GM F AeroAsia

Receiving Inspection Record

Order : 450044710 Supplier THE BOEING COMP ANY
Invoice No : 930642955 Airway Bill : 160-54874621
Part No : 23A02664-3 7 :SIN : NIA
Part Name : CONDUIT ASSY Quantity : l.000 EA
Inspected by : si 12001 Batch : 0001515669

CHARACTERISTICS ACTUAL VALUES INSPECTION DESCRIPTION STATUS

General Document - Invoice INVOICE AVAILABLE Accepted
(ACCEPTED)
General Document - Airway AlRWAYBILL AVAlLABLE Accepted
. Bill (ACCEPTED) .
General Document - Shipping : SHIPPING DOCUMENT NOT Accepted
Document , AV.AILABLE (ACCEPT)
Certificate of Conformity CERTIFICATE OF CONFORMITY FAA FORM 8130-3.AVAILABLE Accepted
AVAILABLE(ACC)
Calibration Certificate CALIBRATION CERTIFICATE Accepted
NO'f AVA.IL(ACCEP)
Servicable Tag SERVICABLE TAG NOT Accepted
AVAILABLE(ACCEPTED)
Test Certificate TEST CERTIFICATE NOT Accepted
AVAlLABLE (ACCEPT)
T echnical Data & Document ACCEPTABLE Accepted
Packaging Tvne CARTON_BDX USED Accepted
Packaging Condition ACCEPTABLE Accepted
Phvsical Condition ACCEPTABLE Accepted
Quantity ACCEPTABLE Accepted
Material Status NEW ITEM Accepted
Preservation Check ACCEPTABLE By: Dwi Alpha/ Dwi Anzkasa F. Accepted
Best Before Date - 31.12.9999 Accepted
DDMMYYYY format

ANY UNSATISFACTORY ITEM? D Yes r:YNo

IF YES, UNSATISFACTORY ITEM TRANSFERRED TO MRlR NO. ~
_.~_L:
_J._
J-

f-"y
D Eligible for .BASA Under EASA Part 145 Approval Number: ~_

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DATE: INSPECTED BY : I '
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Form No.: GMF/Q-016 R6 Page:1

 GMFAeroAsia
GARU DA INDOIU'SlA Gf!OIIP
Material Receiving Tag I

Purchase Order: : 0450044710 Printed By : S322005

Date : 23.11.2017
Vendor: Mat Type :EXP
: THE BOEING COMP ANY Mat Qty 1 EA

Part Number : Batch Number : Mate~ial Description :

23A02664-37:07418 0001515669 CONDlJIT ASSY

1111111111111111111111111
Performed By Insp
Sign and Stamp
Form No. : GMF/Q-008R2
I
--------,
 GM FAeroAsia
Transfer Order
O.A.RODA UIOON!StA GAOUI'
0001543989.0001

Date: 27.11.2017-17:36:02
W/hse: GDC llllllllllll 1111111111111111 Ill
S/Loc: 1000

Srce: 902 001 0450044710

Dest: XDC00l XDC-01

Material: 23A02664-37:07418 R/Qty UoM Batch No Mat Type

Description: CONDUIT ASSY EA 0001515669 EXP

---~- ------- ---

1. Approving <.;1v11 Aviation 2. 3. Form Tracking Number:
Authority/Country: FAA/United States
AUTHORIZED RELEASE CERTIFICATE 73641822371000000036453468
FAA Form 8130-3, AIRWORTl;UNESS APPROVAL TAG

4. Organization Name and Address: AVIALL SERVICES INC. 5. Work Order/Contract/Invoice Number:
2750 REGENT BLVD 450044710
DFW AIRPORT, TX 75261

6. Item: 7. Descri tion: 8. Part Number: 9. Quantit 10. Serial Number: 11 . Status/Work:
1. CONDUIT 23A02664-37 1 NIA NEW
ASSEMBLY

12. Remarks:
ID
AAA
1300 UN: 119008

THIS PMA PART IS NOT A CRITICAL COMPONENT.

