Aerodrome Safety Circular

ASC 2003-019
2003.01.10

APPENDIX 1

AERODROME OPERATOR ATTESTATION
 

I attest that the most critical aircraft, based on wing span, to be used by operators at the aerodrome is __________________________________.

  (Type of aircraft)

I attest that the information, as specified below, on Aerodrome Physical Characteristics provided for __________________________ is accurate,

   (Name of aerodrome)

and I further agree to maintain the physical characteristics of the aerodrome in the same, or improved, condition as they were on the date of the signing of this document. Failing this, I agree to immediately inform NAV CANADA of any change or modification of the aerodrome characteristics in order that an assessment of the continuing validity of these procedures be made.

_________________________________    _______________________

Signature of Aerodrome Operator                 Date

AERODROME PHYSICAL CHARACTERISTICS
RWY ID Threshold Elevation (feet) RWY Orientation (degrees)
Threshold Coordinates (1/100 sec) TYPE OF RUNWAY
Non-Instrument Runway Non-Precision Runway
AIRCRAFT SIZE
(Enter Aircraft wing span)
   
CHARACTERISTICS
Strip Specifications:  
Strip width (each side of centre line) __________ m (ft) __________ m (ft)
Strip length
(Prior to threshold and beyond departure end)
__________ m (ft) __________ m (ft)

Approach / Take-off Slopes and Dimensions:
 
Length of the inner edge __________ m (ft) __________ m (ft)
Distance from threshold __________ m (ft) __________ m (ft)
Divergence (minimum each side) __________ % __________ %
Length (minimum) __________ m (ft) __________ m (ft)
Slope(maximum) __________ %
(1:_____)
__________ %
(1:_____)
Transition Surfaces (Slope) __________ %
(1:_____)
__________ %
(1:_____)
Note:
(1) Aircraft with wingspans greater than 52 m (171 ft) and wider will be evaluated individually.
(2) A form is required for each runway served by an instrument approach procedure.
Date modified: