‫دولة ليبيا‬

STATE OF LIBYA ‫وزارة المواصالت‬

MINISTRY OF TRANSPORT
CIVIL AVIATION AUTHORITY ‫مصلحة الطيران المدني‬
FLIGHT SAFETY DEPARTMENT ‫ادارة سالمة الطيران‬

Flight Safety Department – Operations Section

APPLICATION FOR ETOPS APPROVAL

For Civil Aviation use only

This form is designed to elicit all the required
information from those operators requiring ETOPS
Approval. Operator: ……………………….………..

File Ref: ……………………………….....

Please read the ‘Notes for Completion’ before
completing the form electronically. Date: ……………………………………...

Please note that a minimum of 30 working days will normally be required to check and
confirm the information given. If data is missing or omitted the process may take
considerably longer. The Libyan Civil Aviation Authority may request the applicant for
inspection flights / dispatch capabilities before finalising application.

SECTION I: OPERATOR DETAILS

Operator Name Ghadames Air

AOC Number 034/22

SECTION II: AIRCRAFT DETAILS

Aircraft Type Boeing B777

Registration Marks 5A-GRS

Serial Number 32889

Engine #1 Type / S/N GE90-94B / 900-466

Engine #2 Type / S/N GE90-94B / 900-474

APU Type / S/N ALLIED SIGNAL 331-500 / P-1500

SECTION III: ETOPS APPROVAL CATEGORIES (Tick as applicable)

120 minutes

180 minutes X

Other (Please specify)

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SECTION IV: INTENDED AREAS OF OPERATION & PLANNED UTILISATION

AREAS PLANNED UTILISATION (HRS)

WORLDWIDE MAX 180 min ETOPS

SECTION V: DOCUMENTATION

1 Required Documentation

To process this application copies of the following documents (where relevant) are
required:
Original AOC Variation form. X

Relevant extracts/references from AFM and STC. X

Maintenance Programme, CMP. X

Relevant extracts/references from Operations Manual Part A, B, C and D. X

MEL X

Original documents should not be sent, photocopies are sufficient. Do not send
complete manuals, only the relevant sections/pages will be required. Failure to
include all relevant documentation may result in a delay in processing your application.

SECTION VI: NOTES FOR COMPLETION

1 Applicability
Extended Range Operations with Two-Engine Aeroplanes (ETOPS) applies to operators
wishing to use twin-engined aircraft more than 60 minutes’ flying time from a suitable
diversion aerodrome. Such routes could be long ocean crossings, polar routes or
routes where there are limited diversions available, e.g. trans-Siberia.

The requirements for Operator Approval to carry out ETOPS are laid out in LYCARs –
OPS Part- SPA and GM1/ AMC 20-6 “ EASA AMC 20-6 “.

ETOPS is a major process, which will involve all aspects of a company’s operation. It is
therefore strongly recommended that your Flight Operations Inspector be contacted
before submitting an application. It is likely that an MNPS, RVSM and RNP-10 approval will
also be required.

2 Operator’s ETOPS Approval Submission Matrices

The completed Operator’s ETOPS submission matrices must be submitted together
with the Application for ETOPS Approval. All applicants should complete approval
matrices in full.

Failure to complete the Submissions Matrices may result in a delay in processing your
application.
3 Submissions and Enquiries

Address for submissions: Contact details for

enquiries: LIBYAN Civil Aviation Authority Tel:
+213330256
Flight Safety Department Fax:
+213605322 Main Headquarter , Tripoli ,Libya

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SECTION VII: ETOPS APPROVAL MATRIX – AIRWORTHINESS

ETOPS type design approval for the aircraft type

Supplement 1JCAB
D631W001.246G Revision 55
AFM Status: AFM D631W001-1JCAB Revision 21
03/05/2024
Supplement: 06/18/2024
Not Applicable
STC (if applicable): The 777-200 ER is designed and manufactured as an airplane to be flown up to 180 minutes from
a suitable airport.

CMP Document Number: D044W054, Revision: REV AB, Date: June 11, 2015
CMP Revision:
CMP Supplement: D044W045, REVISION: T, DATE: JUNE 2016

CMP Compliance: Yes / CMP Document Incorporated in the Last AMP revision and ETOPS Manual

Aircraft modification status for The 777 is designed and manufactured as an airplane to be flown up to 180
ETOPS: minutes from a suitable airport.
(SB 777-26-0045, SB 777-31A0179, SB 777-28-0061 Embodied)
Issue 01, Rev00
ETOPS Manual Reference: ETOPS Manual Revision:
Date 13.07.2024

Operator Experience and Reliability

Total Number of
long/range and/or normal
operations with
airframe/engine
combination:
Total number of
airframe/engine hours
and cycles:

