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Attributes | |
ACN | 494673 |
Time | |
Date | 200012 |
Day | Thu |
Local Time Of Day | 0001 To 0600 |
Place | |
Locale Reference | airport : zzz.airport |
State Reference | US |
Altitude | agl single value : 0 |
Environment | |
Light | Night |
Aircraft 1 | |
Controlling Facilities | tower : sfo.tower |
Operator | common carrier : air carrier |
Make Model Name | B737-300 |
Operating Under FAR Part | Part 121 |
Flight Phase | ground : parked ground : maintenance |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | maintenance : technician |
Qualification | technician : airframe technician : powerplant |
Experience | maintenance technician : 3 |
ASRS Report | 494673 |
Person 2 | |
Affiliation | company : air carrier |
Function | oversight : supervisor |
Qualification | technician : airframe technician : powerplant |
Events | |
Anomaly | aircraft equipment problem : critical maintenance problem : improper documentation maintenance problem : improper maintenance non adherence : published procedure |
Independent Detector | other other : person 1 |
Resolutory Action | none taken : detected after the fact |
Consequence | other |
Factors | |
Maintenance | contributing factor : engineering procedure contributing factor : manuals performance deficiency : scheduled maintenance |
Supplementary | |
Problem Areas | Maintenance Human Performance Company Chart Or Publication Aircraft |
Primary Problem | Chart Or Publication |
Narrative:
Upon accomplishing engineering change order modification #xbca, part 1, step 3, on dec/xa/00 on aircraft xyz, the auxiliary tank was improperly deactivated. I called maintenance control because of differences on my engineering change order. They did not find any information to assist me, but we agreed that the intent of the engineer change order was to assure the auxiliary tank would not accept fuel. I called the fuelers out and verified that no fuel would enter the auxiliary tank. On dec/xb/00 I researched the system and found that I had followed the procedures (maintenance manual pats auxiliary tank maintenance 28-01-00 P201 step 2B) for the wrong aircraft effectivity, step 20 was the proper effectivity for aircraft xyz. I immediately contacted maintenance control (dxvo wxxz) and he followed the channels to have the aircraft brought into maintenance to assure the proper procedures were accomplished. There was an effectivity issue within an effectivity issue that I and maintenance control overlooked. The system was effectively deactivated but not by the maintenance manual 28-01-00.
Original NASA ASRS Text
Title: A B737-300 WAS DISPATCHED IN NON COMPLIANCE WITH AN ENGINEERING ORDER TO DEACTIVATE THE AUX FUEL TANK BUT WAS ACCOMPLISHED WITH WRONG MAINT MANUAL EFFECTIVITY.
Narrative: UPON ACCOMPLISHING ENGINEERING CHANGE ORDER MODIFICATION #XBCA, PART 1, STEP 3, ON DEC/XA/00 ON ACFT XYZ, THE AUX TANK WAS IMPROPERLY DEACTIVATED. I CALLED MAINT CTL BECAUSE OF DIFFERENCES ON MY ENGINEERING CHANGE ORDER. THEY DID NOT FIND ANY INFO TO ASSIST ME, BUT WE AGREED THAT THE INTENT OF THE ENGINEER CHANGE ORDER WAS TO ASSURE THE AUX TANK WOULD NOT ACCEPT FUEL. I CALLED THE FUELERS OUT AND VERIFIED THAT NO FUEL WOULD ENTER THE AUX TANK. ON DEC/XB/00 I RESEARCHED THE SYS AND FOUND THAT I HAD FOLLOWED THE PROCS (MAINT MANUAL PATS AUX TANK MAINT 28-01-00 P201 STEP 2B) FOR THE WRONG ACFT EFFECTIVITY, STEP 20 WAS THE PROPER EFFECTIVITY FOR ACFT XYZ. I IMMEDIATELY CONTACTED MAINT CTL (DXVO WXXZ) AND HE FOLLOWED THE CHANNELS TO HAVE THE ACFT BROUGHT INTO MAINT TO ASSURE THE PROPER PROCS WERE ACCOMPLISHED. THERE WAS AN EFFECTIVITY ISSUE WITHIN AN EFFECTIVITY ISSUE THAT I AND MAINT CTL OVERLOOKED. THE SYS WAS EFFECTIVELY DEACTIVATED BUT NOT BY THE MAINT MANUAL 28-01-00.
Data retrieved from NASA's ASRS site as of July 2007 and automatically converted to unabbreviated mixed upper/lowercase text. This report is for informational purposes with no guarantee of accuracy. See NASA's ASRS site for official report.