--co 14c. Approved Organization Number I

NIA NIA I AMO 30-87

13d. Name 13e. Date (dd/mmm/yyyy) 14d. Name 14e. Date(dd/mmm/yyyy)

NIA NIA I Jeff Runciman 10/NOV/2014

This certificate does not constitute authority to install.

Installers working in accordance with the national regulations of a country other than that specified in block 1 must ensure that their regulations recognize certifications from the country specified .

Statements in block 13a or 14a do not constitute installation certification. In all cases, the technical record for the aircraft must contain an installation certification issued in accordance with the

applicable national regulations before the aircraft may be flown .

CANADIAN AERO ACCESSORIES LTD. PHONE: (403) 250 9077 FAX: (403) 250 684 1 www.canadianaero.com

TCCA: AMO 30-87 EASA PART- 145 Approval Certificate Reference Number EASA.145.7019

Customer Repair Order: R3640

Description: NITROGEN CYLINDER Part Number: 410870-3 Seri al Number: 411

I. WORK REQUESTED ,I,

INSPECTION / TEARDOWN REPORT

Removed From: N/ A CAA Work Order: 153604

Other Identification Data: N/A

Time In Service: N/A

Functional Test D Inspection D Repair D Overhaul IZ! Brush Change D Bearing Change D Modification D

Hydrostatic Test O Warranty O Other: HYDROS TA TIC RETEST DUE.

2. REASON FOR REMOVAL ,I,

Scheduled / Time Expired D No Snag Reported O Unscheduled / Snag IZ! UPGRADE TO -5 OR LA TEST#

3. PRETEST ,I,

4. FINDINGS ,I,

CYLINDER PASSED HYDROSTATIC TEST AND ALL APPLICABLE INSPECTIONS.

5. WORK (TO BE) ACCOMPLISHED

Disassembly 181 Wiring Repairs 0 Other Work: Partial Disassembly 0 Dynamic Balancing D

Cleaning 181 Re-Lubrication D Paint stripping 0 Re-Soldering D

Inspection 181 Parts Replacement 1:8:1 NOTO Recharge / Re-Fill D

Hydro-Static Test 181 Reassembly 1:8:1

Commutator I Slip-Rings Restoration 0 Run-in D Contacts Restoration 0 Acceptance Test 1:8:1

Seals Resurfacing 0 PaintD

6. NOTES ,I,

I **CONVERTED TO PIN 410870-5**

Technician : HGRK

Report Prepared By: KA THY JOHNSON

Invoice Number

Export Dt 3/24/2015

Shipper: Bill Lane Avmax 3691 19 st NE

Calgary

Purpose of Shipment

C.I. References SCS5118

AB T2E6S8 CA (403) 250-3185 ID/EIN:801229857RM0002

Broker

Part Nbr : 410870-5 H~ Code: 2804.30.0000

Desc: N2 Ditching Dam

Part Nbr:87140414-112SP HS Code: 8803 . 30 . 0000 Desc: Aircraft Butt Plate, steel

Comments: 1 ) 2) 3)

A. V M A X S f 0

• A R E 3. A I.> I V I ~·; r t:,. ..... t·J f-"

A V '\A ~ .X A '°'. I A I I C".> N ,•.; r I ~ V , C: I ~· I r-J •:

11111111111111111111111111111111111111111111111111111~111111111111111111111111111

Commercial Invoice

Curr USO

Pkgs 2

BOX

Consignee : Michael Hopkins Commutair 85 Sicker Road

Latham

Ult Dest . us Bill T/C 3567 - 7010-2

NY 12110 US (5 18) 690-9080 ID/EIN:

Importer Michael Hopkins Commutair 85 Sicker Road

Latham NY 12110 US (5 18) 690-9080 ID/EIN:

ACI - 633053505269

Air Waybill Nbr. 633053505269 Bill D/T/F 3567-7010-2

Marks/Nbrs: entry MFG:US Net Wgt: 0.00 lbs Unit Qty : 1.00 EA Unit Value :

1 , 600 . 000000 Commodity Value : 1,600.00

Marks/Nbrs: entry MFG: CA Net Wgt: O. 00 lbs Unit Qty : 2 . 00 EA Unit Value : 560.000000 Commodity Value : 1,120.00

Total Shipment Weight: 4.7 Total Commodity Value : 2720 . 00 Terms of Sale: FCA

Freight: 0 . 00 Insurance: 0.00

Others: 0 . 00 Total Invoice Value: 2 , 720.00

I declare all information in this invoice to be true and correct . Signature of shipper: Bill Lane 3/24/2015

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