Total Number of IFSD: 0

Unscheduled engine
0
removal rate /1000FH:

Diversions or Turnback: NIL

Uncommanded
power changes or NIL
surges:

Inability to control the

engine or obtain desired NIL
power:

Problems with ETOPS

NIL
critical systems:

APU Reliability records:

A/C Systems components

Reliability Records:

Records of Major Events: NIL

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SECTION VII: ETOPS APPROVAL MATRIX – AIRWORTHINESS

LYCAA.FSD.OPS.FRM 06 pages: 4 of
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 Maintenance Programme (make reference to the applicable heading in the referred documents)

MP Ref: Amendment Status: Date:

Identification of ETOPS AMP (Identified AS ETOPS

Tasks: Related ETOPS Manual
ETOPS)
Procedures:
AMP Annex Non Duplication of ETOPS Manual
ETOPS Service Checks: PDSC Check list Tasks: Prag 11.1 Dual Maintenance

Engine Trend Monitoring (make reference to the applicable heading in the applicable documents)

Contracted Organisation: GENERAL ELECTRIC (GE)

Contract Ref:
Magnetic Chip AMP Task: 80-005-01/02: Inspect
Trend Monitoring: Engine Trend Monitoring (Detailed) STARTER CHIP
Detector Monitoring:
Program DETECTOR for contamination
(Ref: ETOPS Manual) on Left/Right engine.
Every 2000 FH
Engine Trend Monitoring Engine The Engine Adjustment
Margin Control: Procedure will be done in
Program Adjustment
Procedure: accordance with Engine Manual
(Ref: ETOPS Manual)
(GE Manufacture)
Spectrographic Engine Trend Monitoring
Program Responsibilities: CAMO Manager
Oil Analysis:
(Ref: ETOPS Manual)
TFL-Excel Sheet for
Oil Consumption Record: Monitoring

Maintenance

Part-145 AMO (Name and Approval Ref):

Contracted Maintenance Organisation
GHADAMES AIR (GHT), LYCAR.145.059
MOE (Scope and Procedure Reference):
Inhouse X
MOE: Issue 01, Rev 00 September-2023

Certifying Staff Training (Initial/Current):

Certifying Authorisations (Scope and Currency):

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APPLICATION FOR ETOPS APPROVAL

SECTION VIII – FLIGHT OPERATIONS

Operator’s Operations Manual LYCAA Use

Subjects Requirements
or Document Reference Only

Operations Manual – Part A: General

LYCARs –Air operations Subpart F

Documents/regulations used in
SPA.ETOPS.100- PART.SPA.ETOPS.115 and AMC
compiling ETOPS
20-6 based on EASA AMC 20-6
Manual/Procedures
Brief description of ETOPS

Extended 8.5.1.2 p280

Operations. 8.5.1.3.1 p281
Adequate 8.5.1.3.2 p281
aerodrome. 8.5.1.3.17 p283
Approved one-engine inoperative cruise speed. 8.5.1.3.8 p282
Definitions 8.5.1.3.6 p281
Threshold distance/time.
Adequate ETOPS en-route alternate. 8.5.1.3.16 p283
8.5.1.3.12 p283
Equal time points.
8.5.1.3.13 p283
Rule 8.5.1.3.14 p283
distance/time. 8.5.1.3.5 p281
ETOPS segment.
ETOPS significant system.
Maximum approved diversion
time. Dispatch.
8.5.1.3.9 p282 (To be developed)
Company AOC defined operating area.
Criteria (To be developed)
List of certified aircraft types/engine combinations.
8.5.1.3.15 p283
Approval Approved diversion time.
Crew qualifications. 8.5.2.3.1 p285
ETOPS qualified dispatcher 8.5.2.3.2 p286
Qualifications 8.5.2.3.3 p286
personnel. ETOPS qualified
8.5.2.3.3 p286
operations staff.
ETOPS qualified maintenance personnel.
Training (Initial and Recurrent) and Flight crew training and Operations 8.5.11.1 p313

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APPLICATION FOR ETOPS APPROVAL

Checking Manual. Flight crew currency Flight crew training and currency requirements for
requirements. ETOPS operations are specified in OM-D

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APPLICATION FOR ETOPS APPROVAL

