3819P22114A14_c0v0_FY26_TGI.pdf

FOUO

FOUO: Public availability to be determined under 5 USC 552

TASK GROUP INSTRUCTION

AIM REV 20.11.4.0 (OCTOBER 2020)

TGI COMPONENT NAME: TYPE: PHASE: REPEAT: CHANGE:

NO.: 1A BLR SAF V & PNL AY A 0 0

SHIP/HULL NO.: SHIP/HULL NAME: SYSTEM: PROJ/WO NO: CASREP CAT:

LCC-19 USS BLUE RIDGE 19P

CU PHASE TITLE:

*(K2-1) - F/O – REMOVE AND INSTALL 1A BOILER SAFETY VALVES AND PILOT PANELS

PREPARING ACTIVITY:

PREPARED BY: CODE PHONE DATE

KOUHEI SUZUKI 232. 315-243-2490 22-FEB-2025

APPROVED BY: CODE PHONE DATE

HIDEMI SENDA 232. 315-243-5615 22-FEB-2025

CONCURRED BY: CODE PHONE DATE

CONCURRED BY: CODE PHONE DATE

CONCURRED BY: CODE PHONE DATE

CONCURRED BY: CODE PHONE DATE

REASON FOR WORK/NEED FOR CHANGE:

CHANGE INSTRUCTIONS:

SPECIAL REQUIREMENTS:

CLEANLINESS FOR PIPING SYSTEM/EQUIPMENT LEVEL II

MIC-L-1

WORK CERTIFICATION SIGNATURES

COMPLETION OF WORK REVIEW: BADGE NO.: SHOP/CODE: PHONE: DATE:

ACCEPTANCE OF COMPLETED WORK

PHYSICAL INSPECTION PHYSICAL INSPECTION COMPLETED: BADGE NO.: SHOP/CODE: PHONE: DATE:

REQUIRED:☐YES ☒NO

RECORDS REVIEW: BADGE NO.: SHOP/CODE: PHONE: DATE:

TGI NO.: 1A BLR SAF V & PNL AY A 0

FOUO

SHIP: LCC-19 CHG/VER: 0/0

LIST OF EFFECTIVE PAGES

SHT NO. CHG NO. SHT NO. CHG NO. SHT NO. CHG NO. SHT NO. CHG NO. SHT NO. CHG NO.

1-4 QA34A

(1)

J-1 M 1-5 Map (1)

1. SCOPE/PURPOSE

1.1 Title: 1A Boiler Safety Valves and Pilot Panels: remove and install

1.2 Location of Work:

1.2.1 Fire Room (8-76-0-E)

1.2.2 Blower Room (5-79-0-E)

1.3 Identification:

1.3.1 Quantity (One EA), 1A Boiler High Drum Safety Valve and Pilot Panel Assembly Mfr: Greno Industries Inc.

Specification: MIL-V-24740

1.3.1.1 Quantity (One EA), Safety Valve

Specification: MIL-V-24740, Class I, Style 57 Mfr Id: 6350-357 Size: Inlet 2-1/2-Inch IPS, Outlet 3-1/2-Inch IPS

APL: 88A150412

Item No: V-1 of 2.3.

1.3.1.2 Quantity (One EA), Pilot Panel

Model: 8000

APL: 501550030

Item No: PC-1 of 2.3.

1.3.2 Quantity (One EA), 1A Boiler Low Drum Safety Valve and Pilot Panel Assembly Mfr: Greno Industries Inc.

Specification: MIL-V-24740

1.3.2.1 Quantity (One EA), Safety Valve

Specification: MIL-V-24740, Class I, Style 57 Mfr Id: 6350-357 Size: Inlet 2-1/2-Inch IPS, Outlet 3-1/2-Inch IPS

APL: 88A150412

Item No: V-2 of 2.4.

1.3.2.2 Quantity (One EA), Pilot Panel

Model: 8000

APL: 501550030

Item No: F-100 of 2.4.

1.3.3 Quantity (One EA), 1A Boiler Superheater Safety Valve and Pilot Panel Assembly Mfr: Greno Industries Inc.

Specification: MIL-V-24740

FOUO

SHIP: LCC-19 CHG/VER: 0/0

1.3.3.1 Quantity (One EA), Safety Valve

Specification: MIL-V-24740, Class I, Style 23 Mfr Id: 6350-323 Size: Inlet 2-1/2-Inch IPS, Outlet 3-1/2-Inch IPS

APL: 88A150412

Item No: V-1 of 2.4.

