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[null,"FS-5700-21a, Part 1 (03/2008)"]
[null,"OMB 0596-0015 (Omission of Exp. date approved by OMB)"]
[null,"USDA - Forest Service",{"$nulls":15},"1. Contract/Rental Agreement No."]
[]
[null,"HELICOPTER DATA RECORD",{"$nulls":15},"2. Item No."]
[]
[{"$nulls":17},"3. Designated Base"]
[]
[null,"(Reference FSH 5709.16)",{"$nulls":15},"4. Region/Area"]
[]
[null,"SECTION I - Operator & Aircraft Information (Fill in Blanks)"]
[null,"1. Operator",{"$nulls":11},"2. Address (Street, City, State & ZIP Code)"]
[]
[null,"3. Phone No.",{"$nulls":5},"4. Make and Model",{"$nulls":6},"5. FAA Registration No.",{"$nulls":7},"6. Manufacturer's Serial No.",{"$nulls":8},"7. Hobbs Reading"]
[]
[null,"8. Max Gross Weight",{"$nulls":6},"9. Max Gross Weight",{"$nulls":7},"10. No. of Passengers",{"$nulls":7},"11. Type Fuel",{"$nulls":5},"12. Fuel Flow (Cruise)"]
[null,"(Internal)",{"$nulls":6},"(External)",{"$nulls":15}," ",{"$nulls":10}," "]
[null,"FOR EMPTY WEIGHT SEE CURRENT WEIGHT AND BALANCE DATA"]
[null,"13. Authorized Uses (Initial appropriate boxes)",{"$nulls":13}," ",null,"Expires (Fill in the Blank)",{"$nulls":10},"1900-12-31"]
[{"$nulls":4},"(Line Through Unapproved Uses)"]
[null,"a.",null,"Passenger & Cargo",{"$nulls":9},"h.",null,"Fire Suppression - Interagency",{"$nulls":9},"o.",null,"Approved Left Seat Ops"]
[null,"b.",null,"Low Level Reconnaissance",{"$nulls":9},"i.",null,"Fire Suppression - Local",{"$nulls":9},"p.",null,"Approved MEL (MMEL Rev No.",{"$nulls":9},")(D95)"]
[null,"c.",null,"Cargo Only (Restricted Category)",{"$nulls":9},"j.",null,"Water/Retardant Bucket",{"$nulls":9},"q.",null,"Other",null," "]
[null,"d.",null,"External Load (Sling)",{"$nulls":9},"k.",null,"Fixed Tank",null,null,null,"Tanker No.(",null,null," ",null,")","r",null,"Other",null," "]
[null,"e.",null,"Rappelling",{"$nulls":9},"l.",null,"Longline/Remote Hook",{"$nulls":9},"s.",null,"Other",null," "]
[null,"f.",null,"Aerial Ignition",{"$nulls":9},"m.",null,"Rapid Refuel",{"$nulls":4},"CCR",null,null,"Splash",null,"t.",null,"Other",null," "]
[null,"g.",null,"Manager May Ride (Type 1 Only)",{"$nulls":9},"n.",null,"Air Attack",null,null,null,"Type(",null," ",null,")",null,"u.",null,"Other",null," "]
[]
[null,"14. Approved By (Signature)",{"$nulls":11},"15. Title",{"$nulls":10},"16. Region",{"$nulls":6},"17. Date"]
[{"$nulls":13},"Aircraft Inspector"]
[null,"SECTION II - Airframe Information (Fill in the Blanks)",{"$nulls":18},"SECTION III - Engine Information (Fill in the Blank)"]
[null," 1. Total Airframe Time",{"$nulls":18},"1. Make & Model"]
[null," 2. Date of Last Annual/ Complete Phase Inspection",{"$nulls":18},"2. Total Time",{"$nulls":7},"#1",{"$nulls":4},"#2"]
[null," 3. Last Inspection Type",{"$nulls":10},"Time:",{"$nulls":7},"3. Hours Since New or O/H",{"$nulls":7},"#1",{"$nulls":4},"#2"]
[null," 4. On \"Approved\" Maintenance Program**",{"$nulls":20},"TBO",{"$nulls":7},"HSI"]
[null,null,"(AAIP approved in Ops Spec D73)",{"$nulls":19},"(Ops Spec D102)"]
[null," 5. Airworthiness & Registration",{"$nulls":18},"4. Hours Since HSI",{"$nulls":7},"#1",{"$nulls":4},"#2"]
[null," 6. Date of Last Actual Weighing (24 Months **)",{"$nulls":18},"5. Maintenance Records",{"$nulls":7},"#1",{"$nulls":4},"#2"]
[null,null,"Equipped Weight",{"$nulls":8},"Bid Weight"]
[null," 7. Flight Manual Rev No.",{"$nulls":10},"Date:",{"$nulls":7},"SECTION IV - Operating Certificates (Fill in the Blanks)"]
[null," 8. Time Change, S/B  & AD Listing **",{"$nulls":18},"1. 14 CFR 133 Certificate No."]
