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2. Owner Name (As shown on registration certificate) CHEVRON USA INC. Address (As shown on registration certificate) 7799 EARHART RD. OAKLAND, CA UNITED STATES 94621-4543 3. For FAA Us* Only 4. Type 5. Unit Identification Repair Alteration Unit Make Model Serial No. 0 0I AIRFRAME (As described
erafions are performed in accordance with Parts 21, 43, and 91 of the Federal Aviation Regutations. as appropriate. and the aircraft is registered m the Unled States DATE OF ISSUANCE R 07 MAR 2008 FAA REPRESENTATIVE Brent Archibald DESIGNATION NUMBER ODA-511131-CE Any ale:abort reproduction, or misuse of thi
173-02, Rev IR, dated 7/I 1/18. Composite material Hermes Fabric M 16 — Toile Decoration Grege, (same material) has been previously burnt, reference Skandia burn report TPt/ dated 8/22/17. the LH Divan (Outer Dress Cover Only) with Cowtan & Tout Fabric: 18905-01, EMI Natural. In with Aviation Consultin
y I Manufacturer International Jet Interiors 2221 Smithtown Ave Ronkonkoma, New York 11779 USA Certificated Mechanic C. Certificate No. 'Mc _U.S. Foreign Certificated Mechanic CRS I1JR439Y Certificated Repair Station Certificated Maintenance Organization D. I certify that the repair and/or
or. It) Airplane sNAME OF APPLICANT International Jet Interiors LIST OF DATA tit IDENTIFICATION 7,11TLE TP 268821-14 Rev A Dated 02/18/2014 Skandia. Inc. Flammability Test Report Bunsen Burner Testing Test Specimen P/N's 1 (represents floor covering) 2 (represents floor ducts) 3 (represents
and alle藺o鷓are perlorrned in accordance with Parts21.43.. d91 of theFederalAviatio fifiequ • lions,as appropriate, and the aircraft is registered in the United States, DATE OF ISSUANCE DESIGNATION NUMBER 可 璁囔鋤囤7 Any alteration, reprodu ion, or misuse of this cerlilicate may be punishable by a line not exceeding
RY 405020-CE, Structural special. Recovered the left and right hand drink ledge consoles with Rogers & n: Fabric, FRET #9103-05, Baroque, Treated at Skandia, REF treatment #SKEP41539. See the burn test report WO #46487- 00 and the FORM 8110-3, both dated 04-13-00 and approved by Judy Boggs, D.E.R. #DERV —
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