TB 1-2840-248-20-2
SECTION II--REMOVAL DATA.
Block 14. Removed from (Nomen NHA). Enter "uninstalled" in this block.
Blocks 15 through 24. Leave these blocks blank.
Block 25. Date removed. Enter the julian date the entries in Section II are completed.
Block 26. Enter the Unit Identification Code 'for the organization taking this action. If it is a contractor, enter
the proper CAGE code prefixed with a "K."
Blocks 27 and 28. Leave these blocks blank.
Block 29. Signature and telephone number. The person who completes this form will sign in this block and
enter their telephone number (DSN/AUTOVON or commercial).
Blocks 30, 31, and Remarks. Leave these blocks blank.
NOTE: Take copy 1 and attach it to the old copy 3. If the serial number changed enter the new serial number
from block 56 of the old copy 3, in block 4 of the new copy 2.
COPY 2--SECTION III--REPAIR/OVERHAUL/GAIN DATA (Figure 9, Sheet 4 of 5)
Block 14. Removed from (Nomen NHA). Enter "uninstalled" in this block.
Blocks 15 through 26. Leave these blocks blank.
Block 32. Date checked. Enter the julian date that the maintenance action was completed.
Block 33. Signature and telephone number. The person who completes this form, certifying the work
complete, will sign in this block and enter their telephone number (DSN/AUTOVON or commercial).
Block 34. UIC (this action). Enter the unit identification code for the activity that performed work. If a
contractor does the work enter the CAGE code prefixed with a "K."
Block 35. Manhours to repair/overhaul. Enter the total manhours by hours and tenths it took to do the
work.
Block 36. Inspection & action code. Place the letter which applies in the small box, "E" for repaired, and so
on. Do not use check marks or "X".
Block 37 Reason for gain . After the MWO or other directive is applied, enter code "S" in this block. Block
38. Maint level. Enter the maintenance level of the unit/activity doing the work. ("0" for AVUM, "F" for AVIM,
and "D" for depot level.)
Block 39. UIC (shipped to). Leave this block blank.
Block 40. Actual failure code. Block 10 of this form identifies the apparent failure code or reason for
removal code at removal time for the item listed. Upon further disassembly and repair, the root cause for
failure may be different than that observed at time of removal. The overhaul/repair facility will enter the actual
failure code in
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