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. OMB 2120-0014 02/28/2009 STATION FACILITY MAINTENANCE LOG DATE DATE SUBJECT OF LOG TIME CODE (24 HOURS) SIGNATURE OF SECTOR MANAGER/DESIGNEE FAA Form 6030-1 (10/70) Formerly FAA form 406C Electronic Version (Adobe) MONTH AND YEAR REMARKS DATE INI TIALS SIGNATURE OF MAINTENANCE TECHNICIAN NSN: 0052-00-028-5001 American LegalNet, Inc. www.FormsWorkflow.com