Free Facility Maintenance Log - Federal

Paperwork Reduction Act Statement: This form requires that the sponsor fill out this log, which is a permanent record of all equipment malfunctions, including adjustments made and causes of failures. These logs are kept for all the facilities in the system and take about .5 hours to complete each month for a total of 6 hours per facility per year. Completion of this form is mandatory. An agency may not conduct or sponsor and a person is not required to respond to a collection of information unless it displays a currently valid OMB number. The OMB number associated with this collection is 2120-0014. Comments concerning the accuracy of this burden and suggestions for reducing the burden should be directed to the FAA at: 800 Independence Ave SW, Washington, DC 20591, Attn: Information Collection Clearance Officer, ABA 20. STATION

FACILITY MAINTENANCE LOG

OMB 2120-0014 02/28/2009
MONTH AND YEAR

SUBJECT OF LOG

DATE

TIME CODE (24 HOURS)

REMARKS

INITIALS

DATE

SIGNATURE OF SECTOR MANAGER/DESIGNEE

DATE

SIGNATURE OF MAINTENANCE TECHNICIAN

FAA Form 6030-1 (10/70) Formerly FAA form 406C Electronic Version (Adobe)

NSN: 0052-00-028-5001