Operator’s Operations Manual LYCAA Use

Subjects Requirements
or Document Reference Only

Commander’s responsibilities. 8.5.2.3.1 p285

ETOPS Authorisation
Statement to show when ETOPS are allowed.
8..5.3 (b) p288 and 8.5.3.3.5 p292
Aircraft serviceability and MEL. 8.5 (4) p280 and 8.5.7.8 p306
Communication and navigation 8.5.5.2 p294
facilities. Critical fuel scenario. 8.5.5.1 p293
Critical fuel reserve. 8.5.3.3.6 p292
ETOPS alternate aerodrome selection. 8.5 (f) p 278 and 8.5.1.3.8 p282
ETOPS Flight Preparation and 8.5 (f)(c) p278
ETOPS alternate planning minima.
Planning 8.5.4.1.1 p293
Pre-dispatch and post-dispatch weather minima.
8.5.6 p294
Computerised flight plan.
8.5.2.4.1 p286
Delayed dispatch. 8.5.2.4 p286
Maintenance check (pre-departure service
check). Verification flights.
Crew responsibilities.
8.5.2.3.1 p285
Flight documentation/chart 8.5.6.1 p296
handling. Fuel management. 8.5.11.2 (k) p313
Weather monitoring. 8.5.7.9 p307
Flight Crew Procedures
Change of routing. 8.5 (g) p279 (to be developed) and 8.3.8.1.4.3.3 p245
Diversion decision- 8.5 (g) p279 (to be developed)
making. Icing. 8.5.6.1 (10) p297 and 8.3.8.2 p246
Crew workload management. Crew workload management (to be developed)

Identification of ETOPS aeroplanes. 8.5.1.1 p280

Types of ETOPS operations that are approved. 8.5.1.3.15 p283
Type-related ETOPS Operations
Placards and limitations. 8.5.3.3.5 p292
One-engine inoperative speed. 8.5.1.3.2 p281

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APPLICATION FOR ETOPS APPROVAL

Operator’s Operations Manual LYCAA Use

Subjects Requirements
or Document Reference Only

Operations Manual – Part B: Type Specific

Type-specific Planning
Requirements
Refer to B777 Flight Planning and Performance
ETOPS Fuel Planning Including critical fuel scenario. Manual, Chapter “Enroute”
• 21-27-9 SATCOM BACKUP COOLING FANS.
MEL/CDL ETOPS-specific MEL/CDL items. • 21-31-2 MANUAL CABIN PRESSURE
OUTFLOW VLV CONTROLS.
• 21-31-3 OUTFLOW VALVES.
• 21-51-1 AIR CONDITIONING PACKS.
• 21-52-5 RAM AIR INLET DOOR SYSTEMS.
• 21-61-1 CABIN TEMP CONTROLLERS (CTC).
• 21-61-2 FLT DECK ZONE TEMP CONTROL
SYSTEM.
• 23-27-1 DATA COMM MANAGEMENT SYSTEM
(DCMS) DATA COMM MANAGEMENT SYSTEM
(DCMS).
• 23-27-2 FLT DECK COMM’S SYSTEM
(DATALINK).
• 26-23-1-2 LOWER CARGO COMPATMENT FIRE
EXTINGUISHER
BOTTLES (2B & 2C ).
• 22-11-1 AUTOPILOT FLT DIRECTOR
COMPUTERS (AFDC).
• 22-11-7 AUTO LANDING SYSTEM
(AUTOLAND).
• 23-11-1 HF COMM. SYSTEMS.
• 23-21-1 SELECTIVE CALL SYSTEM (SELCAL)
SELECTIVE CALL SYSTEM (SELCAL).
• 24-11-1 ENG DRIVEN GENERATOR SYSTEMS
(IDG,GCB).
• 24-11-2 IDG OIL PRESSURE INDICATION
SYSTEMS.
• 24-21-1 APU DRIVEN GEN SYSTEM
(GENERSTOR AGCU APB) APU DRIVEN GEN.
SYSTEM (GENERSTOR, AGCU, APB).
• 24-31-1 APU BATTARY.
• 24-31-2 APU BATTARY CHARGER.
• 26-15-1 APU FIRE DETECTION SYSTEM. APU
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APPLICATION FOR ETOPS APPROVAL

FIRE DETECTION SYSTEM.

• 26-22-1 APU FIRE EXTINGUISHER SYSTEM.
• 28-25-2 APU FUEL SHUTOFF VALVE.
• 30-21-1 ENGINE ANTI- ICE SYSTEMS.
• 36-12-3 APU BLEED AIR SHUTOFF SYS (VLV
&/OR INDICATION).
• 49-11-1 AUXILIARY POWER UNIT (APU).

5.3 p147 (to be developed)

Performance data. Refer to B777 Flight Planning and Performance
Aeroplane Systems
Aerodrome technical differences, navigation fit, Manual
communications fit.
Navigation failures. Refer to FCOM and QRH
Action to be taken on ETOPS significant system Refer to FCOM and QRH
Non-normal Procedures
failure. Low fuel scenario. Refer to FCOM and QRH
Crew incapacitation. OM-B 3.3 p117

Operations Manual – Part C: Route and Aerodrome Instructions

Approved area of operation. 0.1 p12 and chap8 p48

ETOPS en-route alternates. Refer to Lido airway manual
Performance restrictions and weather minima for en-route Refer to Lido airway manual
alternates. Meteorological facilities/information. Refer to Lido airway manual
ETOPS Areas and Routes.
Low altitude cruise information. Refer to Lido airway manual
Route minimum diversion Refer to Lido airway manual
altitudes. MSA restrictions. OM-C AIRFIELD BRIEFINGS
Refer to Lido airway manual
Route-specific oxygen requirements.