THE PRODUCT(S)/ARTICLE(S) SHIPPED UNDER THIS APPROVAL WERE PRODUCED
BY JOSLYN SUNBANKCORPORATION. f

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13a.Certifies the items identified above were manufactured in conformity 14 CFR 43.9 Return to Service OOther regulation specified in Block
to: Cert .I hat unless otherwise specified in Block 12, the work iden in Block 11
~ Approved design data and are in a condition for safe operation. and d~scrib Block 12 was accomplished in accordan Title 14, Code of
Federal Regulations, , the items are approved
D Non-approved design data specified in Block 12.
for return to service.
i
13b. Authorized Signature: 13c. Approval/Authorization No.: 14b. Authori:z!ed Signatur,e:
1I
/1/4,,.1. a. e.b!t~-;:t;_ 225678718
!
13d. Name (Typed or Printed): 13e. Date (dd/mrnm/yyyy):
MARK A. DUMONT 10 NOV2017
User/Installer Responsibilities I

It lsimportant to understand that the existence of this document alone does not automatically constitute authority to install the aircraft engine/propeJler/article. Where the user/installer performs work in
1

accordance with the national regulations of an airworthiness authority different than the airworthiness authority of the country specified in Block 1, it is essential that the user/installer ensures that his/her
airworthiness authority accepts aircraft engine(s)propeller(s)/ article(s) from the airworthiness authority of the country specified in the Block 1. Statements in Blocks 13a and 14a do not constitute installation
certification, In all cases, aircraft maintenance records must contain an installation certification issued in accordance with the national regulations by the user/installer before the aircraft may be flown.
FAA Form 8130-3 (02-14) NSN:0052-00-012-9005
 1. Approving Civil Aviation 2. 3. Form Tracking Number:
Authority/Country:

FAA/United States AUTHORIZED RELEASE CERTIFICATE 20150252-0l

FAA Form 8130-3, AIRWORTHINESS APPROVAL TAG
I
4. O rganiza tio n N a m e an d A d d ress : ' -, 5. \Vork Order/Contr:act/ln,oin,
i ~~\~Wef'ili~\"ifLP I
Number:
1600 SW 43rd St, Ste 100, Renton, WA 98057 USA i PO 231813
I

6. Item: 7. Descriplion: 8. Part Number: I 9. Quantity: 10. Serial Number: ]I. St:itus/Work:
I - (25) - ---~- -- ----
CONDUIT ASSY --NEW-----
,,
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12.Rcmarks: '' i
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AIRWORTHINESS APPROVAL ,
,, T~~l'.SJ~I:U-PPED UNDER THIS APPROVAL WERE PRODUCED BY JOSLYN SUNBANK
F~-PM~BN15L'J@ENSED BY TC HOLDER, 1~}!i;))~f '::,ATE 1505 , coor
CERTIFIED TRUE COPY OR\G\NAl
OR~GH\Y\L Oij FILE a: ()
w
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13a. Certlfles the items identified above were manufactured in conformity to: w
c::(

0 Approved design data anil arc iii a condition for safe operatien.
D Non-approved design data specified in Block 12 l
,,"! ./1 -l
B~- Authorized Signature: A / ) 13c. Approval/Autherizaflon
No.: 1,
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NIA

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13d. Name (Typed or Printed):
DART301028NM
13c. Date (dd/mmml,-,yy): 14d; Name (Typed or Printed):
.-NIA

14e. Date (dd/mmmfyyyy): '

>-
a..
l!
i 0
I/ ()
'~ BRIAN E. THOMAS 13/Febl2015 NIA NIA -1
Cl
User/Installer Responsibilities w
:,
1( I
u:
'! Ith important to understand that the existence of this document alone docs not automatically _con,til~tc authority to install the aircraft cnginc/propcller/articlc. l-
a:
Where the user/installer performs work in accordanee with the national regulations of an airwnrthlness authority dillcrcnt than the airworthmess authorny ol the country specified in w
Block I, ii h essential that the user/installer cnsun~ that his/her airworthiness authority accepts n;:ihc(s)/propellcr(sYarticlc(,) from the alrworthlness authority of the country specified in ()
Block 1. w ,.
::J .,,.
I
Statements in Block.~ 13a and 14:i do 1101 constitute installation certification. In all eases, aircraft mai;n1c11ancr records musl contain an installation certification issued in accordance with the a:
i
/,, national rci:ulatiom b~ the u,cr/in~tall,r before the aircraft may b, flown, I I-
F,\,\ Forni !1130 ~ 102-14) NSN: 0052-00-012-9005
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T1 mnnr1 1
BATCH 7364182237 AWASt:IINGTON
02/05/16
.orrectors
Renton WA 98057
www.jkconnectors.com

