I. Pre-Inspection

  • 1. Reviewed previous inspection?

  • 1a. List issues from previous inspections that have not been addressed (explain mitigation and timeframe to correct this issue).

  • 2. Reviewed Airport Master Record (5010 Form)?

  • 2a. List of changes to Airport Master Record (list changes by category and item numbers, give regulation or circular if applicable)

  • 3. Reviewed Airport Sketch?

  • 3a. Describe changes to Airport Sketch (copy of marked up sketch will be sent separately)

  • 4. Reviewed Airport Facility Directory?

  • 4a. List changes or additions that need to be made to the Airport Facility Directory.

II. Runway 17 / 35

  • 1. Length (changes will require completing category XII)

  • 2. Width

  • 3. Surface Condition

  • 4. Pavement Edge

  • 5. Runway Object Free Area / Primary Surface

  • 6. Approach Surface (separate form is required)

  • 7. Transitional Surface

  • 8. Runway Protection Zone

  • 9. Surface Gradient

  • 10. Line of Sight

III Runway 11 / 29

  • 1. Length (changes will require completing category XII)

  • 2. Width

  • 3. Surface Condition

  • 4. Pavement Edge

  • 5. Runway Object Free Area / Primary Surface

  • 6. Approach Surface (separate form is required)

  • 7. Transitional Surface

  • 8. Runway Protection Zone

  • 9. Surface Gradient

  • 10. Line of Sight

IV Taxiways

  • 1. Width

  • 2. Surface Condition

V Safety Areas

  • 1. Dimensions Maintained

  • 2. Ruts/Surface Variations

  • 3. Drainage

  • 4. Objects in Safety Area/Frangible Mounting

VI Markings, Signs and Lighting

  • 1. Runway Markings

  • 2. Taxiway Centerline

  • 3. Taxiway Edge Markings

  • 4. Holding Position Markings

  • 5. Signs Identifying Taxiing Routes

  • 6. Holding Position Signs

  • 7. Signs Internally Illuminated

  • 8. Runway Lighting/Reflectors

  • 9. Taxiway Lighting/Reflectors

  • 10. Airport Beacon

  • 11. Obstruction Marking/Lighting

  • 12. Markings/Signs/Lighting Properly Maintained

Apron Areas

  • Surface condition

  • Debris

  • Obstructions

VII. Fuel Storage Areas

  • 1. Fencing/Locks/Signs

  • 2. Piping protected from vehicles

  • 3. No Smoking signs posted

  • 4. Deadman Controls for loading stations

  • 5. Fire Extinguishers - Inspected/Accessible

  • 6. Emergency Shutoff - Signed/Accessible

  • 7. Fuel Leaks

  • 8. Bonding wire/clips

  • 9. Grounding

  • 10. No vegetation or trash

  • 11. No evidence of smoking

VIII. Mobile Fuelers

  • 1. No Smoking sign in cab

  • 2. Flammability signs/haz mat placards all sides

  • 3. Bonding cables and clips

  • 4. Deadman control

  • 5. Fire Extinguishers - proper type/inspected

  • 6. Emergency shutoffs operable and marked

  • 7. Fuel leaks

  • 8. Vehicle exhaust system - shielded

  • 9. No evidence of smoking - no ashtray in cab

  • 10. Vehicle parking - 10' apart/50' from buildings - on pavement

iX. Traffic/Wind Indicators

  • 1. Wind sock condition

  • 2. Segmented Circle

XI. Wildlife Observations

  • Plover; Magpie; Hawk; Other

XI. Miscellaneous Observations

  • Terminal

  • External Power supply

  • Airways Power Center

  • Water supply

  • Terminal condition

  • Communications

  • Phone - landline

  • Phone - Cell

  • Radio equipment

Roading

  • Ring Road

  • Road signage

XII. Sketches

  • Add drawing

XII. Runway Length Change (required if there was a change in the runway length or displaced threshold)

  • Note: Horizontal DATUM should be NAD83 / Vertical DATUM should be NAVD88

  • 1. Was there a change in the length of a runway or displaced threshold? (if yes complete the applicable parts of this category)

  • 2. Runway ID

  • 3. Type of change

  • 4. Date of change

  • 5. Old runway length

  • 6. New runway length

  • 7. Distance runway extended or shortened/Direction

  • 8. Runway width

  • 9. Runway end changed

  • 10. New Latitude and Longitude

  • 11. New runway end elevation

  • 12. New runway touch down zone elevation (highest elevation in the first 3,000 feet)

  • 13. New runway azimuths (true)

  • 14. Displaced threshold length

  • 15. Displaced threshold width

  • 16. Displaced threshold Latitude and Longitude

  • 17. Displaced threshold elevation

  • 18. Change to ARP Latitude and Longitude (if appropriate)

  • 19. Additional information

Signatures

  • Airport Representative

  • State Inspector

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