1.3.3.2 Quantity (One EA), Pilot Panel

Model: 8000

APL: 501550030

Item No: F-100 of 2.4.

1.3.3.3 Quantity (8 EA), Safety Valve Inlet Side Stud Bolt (MIC-L-I) Material: Alloy Steel, Grade B16 or Equal.

Size: 3/4”-10UNC-2A, 5-1/2 Inch LG

1.3.3.4 Quantity (16 EA), Safety Valve Inlet Side Heavy Hex Nut (MIC-L-I) Material: Alloy Steel, Grade B7 or Equal.

Size: 3/4"-10UNC-2B

1.3.4 Quantity (One EA), Spear Boiler Pilot Panel

Model: 8000

APL: 501550030

Remarks: Located in 1.2.2.

1.4 Security Classification: None.

1.5 Initial Condition: None.

1.6 Contractor work start date: 7/21/2026

1.7 Contractor work completion date: 11/21/2027

2. REFERENCES:

REF.

NO.

DOCUMENT

/DRAWING

NUMBER

DOCUMENT/DRAWING TITLE REV CHG

NO.

COPY

REQ’D

(Y/N)

SOURCE

DOC

(Y/N)

PARA SEC PG CHP

1 NSI FY-25 NAVSEA Standard Items - ORG N 2 LI FY-25 Local Standard Items - ORG N

3 DWG 200-

8337506

INSTALLATION GIS SYSTEM

HIGH DRUM SAFETY VALVE

A Y AL

L

4 DWG 200-

6577980

S/A 1371 LCC-19 SUPHTR/LOW

DRUM SAFE V REPL AND ASSOC

PP INSTL

B Y AL

L

5 TM S6435-

Q1-MMO-

Remote Operated Pilot Sdafety Valve System for 600 PSI Boilers

6 N

3. APPENDICES:

3.1. Appendix “J” TGI Job Summary Information Sheet

3.2. Appendix "M" TGI Material List

3.3. Appendix “D” Deficiency Form

4. GENERAL REQUIREMENTS:

FOUO

SHIP: LCC-19 CHG/VER: 0/0

4.1. Not Applicable.

5. PROCEDURE:

5.1 Accomplish the requirements of 009-27 of 2.1.

5.1.1 Accomplish the requirements of 009-09 of 2.1.

5.2 Remove each equipment listed in 1.3.1 through 1.3.4, using 2.3 through 2.5 and Enclosure-01 for guidance.

5.3 Install each equipment listed in 1.3.1 through 1.3.4, using 2.3 through 2.5 and Enclosure-01 for guidance.

5.3.1 Restore each mating surface exposed by each equipment removal. Repair by removing each high spot, burr, abrasion, and foreign matter, where removal can be accomplished by hand tool.

5.3.2 Remove existing and install each new steam piping joint gasket, conforming to MIL-G-24716.

5.3.3 Document joint/component record of FJ-1 on QA Form 34A, Enclosure-02.

5.4 Accomplish the requirements of 009-32 of 2.1 for each new and disturbed surface.

5.5 Notes:

5.5.1 Planner: Code 232 K. Suzuki, 243-2490

5.5.2 Work Integration Manager (WIM): Code 333 T. Yaginuma, 080-5419-0598

5.5.3 This TGI is response to Boiler Inspection and Repair Management Information System (BIRMIS) for 1A Boiler report dated 17 OCT 2024, Line item “K2-1”.

5.5.4 Each equipment will be overhaul by Original Equipment Manufacturing (OEM). Notify Business Agent (BA) to coordinate the shipment and deliver each removed equipment listed in 1.3.1 through 1.3.4 to A61. OEM TGI number is 3819P22114 A16. Procedure 5.3 may be performed after completion of TGI No. 3819P22114 A16.

5.5.5 JCN EM02-L194 is related to this TGI.

5.6 Government Furnished Material (GFM):

5.6.1 SRF-JRMC will provide GFM listed in Appendix “M”.

5.7 SRF-JRMC will provide the following service work: (TGI No. 3819P22114S13)

5.7.1 [C740] Crane and crane rigging service.

5.7.2 [X99E] Utilities service, electrical.

5.7.3 [X99M] Utilities service, including low pressure air supply, water supply, and steam supply.

5.7.4 [C106.1] Safety inspection for SRF-JRMC employees.

