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TANZANIA CIVIL AVIATION AUTHORIT

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					RADIO STATION SURVEY

FORM: AC-AWS0019
November 2008
Aircraft Radio station Approval Request form
Approval issue/renewal of the following Aircraft Radio Station is required AIRCRAFT REGISTRATION MARK OWNER’S NAME AND ADDRESS 5HAIRCRAFT TYPE:

AIRCRAFT MAY BE INSPECTED AT: Radio Equipment fitted in an aircraft (indicate Type and model) 1 H.F. No: 1 2 H.F. No: 2 3 V.H.F No: 1 4 V.H.F No: 2 5 ADF No: 1 6 ADF Loop No: 1 7 8 9 10 11 12 13 14 15 16 17 VOR No: 1 DME No: 1 Transponder No: 1 ILS Loc No: 1 ILS G/S No: 1 ILS Mkr No: 1 Intercom system: P.A. System: Weather Radar No: 1 Radar Altimeter: PAX Entertainment System:

Power Output Power Output Power Output Power Output ADF No: 2 ADF Loop No: 2 VOR No: 2 DME No: 2 Transponder No: 2 ILS Loc No: 2 ILS G/S No: 2 ILS Mkr No: 2 GPS: EGPWS/GPWS Weather Radar No: 2 TCAS/ACAS ELT

The following additions/alterations/modifications to the equipment have been made since last approved:

The Aircraft Radio station has been serviced/maintained by me and is satisfactory in every respect: Signature of A/c Radio Maintenance Engineer: Engineer’s License No Date: I Certify that the Aircraft station was flight tested by me and is satisfactory in every respects: Signature of Pilot Pilot’s License No: Date: For T.C.A.A. use only: The above Aircraft Radio station has been inspected by me and is approved/not approved* for the following reason(s): Signed ……………………………. Actioned. -----------------------------Date……………………………… Date ……………………………….

FORM: AC-AWS019

November 2008

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RADIO STATION SURVEY

Note:

Please record serial numbers of the installed radio equipment at the time of inspection on the back of this paper.

Indicate Serial Numbers of installed equipment (main):
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 H.F. No: 1 H.F. No: 2 V.H.F No: 1 V.H.F No: 2 ADF No: 1 ADF Loop No: 1 VOR No: 1 DME No: 1 Transponder No: 1 ILS Loc No: 1 ILS G/S No: 1 ILS Mkr No: 1 Intercom system: P.A. System: Weather Radar No: 1 Radar Altimeter: PAX Entertainment System: Power Output Power Output Power Output Power Output ADF No: 2 ADF Loop No: 2 VOR No: 2 DME No: 2 Transponder No: 2 ILS Loc No: 2 ILS G/S No: 2 ILS Mkr No: 2 GPS: GPWS Weather Radar No: 2 TCAS/ACAS

FORM: AC-AWS019

November 2008

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