[null," 9. Maintenance Records",{"$nulls":20},"Expiration Date"]
[null,"10. Flight Instruments (Condition)",{"$nulls":18},"2. 14 CFR 135 Certificate No.**"]
[null,"11. Engine Instruments (Condition)",{"$nulls":18},"3. 14 CFR 137 Certificate No."]
[null,"SECTION V - Equipment (X appropriate boxes)"]
[{"$nulls":15},"Satisfactory",{"$nulls":19},"Satisfactory"]
[{"$nulls":15},"Yes",null,"No",{"$nulls":17},"Yes",null,"No"]
[null," 1. Hobbs Installation  **",{"$nulls":17},"13. Cargo Hook **(Last Inspected",{"$nulls":13},")"]
[null," 2. Free Air Temperature Gauge  **",{"$nulls":18},"Keeperless Hook"]
[null," 3. Seat Belt (All)  **",{"$nulls":17},"14. Personnel Access Step  **"]
[null," 4. Shoulder Harness (All after 01/01/06)  **",{"$nulls":17},"15. Water/Retardant Bucket  **",{"$nulls":9},"(** Either 16 or 17)"]
[null," 5. First Aid Kit  **",{"$nulls":19},"Type",{"$nulls":6},"Gallons"]
[null," 6. Survival Kit  **",{"$nulls":17},"16. Fixed Retardant Tank  **"]
[null," 7. Dual Control (For Pilot Check)  **",{"$nulls":19},"Type",{"$nulls":6},"Gallons"]
[null," 8. Lighting - Night Operation  **",{"$nulls":17},"17. Bucket/Door SW on Collective  **"]
[null," 9. High Visibility Marking Main Rotor  **",{"$nulls":17},"18. Long-Line - Remote Hook"]
[null,"10. Extended Height Gear  **",{"$nulls":19},"(Last Inspected",{"$nulls":10},")"]
[null,"11. Convex Mirror  **",{"$nulls":17},"19. Closed Circuit Refueling"]
[null,"12. Locking Fuel Cap",{"$nulls":17},"20. Defuel Capability"]
[null,"** Required for Interagency Fire",{"$nulls":17},"21. Rappel Anchor (Last Inspected",{"$nulls":14},")"]
[null,null,"N Number",null,null,null,0,{"$nulls":4},"Make & Model",{"$nulls":4},0,{"$nulls":5},"Inspection Date:",{"$nulls":4},"00:00:00"]
[]
[null,"FS-5700-21a, Part 1 (03/2008)"]
[null,"OMB 0596-0015 (Omission of Exp. date approved by OMB)"]
[null,"SECTION V (Continued) - Equipment (X appropriate boxes)"]
[{"$nulls":17},"Satisfactory",{"$nulls":17},"Satisfactory"]
[{"$nulls":17},"Yes",null,"No",{"$nulls":15},"Yes",null,"No"]
[null,"22. Fire Extinguisher **",{"$nulls":19},"36. HAZMAT Book (w/CurrentExemption Letter)"]
[null,"25. Baggage Compartment or Cargo Racks  **",{"$nulls":19},"37. Procurement Document in aircraft"]
[null,"26. Baggage Compartment Mod.",{"$nulls":19},"38. Security Devices"]
[null,"28. Particle Separator/Air Flitration System",{"$nulls":20},"1."]