5.7.5 [C106.2] Gas free inspection for SRF-JRMC employees.

5.7.6 [C133] QA Inspection for (G) symbol(s).

FOUO

J-1

SHIP: LCC-19 CHG/VER: 0/0

APPENDIX "J"

TGI JOB SUMMARY INFORMATION SHEET

SYSTEM: PLANT NO.: COMPONENT NAME: TYPE: PHASE: REPEAT: CU PH

VERSION:

CASREP

CAT:

1A BLR SAF V & PNL AY A 0 0

CU PHASE TITLE:

*(K2-1) - F/O – REMOVE AND INSTALL 1A BOILER SAFETY VALVES AND PILOT PANELS

PRIMARY COMPONENT:

COMPONENT UNIT LIST (FOR ASSEMBLIES):

1A BLR SPHTR STY VLV PA 1A HI DRUM SFTY PLT V- 1A LO DRUM SFTY PLT V- 1A BLR LD SFTY VLV

PA 1A BLR HD SFTY VLV PA 1A SPHTR SFTY PLT V-

ATTACHMENT LIST:

1. ENCLOSURE-01 (3819P22114A14-MAP.docx) saved on 15-FEB-2025 0000.

2. ENCLOSURE-02 (3819P22114A14-QA34A.docx) saved on 21-FEB-2025 0000.

ZONE MANAGER: ZONE: COMPARTMENT: LEVEL: FRAME: SIDE:

KANKE ,KOUHEI

JO: KO: TOTAL MAN HRS: PLANNING ACCEPTANCE:

3819P22114 A14

TOTAL MAT’L COST TOTAL DURATION:

CU PHASE DESCRIPTION:

The purpose of this TGI is to remove and install 1A boiler each safety valve and pilot panel.

Location of Work:

Fire Room (8-76-0-E) Blower Room (5-79-0-E)

TASK NAME

SHOP TSD/WC TS CREW# MHRS

HIGH RAD

HOURS

RC

GRID#

5.1 OMCH: HRs, QA HRs 22 KE PC

5.2 OMCH: HRs, RGRS HRs 22 KE PC

5.3 OMCH: HRs, RGRS HRs, QA HRs 22 KE PC

5.4 PNTR: HRs, QA: HRs 22 KE PC

Machinery Work CFM for paint and misc such as plastic sheets/bags and other consumable.

22 MQ CS

Process Funding Document. 10 CT OM

FOUO

M-1

SHIP: LCC-19 CHG/VER: 0/0

APPENDIX “M”

TGI MATERIAL LIST

SYSTEM: PLANT NO.: COMPONENT NAME: TYPE: PHASE: REPEAT: CU PH

VERSION:

CASREP

CAT:

1A BLR SAF V & PNL AY A 0 0

CU PHASE TITLE:

*(K2-1) - F/O – REMOVE AND INSTALL 1A BOILER SAFETY VALVES AND PILOT PANELS

MATERIAL REFERENCES

REF

NO.

DOCUMENT/DRAWING

NUMBER

DOCUMENT/DRAWING TITLE REV

JOB ORDER: KEY OP:

3819P22114 A14

MATERIAL LIST

ITEM

NO.

PC

NO.

REF

NO.

M

C DESCRIPTION

STOCK

NUMBER

GENERIC

MATL

TYPE LVL QA

HAZ

MAT

DOC

NO.

QTY

REQD/

UNIT

QTY

USED/

UNIT

001 M GASKET, ORIG: C232 K.

SUZUKI 243-2490

ORDERED FOR KTR

T/M: S6435-Q1-MMO-010,

FIG.A-1-2

9B 5330 012886619 NA 4 N 50495164 12/EA

002 M BOLT, BOLT, M18 X 2.5 X 80

MM, MATERIAL CARBON

STEEL, ASTM-A-36, FOR PILOT

PANEL ASSEMBLY,

T/M: S6435-Q1-MMO-010,

FIG.A-1-49

ORIG: C232 K. SUZUKI 243-

ORDERED FOR KTR

9B 5306 LL9303489 NA 4 N 50517463 16/EA

003 M NUT, NUT, M18 X 2.5,

MATERIAL CARBON STEEL,

ASTM-A-36

FOR PILOT PANEL ASSEMBLY,

T/M: S6435-Q1-MMO-010,

FIG.A-1-50

ORIG: C232 K. SUZUKI 243-

ORDERED FOR KTR

9B 5310 LL9303490 NA 4 N 50517467 16/EA

NOTES:

FOUO

M-2

SHIP: LCC-19 CHG/VER: 0/0

MATERIAL LIST

ITEM

NO.

