USCG ARSC CRR.pdf
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- HSCG38-08-R-500033
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USCG ARSC CRR
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U.S. COAST GUARD
COMPONENT REPAIR RECORD
THIS FORM IS USED TO REPORT MAINTENANCE ACTIONS PERFORMED ON COAST GUARD
COMPONENTS BY OVERHAUL/REPAIR FACILITIES.
THE COMPLETED FORM TO BE PROVIDED TO:
ORIGINAL TO: COPY 1: COPY 2:
ACMS - BLDG 78 PACKAGED WITH THE ATTACHED TO
USCG AIRCRAFT REPAIR & SUPPLY CENTER OVERHAULED/REPAIRED INVOICE
ELIZABETH CITY, NC 27909-5001 COMPONENT
OVERHAUL/REPAIR FACILITY TO COMPLETE ALL INFORMATION IN DESIGNATED AREA
MANUFACTURER: _______________________
DATE OF MANUFACTURE: _______________________
TSO: ____________
HRS: ____________
THE FOLLOWING NARRATIVE SUMMARIZES THE WORK PERFORMED ON THIS COMPONENT
DURING THE COURSE OF THIS OVERHAUL/REPAIR.
OVERHAUL/REPAIR FACILITY: ______________________ WORK ORDER NO: ______________
DATE WORK COMPLETED: ________ ITEM BEYOND ECONOMICAL REPAIR: YES____ NO____
THE FOLLOWING MAINTENANCE ACTIONS WERE COMPLIED WITH DURING THE COURSE OF
THIS OVERHAUL/REPAIR.
AUTHORIZED SIGNATURE OR QUALITY ASSURANCE STAMP: _____________________________
FOR ACMS CONTRACTOR: DISENROLLED __________ DATA ENTRY ___________ DATE __________
PART NAME CEI NUMBER SERIAL NUMBER
PART NUMBER: ________________________ NSN NUMBER: ________________________
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| CEI No: |
| Part No: |
| Part Name: |
| NSN No: |
| Date of Mfg: |
| Mfg No: |
| HRS: |
| remarks: |
| TSO: |
| work order: |
| date comple: |
| yes: |
| no: |
| Overhaul/repair: |
| overhaul: |
| stamp: |
| disenroll: |
| data entry: |
| date1: |
| Serial No: |
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