I 11111111111111111111111111 1111111111111
l'nnl ua1e : an-~ - 6 Prinled By : JGC2 Print No. : 2

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I N.o. sosase .I
Ship To: (6] \_
For: Account No. (2911]

I Attn: SUE KAMAT

AVIALL CENTRAL WAREHOUSE
DALLAS CDC
2750 ~EGENT BLVD
Attn: SKIP READ
AVIALL
PO BOX 619408
DALLAS, TX 75354-9048
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DFW AIRPORT, TX 75261 UNITED STATES
UNITED STATES Tel.: 1-972-586-4705 I
Tel.: 1-972-856-1881 I
Fax: 1-972-586-1369 '
S.O.No. : 285465 Our Ref : Q251304 Domestic AWB ; : 660252523937
CustP.O. : 45375191 Your Ref : 45375191 lnt'IAWB ~:
Picked On : Jan-28-2016 Project : ITEM 1 O; LINE 0001 Origin :
Shipped On : Contract : Transport :
Ship Via : FEOEX GROUND Lie No. : Nationality
Freight : COLLECT Expires : Trip/Flight '.
Terms :NET30 '
-ship Via Acct. : FEDEX GROUND Account No. 12398!:i630 'I
-Our Contact : ALEX LEHNHOFF
,,I
_ _,__ -
_:___Lin~_ ---- ______ ,_P/N &,Description- . ----- -- _,,_ - - -Cno --- Order -- - -- o:-ship - -- Back-Order.:: - Packaging -
'c '

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1 23A02664-37=E5 FN 5.000 5.000 EA Qty. Back 0.00~)
Our P/N : 23A02664-37
CONDUIT-FAA-PMA 747SP, 747-100, -200, -300, -400 :
Ref#: ITEM 10; LINE 0001
MFG: (001147) SUNBANK i
LOT 119008 DC 1505 FT 20150252-01
HTS CODE: 8536.30.8000 ECCN: 9A991.d ORIGIN: Unitec States '
CERTIFICATE OF CONFORMANCE: IT IS HEREBY C ERTII IED THAT ALL Mi TERIALS
USED IN JHE QUANTITY CALLED FOR ON THE SUE JECT PURCHASE ORD! RCONFORMTO
THE MATERIAL AND/OR MANUFACTURING SPECIF CATIC 1NS AS CALLED F ::lRONSAID
PURCHASE ORDER AT THE'TIME OF MANUFACTUI ~-
RETURNS:ALL CLAIMS FOR ERROR, SHORTAGE 0 ~DAN AGE MUST BE M, DEWITHIN7
'
DAYS AFTER RECEIPT OF GOODS. PARTS MUST B ~RET WRNED WITHIN 1 1DAYS.OUR '
LIABILITY IS LIMITED TO REPAIR AND/OR REPLACE MENl OF THE PARTS l HIPPED.AN I

AUTHORIZED RM.A. NUMBER MUST ACCOMPANY N.LR TURNED GOOD' .

It, 11 ,1 '
Pick~~~ 171 <"J.c:;,,,,i{JJ
Steve McDonald, PRESIDENT
:
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i1 Supplier: Joslyn SUNBANK LLC Cage Code: 07418 ci
1 Fournisseur Esterline Group Statement number
1740 Commerce Way Nurnero de la dec1ala1ion
l PASO ROBLES 93446
32110000 pk106555. 2

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! Facility :
Etablissomenl
Joslyn SUNBANK LLC
Esterline Group
1710 Commerce Way
Cage Code: 07 418

