Form FAA-6030-1 Facility Maintenance Log 1

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. A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to
comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control Number.
The OMB Control Number for this information collection is 2120-0014. Public reporting for this collection of information is estimated to be approximately 30 minutes per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, completing and reviewing the collection of information. All
responses to this collection of information are mandatory under FAR Part 171. 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.
STATION
OMB

FACILITY MAINTENANCE LOG

DATE

DATE

2120-0014
04/30/2012
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