EXAMPLE
STC CHECK SHEET _____ Application
from STC/Amendment or Drawing List approval (dated
__________). _____ Application
Form 8110-12 _____ Certification
Plan _____ FAA
letter of acknowledgment transmitted. #:
___________________ Date: __________ _____ Compliance
Checklist _____ Drawing
review: Completed/DER Approved. Drawing: __________
Rev: __________ _____ Document
List #: _______________________ Rev.: __________
Date: __________ _____ Report
review: Completed /DER Approved. Report:
______________ Rev: __________ _____ Reports
Submitted:
___________________________________________________________ _____ ___________________
test plan/report acceptable. Number: ___________
Rev: __________ _____ ___________________
systems data reviewed and accepted by:
_______________________ _____ ___________________
data reviewed and accepted by:
______________________________ _____ ___________________
substantiation acceptable. Report:___________ Rev.
__________ _____ ___________________
test
plan/report acceptable. Number: ___________ Rev:
__________ _____ ___________________
substantiation acceptable. Report:___________ Rev.
__________ _____ ___________________
test plan/report acceptable. Number: ___________
Rev: __________ _____ Weight
and Balance supplement acceptable. _____ Flight
manual supplement reviewed and accepted by Flight
Test Branch. _____ TIA
(if applicable) approved/transmitted. _____ Flight
test report complete and acceptable. _____ DER
Statement of Compliance Form(s) 8110-3 received.
_____ Instructions
for Continued Airworthiness reviewed and accepted
by AEG. _____ Part
conformity inspection requested. D/L:
________________ Rev: ___________ _____ Part
conformity inspection acceptable. _____ Installation
conformity inspection requested. D/L: ___________
Rev: ___________ _____ Installation
conformity inspection acceptable. _____ STIR
complete. _____ Other
requirement(s):
___________________________________________________ STC/Drawing
List approval: Signed:
____________________ STC #: _______________ Date:
_______________ _____ Conformity
Inspection Record(s) Form 8110-1 Received:
______________________ _____ Project
closed out: (date _______________). _____ Remarks:_____________________________________________________________ _____________________________________________________________________ _____________________________________________________________________
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