[null,"33. Wire Cutter Kit",{"$nulls":20},"2."]
[null,"34. White Strobe  **",{"$nulls":20},"3. Incorporated into preflight checklist"]
[null,"34. Conspicuity/Pulse Lights",{"$nulls":19},"39. Public Address/Siren System"]
[null,"35. Ops Specs/Operations Manual in aircraft",{"$nulls":19},"40. Other"]
[null,"** Required for Interagency Fire",{"$nulls":19},"41. Other"]
[]
[null,"SECTION VI - Service Truck (X appropriate boxes)"]
[{"$nulls":17},"Yes",null,"No",{"$nulls":15},"Yes",null,"No"]
[null," 1. Capacity**",{"$nulls":9},"U.S. Gallons",{"$nulls":9},"13. Fuel Hoses (Approved Type)**"]
[null," 2. Type Truck",{"$nulls":19},"14. Mechanized Reel"]
[null," 3. License No.",{"$nulls":19},"15. Ground & Bonding Cables  **"]
[null," 4. Condition",{"$nulls":19},"16. Fuel Filtering System  **"]
[null," 5. Fire Extinguishers (2 each 20-B,C) **",{"$nulls":19},"17. Date Filter Changed **"]
[null," 6. Placarded - 49 CFR 172  **",{"$nulls":19},"18. Spare Filters  **"]
[null," 7. Marked w/Type Fuel - 3 Inch Letters **",{"$nulls":19},"19. Gas Engine Protection"]
[null," 8. No Smoking Signs - 3 Inch Letters **",{"$nulls":19},"20. FM Radio"]
[null," 9. Sump & Drain **",{"$nulls":19},"21. Spill Kit **    (",{"$nulls":7},")Gallons Minimum"]
[null,"10. Fuel Meters **",{"$nulls":19},"22. Filter Manufacturer's Manual"]
[null,"11. Differential Pressure Gauge(s)",{"$nulls":19},"23. Record for recording sump draining  **"]
[null,"12. Nozzle Screen/Dust Cap **",{"$nulls":19},"24. Cell phone for FSV Driver"]
[null,"13. Deadman Control (Required for CCR)",{"$nulls":19},"24. Other"]
[]
[null,"SECTION VII - Avionics (X appropriate boxes or Annotate N/A for items Not Required)"]
[{"$nulls":17},"Pass",null,"Fail",{"$nulls":15},"Pass",null,"Fail"]
[null," 1. ELT - Battery Due Date",{"$nulls":7},"(",{"$nulls":6},")",{"$nulls":4},"19. Audio Controls ** (No.",{"$nulls":12},")"]
[null," 2. ELT 91.207 Complied With",{"$nulls":19},"20. Transmitter Selectors"]
[null," 3. ELT TSO# **",{"$nulls":5},"91a",null,null,126,{"$nulls":10},"21. Receiver Selectors"]
[null," 4. #1 VHF-AM Comm. Transceiver  **",{"$nulls":10},720,null,null,760,{"$nulls":5},"22. Microphone/Drop Cords (U-92A/U**)"]
[null," 5. #2 VHF-AM Comm. Transceiver",{"$nulls":10},720,null,null,760,{"$nulls":5},"23. Transceiver PTT"]
[null," 6. #1 VHF-FM Comm. Transceiver  **",{"$nulls":9},"(Type",{"$nulls":4},")",{"$nulls":4},"24. Rappel Audio Control & Drop Cord"]
[null," 7. #2 VHF-FM Comm. Transceiver",{"$nulls":9},"(Type",{"$nulls":4},")",{"$nulls":4},"25. ICS Hot Mic/VOX (Pilot/Copilot **)"]
[null," 8. Aux FM Provisions  **",{"$nulls":19},"26. ICS PTT  **"]
[null," 9. GPS (Panel Mounted ** / Handheld)",{"$nulls":15}," ",null," ",null,"27. Rear Seat PTT (2 Aft Cabin Exits **)"]
[null,null,null,"(Mark IFR / VFR as applicable)",{"$nulls":13}," ",null," ",null,null,null,"------------------------"]
[null,"10. GPS Database (Expiration Date",{"$nulls":14},")",{"$nulls":4},"28. Avionics Placarding"]
[null,"11. Transponder **(Per 91.413) (Due",{"$nulls":14},")",{"$nulls":4},"29. General Condition"]
