Fiche Matricule d'Equipment / Component Log Card
Fiche Matricule d'Equipment / Component Log Card
Fiche Matricule d'Equipment / Component Log Card
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<strong>Fiche</strong>/<strong>Card</strong> No: du/of:<br />
<strong>Fiche</strong> <strong>Matricule</strong> <strong>d'Equipment</strong> / <strong>Component</strong> <strong>Log</strong> <strong>Card</strong><br />
6 Modifi cations Appliques / Modifi cations Embodied<br />
No Date Remarques No Date Remarques No Date Remarques<br />
7 8<br />
Instructions Techniques Speciales Appliquees / STI's Instructions Speciales Appliquees / SI's<br />
No Date No Date No Date No Date No Date<br />
9 Entretien Majeur et RG / Reconditioning<br />
Nature / Type<br />
Organe. Reparateur<br />
Repair Unit<br />
Date Fin Troy<br />
Date Completed<br />
Fonctionnement<br />
Life Consumed<br />
Observations / Remarks<br />
MOD Form 735<br />
(Revised Jan 90)<br />
PPQ = 50
Cut out as indicated and paste onto the upper section of page 1 in landscape<br />
orientation with the title to the right. (Edge 'X' to be 1mm above the fold line).<br />
1<br />
Designation du Composant<br />
Inspector IC at:<br />
<strong>Fiche</strong> <strong>Matricule</strong> <strong>d'Equipment</strong> / <strong>Component</strong> <strong>Log</strong> <strong>Card</strong><br />
2 Marche ou Command / Contract No<br />
Reference No<br />
Date<br />
Organisme Emettuer / Issued by<br />
A<br />
B<br />
C<br />
3 Inspection et Controle / Inspection and Test Certifi cate<br />
Certifi ed that this equipment has been inspected and tested and is fi t for service. Complete anti-corrosion<br />
treatment has been carried out in accordance with the contract referred.<br />
A<br />
Inspector IC at:<br />
B<br />
Inspector IC at:<br />
C<br />
4<br />
5<br />
No de Nomenclature<br />
N de Serie<br />
Constructeur<br />
No Construzione<br />
Ensemble de Rattachement<br />
Rep<br />
Rep<br />
Neuf /New<br />
Nom / Name<br />
Date Livrais<br />
Date Delivered<br />
Identifi cation du Materiel / Identifi cation of <strong>Component</strong><br />
Matériel Neuf / New<br />
Signature / Unterschrift / Firma<br />
Matériel Réparé ou Révisé / After Reconditioning<br />
Matériel Réparé ou Révisé / After Reconditioning<br />
Date Mise en Ser<br />
Installation<br />
Date Timbre / Stamp<br />
Stockage<br />
Shelf<br />
Description<br />
Section/Reference Number<br />
Serial Number<br />
Manufacturer<br />
Part Number<br />
Related Assembly<br />
Nom / Name Signature Date Timbre / Stamp<br />
Nom / Name<br />
Signature<br />
Garantie / Life Guaranties<br />
Renseignements Particuliers / Remarks<br />
Date Timbre / Stamp<br />
Utilisation<br />
In Use<br />
X
10<br />
Limites de Fonctionnement<br />
Authorized Life<br />
Avant Entretien Mineur Avant RG<br />
Units<br />
Type<br />
11<br />
Formation<br />
Unit<br />
Date de<br />
Mouvement<br />
Transfer Date<br />
Periodicite Entretien Mineur<br />
Periodic Maintenance<br />
Equipment Support<br />
Mutations et Utilisations Successives / Transfers, Installations, Repairs & Replacements<br />
Positions<br />
Location<br />
Installed<br />
Support<br />
Installation<br />
Fonctionnement<br />
Life Consumed<br />
Parteil<br />
Item Part<br />
Section/ Reference Description Serial Number Location<br />
Total<br />
Item<br />
Remove this portion after typing above details<br />
Coeffi cient d'Utilisation<br />
Coeffi cient<br />
Motif du Mouvement et Travaux Effectues<br />
Authority for Transfer, Nature of Fault<br />
and Work Details<br />
Work<br />
Order No
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