Total 100% SMALL BUSINESS SET-ASIDE FOR Preventative Maintenance and Repair Services for Hoisting/Lifting Equipment

ALL INSPECTIONS AND EQUIPMENT CONDITIONS RECORDED ON THIS FORM HAVE BEEN DETERMINED IN ACCORDANCE WITH DIAGNOSTIC PROCEDURES AND STANDARDS IN THE TM CITED HEREON. EQUIPMENT INSPECTION AND MAINTENANCE WORKSHEET For use of this form, see DA PAM 750-8; the proponent agency is DCS, G-4. HOT STARTS d. b. HOURS ROUNDS FIRED c. 10. 9a. SIGNATURE 3. REGISTRATION/SERIAL/NSN 1. ORGANIZATION 2. NOMENCLATURE AND MODEL 5. DATE 6. TYPE INSPECTION APPLICABLE REFERENCE 7. TM NUMBER TM DATE TM NUMBER TM DATE COLUMN a COLUMN b COLUMN c Enter TM item number. Enter the applicable condition status symbol. Enter deficiencies and shortcomings. COLUMN d shortcoming listed in Column c. Show corrective action for deficiency or STATUS SYMBOLS COLUMN e action initial in this column. Individual ascertaining completed corrective Indicates a deficiency in the equipment that places "X" it in an inoperable status. Indicates a deficiency, however, the CIRCLED "X" Indicates that a required HORIZONTAL DASH "(-)" Indicates a material defect other DIAGONAL "(/)" LAST NAME INITIAL IN BLACK, BLUE-BLACK INK, FOR AIRCRAFT - Status symbols will be recorded in red. (Maintenance Supervisor) MANHOURS REQUIRED TM ITEM NO. a STATUS b DEFICIENCIES AND SHORTCOMINGS c INITIAL WHEN CORRECTED e CORRECTIVE ACTION d DA FORM 2404, FEB 2011 PREVIOUS EDITIONS ARE OBSOLETE. APD LC v1.00ES 4a. MILES 8b. TIME 9b. TIME 8a. SIGNATURE (Person(s) performing inspection) equipment may be operated under specific limitations as directed by higher authority or as prescribed locally, until corrective action can be accomplished. inspection, component replacement, maintenance operation check, or test flight is due but has not been accomplished, or an overdue MWO has not been accomplished. OR PENCIL - Indicates that a completely satisfactory condition exists. than a deficiency which must be corrected to increase efficiency or to make the item completely serviceable. -- 1 of 2 -- DEFICIENCIES AND SHORTCOMINGS TM ITEM NO. a STATUS b c INITIAL WHEN CORRECTED e CORRECTIVE ACTION d DA FORM 2404, FEB 2011 APD LC v1.00ES -- 2 of 2 --