Nurrber of pages(s)
PASO ROBLES 93446 Nombra do fcuilles(s)
!
i Customer: J 6 K CONNECTORS
,.l Client 1600 SW 43 RD STREET 100 STATEMENT OF CO~FORMITY
n
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RENTON 98057 (NF L 00-01 SC)
UNITED STATES OF AMERICA
I
DECLARATION DE CONFORMITE
Corrpany: j & K CONNECTORS (NF L 00-01 sc]
El,11Jlisscmen1 1600 SW 43 RD STREET 100
RENTON 98057 Nurrber and date of the picking list
Nurnero et date do la hsto de prolevem~nl
UNiTED STATES OF AMERICA
111111111111 lllll lllll lllll lllll llll llll I 02/02/2015
pk106555
Contract number : 231813 Acknow1edgrrent No: 210554 2
Numcro de conrrat N" d"accus6 r6ceplion

Sunbank Part Number I Article Sunbenk Rev

1111~1111111111111111 mi ~H 11~ mi 111111111111m 11111111111 ii nm 11111m B
23A02664-37-F04
Customer Part Numbe< / Artide a1e111
1111~111111 fflrnllll lllll lllll lllil Iii 11111111111m111111111
23A026(-37
Designatio11
Der1om,nu11or,

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1--- ------~o~o_u!~_A_s~~~s~_v _
i Serial or batch nurrber Quantity

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Observations :
Numero do serle ou 101 Ouantite
1505 119008 25

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:1
1 2
CERTIFIED ~IJE COPY
H~
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number designations Curren! Rcv,s,on or
Eleclroless Nrckel Per AMS-C-260/4 / ASTMB7J3-90
Cadmium Per /IMS rJO-P-416
ORIGINAL ( N FILE \
~\\! Passwation Per /\MS-00-P-3~

1! We nerebv cenily mnt ul' maronars pr.x.as,e~ anrl Iimshes used m rt,,~ na11:i1nr.1urc or uems shippad herein have been mspecteo and I or
I tested lo the materials
-
and/ or manufacturing specllicauons molcateo 1n crawmqs
or specittcauons as calleo for on me subjebl
purchase orn ~r
Physical. electrical and/ or che,nicul test reports arc on file. Ma1cnHI "sec rn tne manufacturing of Items <lo not contain tuncucnal mercury er
ozone depleting svbstances.A retum mercnanotse aumonzatrcn (RMI\) number will be required ror any merchandise returned lo lhis facility
!
Supplier Quality Manager/ Responsable QualitO Foumisseur
Name and title : Gary M. CARR - Director of Quality Assurance Signatures :
Norn el Foncuon

Date: 02/03/2015
Reserve a rorganisme de surveillance
Inspection body only /
Narre and title : Signatures :
Norn cl Fonclion

I Date: _
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SUNBANK Joslyn Sunbank Company. LLC

1740 Commerce Way
Pa~o Hoblr.s, CA 934413
DELIVERY NOTE : Page: 1
Tft_ 1805, ,:'Jt3~2BJP f..:;-p 1bO:), /]t,.:;.:,,i ~
Cage Code 07118
i Air-Dry Company of America. LLC
i Phono (805) 217-0-134
Caqe Code 01496
I 11111111111111111111111111111111111111111111~1111
! KC104309 \
I Customer K11810 Ship-T,o: K1181000
iH Our contact
Email
Joanne Smith
Contact at delivery Phb:
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805-238-2840
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Carrier
lnvoiceable Account
UPS BROWN
J & K CONNECTORS
1600 SW 43 RD STREET 100
RENTON 98057
I\ Transport Means : COLLECT
UNITED STATES OF AMERICA
ij Sales terms : FCA RENTON
!I Bon De Transport : 129767300358949350
SHIPPING CONTAINER
(4C) Release date: 02/03/2015
11111111111111111~11111111111111111111111111111111111111111
11 02/03/2015
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Nb Box: 1 Dim : L(0) xW(0I ~H(0) IN Vol: 0 13 Gross weight : I 44 K~ Net : 3 :1 l<G
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Our Order: 210554 Line: 2 Our Description : CONDUIT ASSEMBLY i
(K) Customer Order/Linc : 231813/2 (7Q} Quantity dellvered : 25