[null,"12. Altimeter/Static** (Per 91.411)(Due Date",{"$nulls":14},")",{"$nulls":4},"30. Avionics Records, Diagrams & Schematics"]
[null,"13. Magnetic Compass Placard ",{"$nulls":19},"31. Accessory Power (3 Pin)  **"]
[null,"14. TCAS/TCAD",{"$nulls":19},"32. Cargo Hook Connector (9 pin)  **"]
[null,"15. Automated Flight Following System",{"$nulls":19},"33. Other"]
[null,"16. Verify AFF Operational",{"$nulls":19},"34. Other"]
[null,"17. Additional GPS Antenna",{"$nulls":19},"35. Other"]
[null,"18. GPS Dataport",{"$nulls":19},"36. Other"]
[null,"17. Other",{"$nulls":19},"37. Avionics Inspection Completed By:"]
[null,"18. Other",{"$nulls":19},"   "]
[null,"** Required for Interagency Fire"]
[]
[null,null,"Notes/Discrepancies:"]
[]
[]
[]
[]
[null,"SECTION VIII - (Forest Service Inspector Use Ony)"]
[]
[null,null,"Card Issue Date:",{"$nulls":8},"Fed Resources Database Updated",{"$nulls":14},"Copy filed with Contract and/or CO"]

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[null,"FS-5700-21a, Part 2 (03/2008)"]
[null,"OMB 0596-0015 (Omission of Exp. date approved by OMB)"]
[null,"USDA - Forest Service",{"$nulls":15},"1. Contract/Rental Agreement No.",{"$nulls":9},0]
[{"$nulls":27},0]
[null,"INTERAGENCY FIRE",{"$nulls":15},"2. Item No.",{"$nulls":9},0]
[{"$nulls":27},0]
[null,"HELICOPTER DATA RECORD",{"$nulls":15},"3. Designated Base",{"$nulls":9},0]
[{"$nulls":27},0]
[null,"(Reference FSH 5709.16)",{"$nulls":15},"4. Region/Area",{"$nulls":9},0]
[{"$nulls":27},0]
[null,"SECTION I - Operator & Aircraft Information (Fill in Blanks)"]
[null,"1. Operator",{"$nulls":11},"2. Address (Street, City, State & ZIP Code)"]
[null,0,{"$nulls":11},0]
[null,"3. Phone No.",{"$nulls":5},"4. Make and Model",{"$nulls":6},"5. FAA Registration No.",{"$nulls":7},"6. Manufacturer's Serial No.",{"$nulls":8},"7. Hobbs Reading"]
[null,0,{"$nulls":5},0,{"$nulls":6},0,{"$nulls":7},0,{"$nulls":8},0]
[null,"8. Max Gross Weight",{"$nulls":6},"9. Max Gross Weight",{"$nulls":7},"10. No. of Passengers",{"$nulls":7},"11. Type Fuel",{"$nulls":5},"12. Fuel Flow (Cruise)"]
[null,"(Internal)",null,null,0,null,null,null,"(External)",null,null,0,{"$nulls":4},0,{"$nulls":7}," ",{"$nulls":5},0]
[null,"FOR EMPTY WEIGHT SEE CURRENT WEIGHT AND BALANCE DATA"]
[null,"13. Authorized Uses (Initial appropriate boxes)",{"$nulls":15},"Expires (Fill in the Blank)",{"$nulls":10},"1900-12-30"]
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[null,"g.",null,"Manager May Ride (Type 1 Only)",{"$nulls":9},"n.",null,"Air Attack",null,null,null,"Type(",null," ",null,")",null,"u.",null,"Other",null," "]
[]
[null,"14. Approved By (Signature)",{"$nulls":11},"15. Title",{"$nulls":10},"16. Region",{"$nulls":6},"17. Date"]
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[null,"FS-5700-21a, Part 3 (03/2008)"]
[null,"OMB 0596-0015 (Omission of Exp. date approved by OMB)"]
[null,"USDA - Forest Service",{"$nulls":15},"1. Contract/Rental Agreement No.",{"$nulls":9},0]
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[null,"(Reference FSH 5709.16)",{"$nulls":15},"4. Region/Area",{"$nulls":9},0]
[{"$nulls":27},0]
