5010-5 Airport Master Record (Newly established private use air

FORM APPROVED OMB 2120-0015
1/31/2012

AIRPORT MASTER RECORD

U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL AVIATION ADMINISTRATION

>1 ASSOC. CITY:
>2 AIRPORT NAME:
3 CBD TO AIRPORT (NM):

4. STATE:

LOC ID:
5 COUNTY:
7 SECT AERO CHT:

6 REGION/ADO:

GENERAL

FAA SITE NR:

BASED AIRCRAFT

SERVICES

90 SINGLE ENG:
91 MULTI ENG:
92 JET:
TOTAL

>70 FUEL:

10 OWNERSHIP:
11 OWNER:
12 ADDRESS:

93 HELICOPTERS:
94 GLIDERS:
95 MILITARY:
96 ULTRA-LIGHT:

13 PHONE NR:
14 MANAGER:
15 ADDRESS:
16 PHONE NR:
17 ATTENDANCE SCHEDULE:
MONTHS
DAYS

FACILITIES

HOURS

>80 ARPT BCN:
>81 ARPT LGT SKED:
>82 UNICOM:
83 WIND INDICATOR:
84 SEGMENTED CIRCLE:
85 CONTROL TWR:
86 FSS:
87 FSS ON ARPT:
88 FSS PHONE NR:
89 TOLL FREE NR:

18 AIRPORT USE:
19 ARPT LAT:
20 ARPT LON:
21 ARPT ELEV:
22 ACREAGE:
>23 RIGHT TRAFFIC:
24 NON-COMM LANDING:

RUNWAY DATA
>30 RUNWAY IDENT:
>31 LENGTH:
>32 WIDTH:
33 SURF TYPE-COND:

LIGHTING/APCH AIDS
>40 EDGE INTENSITY:
>42 RWY MARK TYPE-COND:

OBSTRUCTION DATA
50 PART 77 CATEGORY:
51 DISPLACED THLD:
52 CTLG OBSTN:
53 OBSTN MARKED/LGTD:
54 HGT ABOVE RWY END:
55 DIST FROM RWY END:

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(>) ARPT MGR PLEASE ADVISE FSS IN ITEM 86 WHEN CHANGES OCCUR TO ITEMS PRECEDED BY>
>1 I 0 REMARKS:

111 OWNER/MANAGER SIGNATURE
FAA Form 5010-5 (4/96) SUPERSEDES PREVIOUS EDITION

113 DATE:
NSN: 0052-00-845-3003

Note:
The intent of this form is to notify the FAA that the landing area on the reverse side is now operational. Please complete the form
and return it to the FAA Regional Office or Airports District Office that airspaced the landing area when the landing area is fully
operational. Contact the office if you have any questions regarding this form.

Paperwork Reduction Act Statement:
The information collected on this form is necessary because it is the description of the physical and operational characteristics of
the airport that will be on file with the FAA. The information will be maintained in FAA computers for record keeping purposes and
use in airspace studies. Some of the information on this form is critical to aviation safety and will be published in flight information
handbooks and charts for pilot use. The burden associated with completing this form is estimated to be 2 hours. Providing this
information is mandatory if the proponent wishes to have the airport on file with the FAA and entered into the National Airspace
System. No assurances of confidentiality are given. 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 control number. The OMB control number associated
with this collection is 2120-0015.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, AES-200

TO MAIL THE COMPLETED FORM:

1. Reverse fold the form so that the address is on the outside.
2. After folding, fasten the folded form together with a piece of tape at the place marked ''Tape Here''.
3. No postage is required for mailing.

FAA Form 5010-5 (4-96) SUPERSEDES PREVIOUS EDITION

U.S. Department of Transportation
Federal Aviation Administration

NO POSTAGE
NECESSARY
IF MAILED
IN THE
UNITED STATES

Washington D.C. 20591

OFFICIAL BUSINESS
PENALTY FOR PRIVATE USE $300

BUSINESS REPLY MAIL
FIRST CLASS

PERMIT NO. 12438

WASHINGTON. D.C.

POSTAGE WILL BE PAID BY THE FEDERAL AVIATION ADMINISTRATION

PLACE ADDRESS LABEL HERE

Tape

Here