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25

i (P) Customer Part Number : 23A02661-37 PICKING LIST : PK1(16555

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l 23A02664-37 PK106555

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(1P) Our Part Number: 23A02664-3"1F04 ~!Y _!>ack1><EC< : _ -- U -- -- -

fl Inspection:
-lij.r---- -1-11rn~m11ij11111m1111111~1mm1~1111m1ij1111Rrn11m1111- Invoice:
1, 23A02664-37 -F04 Origin:

l! Commodity Code: 8536.30.8000 Origin: UNITED STATES OF AMERICA

!! Ship Acct#s
ij Fed X 0981-0192-6
I Confirming to Joslyn Sunbank Co. LLC I Airdry Co. of America LLC standard t
'\ erms & conditions only. Standard terms are Net 30, Terms subject to credit a
\. pproval; FOB shipping point Par.kaging to ASTM D 3951-82. Sunbank/Arrdry ass
i umes no responsibility for uninsured merchandise lost or damaged during ship
ment when ship':1ents are made FCAft Point of origin. All returns or adjustments

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must be made within ten ( 10) days a er receipt of shipment, Joslyn Sunbank
Co. LLC (""Sunbank'"') t Airdry Co. of America LLC (""ADC"") will not be res
ponsible for discrepancies in count after thirty days. Return merchandise au
lfj thorizalion number will be required for any merchandise returned to Joslyn S
unbank Co. LLC (cage code: 07418) / Airdry Co. Of Amenca LLC (cage code: 01
496). Items cited in this order are not eligible for installation on Type Ce ','1
rtified product for which eligibility has not been established. Visit www .su
I nbankcorp.com/termscor-d.mdex html for current FAA/PMA hsl1ng & Joslyn Sunb
I
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ank terms & Conditions.
DATE CODE MUST BE SUPPLIED ON THE PACK SLIP FOR EACH INDIVIDUAL PART
i These commodities, technology or software are governed by the Export Admlnis
Ifi
~
tratlon Regulations (15 CFR 730-774). Diversion contrary to U.S. law is proc-:1!!lt>ll\..,l"111l
hiblled. \EDlRUECOP
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ORIGINAL ON f
'' AVIALL-TRUE CERTIFIED COPY -11/10/2017-AEPLER- 7364182237
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 DELIVERY! NOTE : Page: 2
Esterline?:
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11111111111111111111111111111111111111111111111111
KC104309

lj These commodities, technology or software are exported from the United

II States of America in accordance with the export Administration Regulations.
11 Diversion contrary lo U.S. law 1s prohibited
'l No license required (NLR) for the export destlnanon spec1!:cc
ECCN/USML: 9A991.d
11

!1

END OF DOCUMENT

I
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CERT!f!ED TR~E COPY

ORiGH~Al O:N FILE
o.- dli/T .......,.. I -- ----_-
TIME:15:14:26
A Boeing subsldia,y DELIVERY NUMBER: 8005156377 EMP:00000000
I
Boeing PO #:4500057275 ROUTE: us DB Schenker 1 ORD TYP: ZOR 1-42
CUSTOMER PO:450044710 I CURRENCY:USD
ORDER NUMBER:1003579854 Shipped on behalf of Boeing Material Managemerff:RMS:Ne~r~nt:5002
ORDER DATE:10NOV17
-, I ,
S 1000 S 20020856 I F 20020856 .
H AVIALL CENTRAL WAREHOUSE H PT GARUDA MAINT FAGILITY AEROASIA O PT GARUDA MAINT FACILITY AEROASIA
I DALLAS CDC I BANDARA SOEKARNO HATIA R BANDARA SOEKARNO HATIA
P 2750 REGENT BLVD P MATERIAL DEPARTMENJT W MATERIAL DEPARTMENT
DFW AIRPORT TX 75261 GEDUNG MANAJEMEN GARUDA LANTAI 3 A GEDUNG MANAJEMEN GARUDA LANTAI 3
F USA T 19130 TANGERANG R 19130 TANGERANG
R 0 INDONESIA D INDONESIA
0
M T