[null,"SECTION I - Operator & Aircraft Information (Fill in Blanks)"]
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[null,0,{"$nulls":11},0]
[null,"3. Phone No.",{"$nulls":5},"4. Make and Model",{"$nulls":6},"5. FAA Registration No.",{"$nulls":7},"6. Manufacturer's Serial No.",{"$nulls":8},"7. Hobbs Reading"]
[null,0,{"$nulls":5},0,{"$nulls":6},0,{"$nulls":7},0,{"$nulls":8},0]
[null,"8. Max Gross Weight",{"$nulls":6},"9. Max Gross Weight",{"$nulls":7},"10. No. of Passengers",{"$nulls":7},"11. Type Fuel",{"$nulls":5},"12. Fuel Flow (Cruise)"]
[null,"(Internal)",null,null,0,0,null,null,"(External)",null,null,0,{"$nulls":4},0,{"$nulls":7}," ",{"$nulls":5},0,{"$nulls":5}," "]
[null,"FOR EMPTY WEIGHT SEE CURRENT WEIGHT AND BALANCE DATA"]
[null,"13. Authorized Uses (Initial appropriate boxes)",{"$nulls":15},"Expires (Fill in the Blank)",{"$nulls":10},"1900-12-30"]
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[]
[null,"14. Approved By (Signature)",{"$nulls":11},"15. Title",{"$nulls":10},"16. Region",{"$nulls":6},"17. Date"]
[{"$nulls":31},"00:00:00"]

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["FS-5700-21a, Part 4 (03/2008)"]
["MB 0596-0015 (Omission of Exp. date approved by OMB)"]
["INTERAGENCY HELICOPTER LOAD CALCULATON       Electronic Version (03/2008)",{"$nulls":6},"MODEL",null,0]
[{"$nulls":7},"N#",null,0]
["PILOT(S)",null," ",{"$nulls":4},"DATE"]
["MISSION",null," ",{"$nulls":4},"TIME",null," "]
[1,"DEPARTURE",null," ",null,null,null,"PA"," ",null,"OAT"," "," "]
[]
[2,"DESTINATION",null," ",null,null,null,"PA"," ",null,"OAT"," "," "]
[]
[3,"HELICOPTER EQUIPPED WEIGHT",{"$nulls":5},0]
[4,"FLIGHT CREW WEIGHT"]
[5,"FUEL WEIGHT",null,0,"gals   X",7,"lbs/gal",0]
[6,"OPERATING WEIGHT  (3 + 4 + 5)",{"$nulls":5},0]
[null," ",null,null,null,"Non-Jettisonable",{"$nulls":4},"Jettisonable"]
[null," ",null,null,null,"HIGE",null,"HOGE",null,null,"HOGE- J"]
["7a","PERFORMANCE REFERENCE (List chart/supplement from Flight Manual)"]
["7b","COMPUTED GROSS WEIGHT     (From Flight Manual Performance Section)",null,null,null," ",null," ",null,null," "]
[8,"WEIGHT REDUCTION                       (Required for all Non-Jettisonable loads)",null,null,null," ",null," ",null,null," "]
[9,"ADJUSTED WEIGHT                         (7b minus 8)",null,null,null,{"$error":"#VALUE!"},null,{"$error":"#VALUE!"},null,null,{"$error":"#VALUE!"}]
[10,"GROSS WEIGHT LIMITATION      (From Flight Manual Limitations Section)",null,null,null," ",null,0,null,null," "]
[11,"SELECTED WEIGHT                   (Lowest of 9 or 10)",null,null,null,{"$error":"#VALUE!"},null,{"$error":"#VALUE!"},null,null,{"$error":"#VALUE!"}]
[12,"OPERATING WEIGHT                     (From Line 6)",null,null,null,0,null,0,null,null,0]
[13,"ALLOWABLE PAYLOAD                  (11 minus 12)",null,null,null,{"$error":"#VALUE!"},null,{"$error":"#VALUE!"},null,null,{"$error":"#VALUE!"}]
[]
[14,"PASSENGERS/CARGO",{"$nulls":4}," ",null,null,null," "]
[null," ",{"$nulls":8}," "]
[null," ",{"$nulls":8}," "]
[{"$nulls":10}," "]
[{"$nulls":10}," "]
[15,"ACTUAL PAYLOAD  (Total of all weights listed in Item 14)                                     Line 15 must not exceed Line 13 for the intended mission (HIGE, HOGE or HOGE-J)",{"$nulls":8},0]
["PILOT SIGNATURE",null,null," ",{"$nulls":6},"HazMat Onboard"]
["MANAGER SIGNATURE",null,null," ",{"$nulls":6},"Yes         No        "]

{"sheet":"Instructions","index":4,"n_rows":7,"n_cols":1,"rows_kept":7,"cut":false,"hidden":false,"merged":[],"flags":["formulas_cached_only"]}
["Instructions - FS 5700-21a (Helicopter Data Record), FS-5700-21b (Helicopter Fire Card), and FS-5700-21c (Helicopter Data Card)"]
["1.  A.  This form may be filled in on the computer, or blank forms may be printed and filled in by hand.  Computer:  When the information is entered on the 5700-21a - Part 1, the information will be automatically transferred to the FS-5700-21a - Part 2, Fire Card.  \n B.  Printing:  Click on the tab along the lower edge of the worksheet to gain access to the individual sheets.  The forms should print one page for each form.  If this does not happen do the following:  (1) Click on “File”, “Page Setup”, Margins”, Check that all margins are set to: “.25”."]
["2.  SPECIAL USES – If a Special Use is Authorized, clicking on the item on FS-5700-21a - Part 1, a check mark will appear in the provided space.  You will have to Initial the Authorized Uses on the card, and line through the items not authorized.  Any Additional Uses will also automatically be filled in on the FS-5700-21a - Part 2, Fire Card."]
["  \nA RED TRIANGLE indicates a drop down box which provides information on what information is required, or what should be looked for, as in the example in the upper right corner of this block.  \n\n3. To Insert your information in blocks 13. Title, and 14. Region, Click on “Tools”, “Protection”, “Unprotect Sheet”.  Remember to Re-Protect the sheet and Card(s) afterward.\n\nSUGGESTION:  Before or After completing a form, save it to a separate file i.e. N12345.xls.  I recommend you make a folder for “Helicopters” and then sub-folders for the individual operators, and save the different “N” numbers in the operators file.\n\nPlease forward all comments, questions, noted discrepancies, and suggestions to:\n\nGil Elmy\nWork: 801-622-9170\nCell: 801-540-8473\ne-mail: gelmy@fs.fed.us"]
["BURDEN AND NONDISCRIMINATION STATEMENTS"]
["\nAccording to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number.  The valid OMB control number for this information collection is 0596-0015.  The time required to complete this information collection is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  \n\nThe U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance.  (Not all prohibited bases apply to all programs.)  Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at 202-720-2600 (voice and TDD).\n\n"]
["To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call toll free (866) 632-9992 (voice).  TDD users can contact USDA through local relay or the Federal relay at (800) 877-8339 (TDD) or (866) 377-8642 (relay voice).  USDA is an equal opportunity provider and employer."]