PC

NO.

REF

NO.

M

C DESCRIPTION

STOCK

NUMBER

GENERIC

MATL

TYPE LVL QA

HAZ

MAT

DOC

NO.

QTY

REQD/

UNIT

QTY

USED/

UNIT

004 M LOCK WASHER, LOCK

WASHER, M18, MATERIAL:

CARBON STEEL, ASTM-A-36,

FOR PILOT PANEL ASSEMBLY,

T/M: S6435-Q1-MMO-010,

FIG.A-1-51

ORIG: C232 K. SUZUKI 243-

ORDERED FOR KTR

9B 5310 LL9303491 NA 4 N 50517480 16/EA

005 M WASHER,FLAT, WASHER,

FLAT, M18, MATERIAL

CARBON STEEL, ASTM-A-36,

FOR PILOT PANEL ASSEMBLY,

T/M: S6435-Q1-MMO-010,

FIG.A-1-52

ORIG: C232 K. SUZUKI 243-

ORDERED FOR KTR

9B 5310 LL9303492 NA 4 N 50517485 16/EA

006 M GASKET,SPIRAL WOUND,

ORIG: C232 K. SUZUKI 243-

ORDERED FOR KTR

FOR LOW DRUM VALVE

OUTLET FLANGE SPIRAL

GASKET

9B 5330 013387810 NA 4 N 50495167 1/EA

007 M GASKET,S, ORIG: C232 K.

SUZUKI 243-2490

ORDERED FOR KTR

FOR LOW DRUM VALVE

INLET FLANGE SPIRAL

GASKET

9B 5330 013387888 NA 4 N 50495179 1/EA

008 M STUD,CONTINUOUS THR,

ORIG: C232 K. SUZUKI 243-

ORDERED FOR KTR

FOR LOW DRUM VALVE

OUTLET FLANGE BOLT

9B 5307 006853458 NA 4 N 50495168 8/EA

009 M STUD,CON, ORIG: C232 K.

SUZUKI 243-2490

ORDERED FOR KTR

FOR LOW DRUM VALVE

INLET FLANGE BOLT

9B 5307 006376493 NA 4 N 50495181 8/EA

010 M NUT,PLAI, ORIG: C232 K.

SUZUKI 243-2490

ORDERED FOR KTR

FOR LOW DRUM VALVE

OUTLET FLANGE NUT

9B 5310 006373631 NA 4 N 50495182 16/EA

011 M NUT,PLAIN,HEXAGON, ORIG:

C232 K. SUZUKI 243-2490

ORDERED FOR KTR

FOR LOW DRUM VALVE

INLET FLANGE BOLT

9B 5310 008405873 NA 4 N 50495138 16/EA

012 M GASKET,S, ORIG: C232 K.

SUZUKI 243-2490

ORDERED FOR KTR

FOR LOW DRUM VALVE

UPPER AND LOWER

ACTUATION FLANGE GASKET

9B 5330 013387816 NA 4 N 50495183 2/EA

FOUO

M-3

SHIP: LCC-19 CHG/VER: 0/0

MATERIAL LIST

ITEM

NO.

PC

NO.

REF

NO.

M

C DESCRIPTION

STOCK

NUMBER

GENERIC

MATL

TYPE LVL QA

HAZ

MAT

DOC

NO.