-- -
0
ITEM ORDER SHIP QUANTITY
DESCRIPTION QUANTITY QUANTITY BACK ORDER UNIT PRICE EXTENDED UNIT PRICE
00010 E5 23A02664-37 , 1 1 0 EA 479.08 479.08
. CONDUIT:
ELECTRICAL;\!\f/FITIINGS
BATCH 7364182237 , 1
PARTS TOTAL 0.00
CURRENCY:USD

I
II
I
This is not a~ Invoice.
For payment processing, please
I
refer to Invoice.
These commodities, technology or software were exported from the United States in' accordance with the Export Administration Regulations. Diversion
contrary to U.S. law is prohibited. I - .
GERTI Fl CATE OF CON FOR MANCE I - DISCOUNT TERMS APPLY ONL y TO SUB TOTAL ALL
It is hereby certified that Aviall Services, Inc., Is an approved distnbutor and meets all requirements of ISO9001, AS9100, AS9120 and AC 00-56 at 2750 Regent Blvd. DFW Airport, Texas. The products, articles or RETURNED MERCHANDISE SUBJECT TO HANDLING
parts referenced on this document are in new or overhauled condmon and were purchased from an approved source (FAA, EASA, TCCA, Mil Spec or Commercial). The Onginal Manufacturers' Certifications are
maintained on file at our central office location, and copies are available upon request or at Aviall.com. For overhauled or repaired products, artides or parts, the original FAA 8130-3 / EASA Form 1 (Return to FEE.
Service) or Yellow Tag, from the FAAfJAA/EA SA approved Air Agency are attached to the component.
TI-US IS TO CERTIFY THAT AVIALL HAS COMPLIED WITH
THE PROVISIONS OF THE FAIR LABOR STANDARDS ACT
OF 1938 AMENDED.

~ CUSTOl\-1ER COPY
JR Hofmann, Director, Global Quality Date
,V18 RS-06
 .tH 11:a _- iil/D utJ.l!l!Jl1JISIT
TIME:15:14:26
A Boeing subsidiary
DELIVERY NUMBER:soos155377 EMP:00000000
Boeing PO #:4500057275 ORD TYP: ZOR 142
CUSTOMER PO:450044710
: ROUTE: us DB Schenker CURRENCY:USD
ORDER NUMBER:1003579854 Shipped on behalf of Boeing Material Managemerff:RMS:Ne~Y~nt:5002
I
ORDER DATE:10NOV17
'
s 1000 s 20020856 F 20020856
H AVIALL CENTRAL WAREHOUSE H PT GARUDA MAINT F.A;CILITY AEROASIA 0 PT GARUDA MAINT FACILITY AEROASIA
I DALLAS CDC I BANDARA SOEKARNO: HATIA R BANDARA SOEKARNO HATTA
p 2750 REGENT BLVD p MATERIAL DEPARTMENT W MATERIAL DEPARTMENT
DFW AIRPORT TX 75261 GEDUNG MANAJEMEN GARUDA LANTAI 3 A GEDUNG MANAJEMEN GARUDA LANTAI 3
F USA T 19130 TANGERANG '1 R 19130 TANGERANG
R 0 INDONESIA D INDONESIA
0
M T
0

This is not an Invoice.

For payment processing, please refer to Invoice.
These commodities, technology or software were exported from the United States in accordance with the Export Administration Regulations. Diversion
contrarv to U.S. law is orohibited. I
CERTIFICATE OF CONFORMANCE DISCOUNT TERMS APPLY ONLY TO SUB TOTAL ALL
It is hereby certified that Av1all Services, Inc., is an approved distributor and meets all requirements of ISO9001, AS9100, AS9120 and AC 00-56 al 2750 Regent Blvd DFW Airport, Texas. The products, artides or
parts referenced on this document are in new or overhauled condrtion and were purchased from an approved source (FAA, EASA, TCCA, Mil Spec or Commeraal) The Original Manufacturers' Certifications are RETURNED MERCHANDISE SUBJECT TO HANDLING
maintained on file at our central office location, and copies are ava1lalje upon request or at Aviall.com. For overhauled or repaired products, arudes or 'parts, the original FAA 8130-3 / EASA Form 1 (Return to FEE.
Service) or Yellow Tag, from the FA/1/JA/1/EASA approved Air Agency are attached to the component. \
THIS IS TO CERTIFY THAT AVIALL HAS COMPLIED WITH
' THE PROVISIONS OF THE FAIR LABOR STANDARDS ACT
OF 1938 AMENDED.