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APPLICATION FOR ETOPS APPROVAL

Operator’s Operations Manual LYCAA Use

Subjects Requirements
or Document Reference Only

Operations Manual – Part D: Training

General:
 ETOPS overview.
 ETOPS regulations.
 ETOPS type design approval.
 Definitions
 Approved one-engine inoperative speed.
 Maximum approved diversion time.
 Operator’s approved diversion time.
 ETOPS area of operation.
 ETOPS routes.
Ground, Simulator and Line
 ETOPS alternate aerodromes and weather minima.
Training
 Navigation system accuracy, limitations and operating
procedures.
 Meteorological facilities and information.
 In-flight monitoring and procedures.
 Computerised flight plan.
 Charts and position plotting.
 Equal time point.
 Critical fuel.

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APPLICATION FOR ETOPS APPROVAL

Operator’s Operations Manual LYCAA

Subjects Requirements
or Document Reference Use Only

Operations Manual – Part D: Training

General:
 ETOPS overview.
 ETOPS regulations.
 ETOPS type design approval.
 Definitions
 Approved one-engine inoperative speed.
 Maximum approved diversion time.
 Operator’s approved diversion time.
 ETOPS area of operation.
 ETOPS routes.
Ground, Simulator and Line
 ETOPS alternate aerodromes and weather minima.
Training
 Navigation system accuracy, limitations and operating
procedures.
 Meteorological facilities and information.
 In-flight monitoring and procedures.
 Computerised flight plan.
 Charts and position plotting.
 Equal time point.
 Critical fuel.

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APPLICATION FOR ETOPS APPROVAL

Operator’s Operations Manual LYCAA

Subjects Requirements
or Document Reference Use Only

Operations Manual – Part D: Training (Cont’d)

Normal procedures:
 Flight planning and dispatch.
 ETOPS fuel requirements.
 Route alternate selection – weather minima.
 MEL – equipment-specific.
 ETOPS service check and technical log.
 Pre-flight FMS set-up.
 Flight performance progress monitoring.
 Flight management, navigation and communication systems.
 Aeroplane system monitoring.
Ground, Simulator and Line  Weather monitoring.
Training cont.  In-flight fuel management (to include independent cross-
checking of fuel quantity).
Non-normal procedures:
 Diversion procedures and diversion ‘decision making’.
 Navigation and communication systems, including
appropriate flight management devices in degraded
modes.
 Fuel management with degraded systems.
 Procedures for single and multiple failures in flight
affecting ETOPS sector entry and diversion decisions.
 Operating on standby power.
 Operating restrictions associated with system failures
including any applicable MEL considerations.

ETOPS Simulator Training and Line

Pilot’s conversion course.
Flying
Annual refresher course.
Under Supervision.

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APPLICATION FOR ETOPS APPROVAL

Operator’s Operations Manual LYCAA Use

Subjects Requirements
or Document Reference Only

Operations Manual – Part D: Training (Cont’d)

Outline of training syllabus to include:

 ETOPS regulations.
 Operational approval.
 Aeroplane performance.
 Diversion procedures.
Flight Operations Staff and
 Area of operation.
Dispatchers.
 Fuel requirements.
 Dispatch consideration: MEL, CDL, weather minima and
alternate airports.
 Delayed dispatch.
 Documentation

Safety Management System

Attach an Operational Risk Assessment highlighted associated

Operational Risk Assessment
risks and mitigating actions.

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APPLICATION FOR ETOPS APPROVAL

Further Comments to support your application:

Continuing Airworthiness Manager Name: Signature: ...........................................

...

Nominated Person Flight Operations Name: Signature: ...........................................

...

Compliance Monitoring Manager Name: Signature: ...........................................

...

Date:

For Civil Aviation Directorate use only

Airworthiness Inspectorate Flight Operations Inspectorate

Conformity with operational criteria as contained in AMC 20-6, and all

Conformity with Initial and Continuing Airworthiness Requirements:
relevant provisions have been covered by operator’s application and AOC
variation form.

Satisfactory Yes No Satisfactory Yes No

Name:
…………………………………………..………………………………………... Name: ………………………………………………………………………..………………….

Signature: ……………………….…..……...…….. Date: …………….….. Signature: ………………………………….….…..….. Date: ……………………………

………...

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