QTY

REQD/

UNIT

QTY

USED/

UNIT

013 M STUD,CONTINUOUS THR,

ORIG: C232 K. SUZUKI 243-

ORDERED FOR KTR

FOR LOW DRUM VALVE

UPPER AND LOWER

ACTUATION FLANGE BOLT

9B 5307 006376465 NA 4 N 50495170 8/EA

014 M NUT,PLAI, ORIG: C232 K.

SUZUKI 243-2490

ORDERED FOR KTR

FOR LOW DRUM VALVE

UPPER AND LOWER

ACTUATION FLANGE NUT

9B 5310 006373628 NA 4 N 50495185 16/EA

015 M GASKET,SPIRAL WOUND,

ORIG: C232 K. SUZUKI 243-

ORDERED FOR KTR

FOR HIGH DRUM VALVE

OUTLET FLANGE SPIRAL

GASKET

9B 5330 013387810 NA 4 N 50495171 1/EA

016 M GASKET,S, ORIG: C232 K.

SUZUKI 243-2490

ORDERED FOR KTR

FOR HIGH DRUM VALVE

INLET FLANGE SPIRAL

GASKET

9B 5330 013387888 NA 4 N 50495186 1/EA

017 M STUD,CONTINUOUS THR,

ORIG: C232 K. SUZUKI 243-

ORDERED FOR KTR

FOR HIGH DRUM VALVE

OUTLET FLANGE BOLT

9B 5307 006853458 NA 4 N 50495172 8/EA

018 M STUD,CON, ORIG: C232 K.

SUZUKI 243-2490

ORDERED FOR KTR

FOR HIGH DRUM VALVE

INLET FLANGE BOLT

9B 5307 006376493 NA 4 N 50495187 8/EA

019 M NUT,PLAI, ORIG: C232 K.

SUZUKI 243-2490

ORDERED FOR KTR

FOR HIGH DRUM VALVE

OUTLET AND INLET FLANGE

NUT

9B 5310 006373631 NA 4 N 50495189 16/EA

020 M GASKET,S, ORIG: C232 K.

SUZUKI 243-2490

ORDERED FOR KTR

FOR HIGH DRUM VALVE

UPPER ACTUATION FLANGE

GASKET

9B 5330 013387832 NA 4 N 50495190 1/EA

021 M GASKET,S, ORIG: C232 K.

SUZUKI 243-2490

ORDERED FOR KTR

FOR HIGH DRUM VALVE

LOWER ACTUATION FLANGE

GASKET

9B 5330 013387849 NA 4 N 50495191 1/EA

FOUO

M-4

SHIP: LCC-19 CHG/VER: 0/0

MATERIAL LIST

ITEM

NO.

PC

NO.

REF

NO.

M

C DESCRIPTION

STOCK

NUMBER

GENERIC

MATL

TYPE LVL QA

HAZ

MAT

DOC

NO.

QTY

REQD/

UNIT

QTY

USED/

UNIT

022 M STUD,CON, ORIG: C232 K.

SUZUKI 243-2490

ORDERED FOR KTR

FOR HIGH DRUM VALVE

UPPER ACTUATION FLANGE

BOLT

9B 5307 006376494 NA 4 N 50495193 8/EA

023 M STUD,CONTINUOUS THR,

ORIG: C232 K. SUZUKI 243-

ORDERED FOR KTR

FOR HIGH DRUM VALVE

LOWER ACTUATION FLANGE

BOLT

9B 5307 006376465 NA 4 N 50495173 8/EA

024 M NUT, HEX, ORIG: C232 K.

SUZUKI 243-2490

ORDERED FOR KTR

FOR HIGH DRUM VALVE

LOWER ACTUATION FLANGE

NUT

NUT, HEX, 1/2"-13UNC-2B,

ALLOY STEEL, ASTM A194,

GRADE 7.MIL-DTL-1222 TY I,

GRADE 7.

9Z 5310 LL4709555 NA 4 N 50507412 16/EA

025 M NUT, HEX, ORIG: C232 K.

SUZUKI 243-2490

ORDERED FOR KTR

FOR HIGH DRUM VALVE

UPPER ACTUATION FLANGE

NUT

NUT, HEX HEAD,

SPEC: MIL-DTL-1222 TYPE I &

ASTM A194,

SIZE: 3/4"-10UNC-2B,

MATL: ALLOY STEEL, GRADE

7, DO NOT CROSS NSN: 5310-00-

637-3631(GRADE 4 OR 7)

9Z 5310 LL4709559 NA 4 N 50497486 16/EA

026 M GASKET,SPIRAL WOUND,

ORIG: C232 K. SUZUKI 243-

ORDERED FOR KTR

FOR SUPERHEATER VALVE

OUTLET FLANGE SPIRAL

GASKET

9B 5330 013387810 NA 4 N 50495174 1/EA

027 M GASKET,S, ORIG: C232 K.

SUZUKI 243-2490

ORDERED FOR KTR

FOR SUPERHEATER VALVE

INLET FLANGE SPIRAL

GASKET

9B 5330 013387888 NA 4 N 50495194 1/EA

028 M STUD,CONTINUOUS THR,

ORIG: C232 K. SUZUKI 243-

ORDERED FOR KTR

FOR SUPERHEATER VALVE

OUTLET FLANGE BOLT

9B 5307 006853458 NA 4 N 50495175 8/EA

FOUO

M-5

SHIP: LCC-19 CHG/VER: 0/0

MATERIAL LIST

ITEM

NO.