~ CUSTOMER COPY
,V18 RS-06 JR Hofmann, Director, Global Quality Date
 '-''-'111111~1 '-'IUI 111 Y '-'1'-'~

Page 1 of 1
The Boeing Company
100 North Riverside Plaza
Chicago, IL 60606

Ship From Location: Ultimate Consignee: Proof of Filing, exemption, exclusion

THE BOEING COMPANY PT GARUDA MAINT FACILITY AEROASIA
C/O AVIALL SERVICES INC BANDARA SOEKARNO HATTA :
ROUTED EXPORT TRANSACTION
AVIALL CENTRAL WAREHOUSE MATERIAL DEPARTMENT
2750 REGENT BL VD. GEDUNG MANAJEMEN GARUDA LANTAl 3 Forwarder:
DFW AIRPORT TX 75261 19130 TANGERANG
INDONESIA SCHENKER INC
I

Tracking Number: Shipment Number:

' 52248899 8005156377

Boeing SOC Call Center: 206-662-9615 Contact Name/Phone:
I
Sold To: Intermediate Consignee: I Date of Shipment: Proforma Number:
BOEING CO. MM PROGRAM 66(ICAT) PT GARUDA MAINT FACILITY AEROASIA
PO BOX 66716 BANDARA SOEKARNO HATTA Nov 10, 2017 9306462955
ST LOUIS MO 63166-6716 MATERIAL DEPARTMENT
GEDUNG MANAJEMEN GARUDA LANTAI 3' lncoterms & Named Place: Customs Declaration Number:
19130 TANGERANG I
INDONESIA EXW Shipping Point 7170232435

Total Number of Packages: Total Gross Weight (lbs.):

2.205
Contact Name/Phone: Contact Name/Phone:
Special Instructions :

' Customer -Delivery No. ' e~rt Nu~b~r and,D~criptio,n, . , "'i : Part? 1Part I' N~!.:. Gross;; coo US Export ,, ECCN ,'!; Hl'SC:t.
,-,, . Unit
,,
,Total '<;:
, '.i:,_80,J~umber<. ", ;,
'"i:'' ., :5:~nal ~mb,e[1;-. ,: . , 1,, ,' qtY,;; . UoM .Wt. ..,
',,
. ;yvt., ~. ',::: Apihority .
,'
'lt '
,,, ,i -,Nu~b~, J
; Price
: ,- ~-.- 1 Value .,

23A02664-37 - CONDUIT: ELECTRICAL,W/

450044710 8005156377 FITIINGS
1 EA 1 1 us NLRAT 9A991.d 8803300010 $479.08 $479.08
I

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I Total Invoice Value: I $479.08

These items are controlled by the U.S. Government and authorized for export only to the country of ultimate destination for use by the ultimate consignee or end user(s) here in identified. They may not be resold,
transferred, or otherwise disposed of, to any other country or to any person other than the authorized ultimate, consignee or end-user(s), either in their original form or after being incorporated into other items,
without first obtaining approval from the U.S. government or as otherwise authorized by U.S. law and regulations.
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Shlppe(s Name and Address
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Shippe~'sAccountNumber "'ll NotNegotlable
Air Waybill
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-5487_
,4621_

AVIALL SERVICES INC

2750 REGENT BLVD
DALLAS TX 75261 US
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lssued By s2- 0UElSWr, cATHA:i:-!"!'!'l:: 1Fic AIRWAYs LIMITED
33TH FLOOR, ONE PACIFIC PLACE.
HONG KONG

972586100q
Copies 1, 2 a_nd 3 of;thi~ Air Waybill are orig{na1s and tiave the s~me validity,