PC

NO.

REF

NO.

M

C DESCRIPTION

STOCK

NUMBER

GENERIC

MATL

TYPE LVL QA

HAZ

MAT

DOC

NO.

QTY

REQD/

UNIT

QTY

USED/

UNIT

029 M STUD,CONTINUOUS THR,

ORIG: C232 K. SUZUKI 243-

ORDERED FOR KTR

FOR SUPERHEATER VALVE

INLET FLANGE BOLT

1H 5307 012345608 L1 I 1 N 50495141 8/EA

030 M NUT,PLAI, ORIG: C232 K.

SUZUKI 243-2490

ORDERED FOR KTR

FOR SUPERHEATER VALVE

OUTLET FLANGE NUT

9B 5310 006373631 NA 4 N 50495195 16/EA

031 M NUT,PLAIN,HEXAGON, ORIG:

C232 K. SUZUKI 243-2490

ORDERED FOR KTR

FOR SUPERHEATER VALVE

INLET FLANGE BOLT

1H 5310 013833251 L1 I 1 N 50495143 16/EA

032 M GASKET,S, ORIG: C232 K.

SUZUKI 243-2490

ORDERED FOR KTR

FOR SUPERHEATER VALVE

UPPER AND LOWER

ACTUATION FLANGE GASKET

9B 5330 013387816 NA 4 N 50495197 2/EA

033 M STUD,CONTINUOUS THR,

ORIG: C232 K. SUZUKI 243-

ORDERED FOR KTR

FOR SUPERHEATER VALVE

UPPER AND LOWER

ACTUATION FLANGE BOLT

9B 5307 006376465 NA 4 N 50495145 8/EA

034 M NUT,PLAI, ORIG: C232 K.

SUZUKI 243-2490

ORDERED FOR KTR

FOR SUPERHEATER VALVE

UPPER AND LOWER

ACTUATION FLANGE NUT

9B 5310 006373628 NA 4 N 50495198 16/EA

FOUO: Public availability to be determined under 5 USC 552 SHEET_____OF_____

☐ NUCLEAR APPENDIX "D"

DEFICIENCY FORM

☐ NON-NUCLEAR

1. SHIP/HULL NO.: 2a. DL or DR No.

(Circle One)

2b. REVISION: 3a. COMPONENT NAME: 3b. TYPE: 3c. PHASE: 3d. REPEAT:

LCC-19 1A BLR SAF V & PNL AY A 0

4a. ICN: 4b. KEY OP: 5. LOC SPACE/LVL: FRAME: P/S/C: 6. CAUSED BY:

3819P22114 A14

7. DESCRIPTION:

8. ORIGINATOR: NAME: BADGE: SHOP/CODE: DATE: PHONE NO.:

9. CORRECTIVE ACTION:

10. EVALUATOR: NAME: BADGE: SHOP/CODE: DATE: PHONE NO.:

FOR NON-NUCLEAR USE ONLY

11. RFD/RFW REQ’D ☐ LAR REQ'D ☐

ILS MOD REQ’D ☐

SRD/PLAN REV REQ'D ☐

DWG NO.: _____________________ S/A NO.: ___________________

12. ISOLATION SIGN: BADGE: SHOP/CODE: DATE: PHONE NO.:

SATISFACTORY:

13. SUBSAFE OQE RECORD? SIGN: BADGE: SHOP/CODE: DATE: PHONE NO.

YES ☐ NO ☐

14. CORRECTIVE ACTION SIGN: BADGE: SHOP/CODE: DATE: PHONE NO.

COMPLETE:

15. INSPECTION REQ’D? INSPECTION COMPLETE/SIGN: BADGE: SHOP/CODE: DATE: PHONE NO.

_________:YES ☐ NO ☐

16. RECORDS REVIEW SIGN: BADGE: SHOP/CODE: DATE: PHONE NO.

COMPLETE (DR ONLY)

DL’s ISSUED

(DR ONLY)

FOUO: Public availability to be determined under 5 USC 552 SHEET_____OF_____

☐ NUCLEAR Deficiency Form Continuation Sheet ☐ NON-NUCLEAR

1. SHIP/HULL NO.: 2a. DL or DR No.

(Circle One) 2b. REVISION: 3a. COMPONENT NAME: 3b. TYPE: 3c. PHASE: 3d. REPEAT:

LCC-19 1A BLR SAF V & PNL AY A 0

MAPPING PLAN

3819P22114A14 ENCLOSURE-01

SHEET 1 OF 1

FJ-1

COMUSFLTFORCOMINST 4790.3 REV D CHG 3

07 Nov 2023

JOINT/COMPONENT ASSEMBLY RECORD Planning must fill in blocks identified by a prior to issuing.

QA FORM 34A

(For Assemblies Not Requiring Torque Documentation)

PAGE __1___ OF __1___

1. SHIP HULL

NO.

2. JCN 3. LWC/SHOP 4. CWP/REC

NO.

5. SYSTEM/COMPONENT/ROTATABLE POOL

NO

USS BLUE RIDGE LCC-19 EM02-L194 KTR N/A 1A Superheater Safety Valve Inlet Flange

6. REFERENCES (Specify Assembly Number if applicable.)

A. MAPPING PLAN, ENCLOSURE-01 B. TGI No. 3819P22114 A14 C.

D. E. F.

7. NEW MATERIAL

PC

NO.

REF. JOINT

ID

DESCRIPTION

(Include thickness for shims; diameter and thread pitch for fasteners)

QTY LOE IDENT (E.G., MIC NO/NSN/ROTATABLE POOL

NO)

(FOR LEVEL I FASTENERS: Include Material Marking, Color Code, Heat/Lot Number, and

Manufacturer’s Symbol)

CRAFT

INT

8. JOINT DATA

FOR OTHER THAN JOINT MAKE-UP, DESCRIBE

THE SPECIFIC ATTRIBUTE AND LOCATION OF

THE ACCEPTANCE CRITERIA. IDENTIFY

JOINTS THAT REQUIRE CONTROLLED

ASSEMBLY PROCEDURES.

INSPECTOR (SHIPYARDS ONLY - FOR CONTROLLED ASSEMBLY JOINTS ONLY) & CRAFTSMAN

SIGNATURE CERTIFIES:

(1) JOINT SEALING SURFACES, ALIGNMENT, GAP AND PARALLELISM ARE SAT PER

SPECIFIED REQUIREMENTS AND STUDS HAVE BEEN CHECKED FOR ROTATION IF APPLICABLE, OR

ATTRIBUTE IS ACCEPTABLE PER SPECIFIED CRITERIA.

(2) ALL NEW MATERIAL ASSOCIATED WITH THIS JOINT MEETS SPECIFIED REQUIREMENTS, IS

INSTALLED & LISTED IN BLOCK 7; EXISTING MATERIAL ASSOCIATED WITH THIS JOINT IS

ACCEPTABLE AND CORRECTLY INSTALLED.

FOR FLEET ONLY: FOR NON-CONTROLLED ASSEMBLIES WHEN NO SPECIFIC ATTRIBUTE IS

SPECIFIED, INSPECTOR SIGNATURE CERTIFIES ACCEPTANCE OF LEVEL I MATERIAL ONLY.

JOINT ID & JOINT TYPE OR ATTRIBUTE

DESCRIPTION

JT.

REF

(C) FOR

CRAFTSMAN OR

(I) FOR

INSPECTOR

CRAFTSMAN SIGNATURE/BADGE/DATE (FOR EACH JOINT/ATTRIBUTE)

INSPECTOR SIGNATURE/BADGE/DATE (FOR EACH (I) JOINT/ATTRIBUTE)

(C)

A. FJ-1

A B

B.

C.

D.

E.

9. LOCKING DEVICE INSTALLED

OR REQD ACTION:

NA

MATL. DESCRIPTION/NSN/PC. NO. JT. ID. CRAFTSMAN SIGNATURE/BADGE/DATE SAT

10. REMARKS (CRAFTSMAN/QAI SUBMIT A DF TO RESOLVE UNSAT DATA) (FOR USE WHEN SIGNATURE DOES NOT ALREADY

APPEAR ON FORM)

INITIAL SIGNATURE/BADGE NO.

11. LWC SUPERVISOR/SHOP SUPERVISOR SIGNATURE/BADGE NO (RECORD

REVIEWED FOR FINAL ACCEPTANCE)

12. QAS SIGNATURE /BADGE NO (RECORD HAS BEEN REVIEWED FOR

COMPLETENESS)

3819P22114A14 ENCLOSURE-02-1 TOTAL 1