Consignee's Name and Address Conignee'a Aocour~t Number It is agreed that the goods descnoed herein are accepted in apparent good order and condition
L
PT' GARUDA MAINTENANCE FACILITY
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(exc_ept as noted) fo,:.carriage SUBJECT TO THE CONDfflONS OF CONTRACT ON THE .
REVE~~E HEREOF. ALL ,GPQQS MAY !3E CARRIED B)' ANY OTHER MEANS INCLUDING .
ROAD OR ANY OTHER CARRIER UNLESS SPECIFIC CONTRARY INSTRUCTIONS ARE
GEDUNG MANAJEMEN GARUDA LANTAI 3 GIVEN HEREON BY THE SHIPPER, AND SHIPPER AGREES ,THAT THE SHIPMENT MAY
TANGERANG INDONES ID ; BE CARRIED VfA INTERMEDl~TE STOPPING P.LACES WHICH THE CARRIER'DEEMS
' APPROl'RIATE. THE SHIPP ER'S ATIENTIO N IS DRAWN :ro THE NOTICE CONGER NING
CARRIER'~ll.lMITATIQN Of LIABILITY. Shipper may increa~!" suchsrn ltatlcnol liability by
declarin? a higher value for carnage and paying a supplemental charge ff required. .

lssuingCarrie(s Agent Name and City

SCHENKER INTERNATIONAL INC. I
WEST AIRFI~LD DRI
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Agent's IATACode I Account No. '\
33~4477/Ql64 411214 \
Airpo!1 of De~e (Addr. of,First Cam~r) and_Re~u~st~d Rquting :l t<etereoceNum_oer\' /')~ OdlonalShinnrnnfnfonnatlo~f /

DALLAS FORT WQRT_H ' I \.'v,(;1~

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. To. By_FirstCamer~ "'"~"'""'"'"'atn / to .. by to ~Y1 Currenoy'JCHosl WTNALI ''1l!her :0~~yaIuef~t\niage Decla,:ooValuefor.Customs
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00
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,Alrpor:t of Destinabon '. I CGK
Flight/Date."'- '""'"'"""_0'"
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Amount of lnsuranca -,1
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INSURANCE~ IICerrieioffers irsurance andsich lmuranceil
.-,

."CENGKAREN G . ,_CX071/.14. I _ CX777/16\_

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' requested In a:cori:tarlie withcondllons on re\ef5 8 ttereof lndi:a!e
8!11DUntlobelro~redln!gu~lnlx1(ma~ed"Amourloflnsurance..

Handling_ lnfoonatio~ SPX 450044 'i oa..

450044.53,2. 450044695. 4,SO_D42250 . 4500_43902. 450044,710." 80_051,59565 :. 9306.
4/;JqB7. -80051!?1700. 9306,491588. 8005156786. 93064 N,FY PT. SCHENKE)l. PETROLOG._UTJ\t-!A ,SOEWARNA. BUSINE
-SS PARK KAV J ",LOT-. 1 JAKARTA 19110 ID TE 622155912_79~ ~---!,- _C--~--'-l
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No.of -Rate ,/ -. Naiui-e and Quantity of Goods

. Gross k\ .. - .Commodity Ch_arg-eable
-. -Pieces _/charge Total _(inct Dimensions ~rVo(ume)
Weight lb ltem No. .W~ight
RCP-
9 19.0 .. K M . 19.0 ?o_a .. oo

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soo .oo.
Valu.tlon Chame /
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1--7 NOV 2017
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Tatar other Charoes Due Anent !.

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,C/f) /lJ ji\\,1p~{ij!tj;ll!I that the p ~lc~la15 on the !Ille hereof areco:~!lfa
CO~ CONTAI S DAN:lEROUS GOODS,,SUCH ~ ITT
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~ PROPERCONDnlON F ~ CARRIA GE BY AIRACCORDING .
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s11lna~re of6h10Der"or
Total Prenaid Total Colloct "/
'
500.00
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I'\. Cu Come rslon Rates / , cc Chames In Oest CUrrem.i / CATHAY-PACIFIC ~IR~AYS L~MITED
.ll, !'<0.'l .201.7 . D.FW

For Camel's lke Orn/ ' Charoes Bl Destination /

Execded oo (Date)
'~~"= 01a=1=
co=ne<1
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I at (Place) Signcf.ure of lssulrg Canter or is Agent

160-54874621
al Des tin'atlon