3819P25507A01_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.: MN FEED 8-76-0-E PP A 0 0

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

LCC-19 USS BLUE RIDGE 25511 19P

CU PHASE TITLE:

*F/O - ACCOMPLISH THE RADIOGRAPHIC TEST INSPECTION FOR TGI NO. 3819P25507R01

PREPARING ACTIVITY:

PREPARED BY: CODE PHONE DATE

TAKAHIRO SHIBANO 234. 315-243-3583 25-APR-2025

APPROVED BY: CODE PHONE DATE

SHINICHI ITO 234. 315-243-4297 25-APR-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:

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.: MN FEED 8-76-0-E PP 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.

1-3 QAJ20A

(1-3)

J-1 M-1 Map (1)

1. SCOPE/PURPOSE

1.1 Title: Onboard Radiographic Test (RT) Inspection of Piping Welded Joint; accomplish

1.2 Location of Work:

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

1.3 Identification:

1.3.1 Quantity (3 EA), Welded Joint, Piping

System: No. 1B Main Feed, Economizer Outlet Size: 5 Inch IPS and 4 Inch IPS Material: Carbon Steel Joint Design: Butt Weld, P-3 Joint ID: PJ-1, PJ-2 and PJ-5 of TGI No. 3819P25507R01 Piping Class: Class P-1 Piping Remarks: See Mapping Plan Enclosure-01 for detail.

1.4 Security Classification: None.

1.5 Initial Condition: None.

1.6 Contractor work start date:

1.7 Contractor work completion date:

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-26 NAVSEA Standard Items - 1 N 2 LI FY-26 Local Standard Items - ORG 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:

4.1 None.

5. PROCEDURE:

7/21/2026

11/21/2027

FOUO

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

5.1 Accomplish the requirements of 009-112 of 2.1.

5.2 Accomplish the requirements of 009-012 of 2.1, including Table One, Column A, Line 11 for RT inspection of each welded joint listed in 1.3.1, using Enclosure-01 for guidance.

5.2.1 Accomplish the requirements of 009-009 of 2.1.

5.2.2 Obtain each copy of QA Form 20 Enclosure-02-1 through Enclosure-02-3 of TGI No. 3819P25507R01 for verification of joint ID PJ-1, PJ-2 and PJ-5. See 5.3.4.

5.2.3 Accomplish the requirements of 099-911YO of 2.2, using QA Form J20A Enclosure-02-1 through Enclosure- 02-3.

5.3 Notes:

5.3.1 Planner: Code 234 T. Shibano, 243-3583

Engineer: Code 260 T. Uno, 243-5085

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

5.3.3 Welding of each joint has been accomplished by SRF-JRMC in accordance with TGI No. 3819P25507R01 for joint ID PJ-1, PJ-2 and PJ-5.

5.3.4 SRF-JRMC WIM will provide a copy of QA Form 20 when requested by the Contractor.

5.3.5 JCN EM02-8919 is related to this TGI.

5.4 Government Furnished Material (GFM): None.

5.5 SRF-JRMC will provide the following service work: (TGI No. 3819P25507S03).

5.5.1 [C740] Crane and crane rigging service.

5.5.2 [X99E] Utilities service.

5.5.3 [X99M] Utility service, including low pressure air supply, water supply, and steam supply.

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

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

5.5.6 [C106R] RSO and ARSO service for RT.

5.5.7 [C135] QA inspection for (G)Symbol inspection.

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:

25511 MN FEED 8-76-0-E PP A 0 0

CU PHASE TITLE:

*F/O - ACCOMPLISH THE RADIOGRAPHIC TEST INSPECTION FOR TGI NO. 3819P25507R01

PRIMARY COMPONENT:

COMPONENT UNIT LIST (FOR ASSEMBLIES):

ATTACHMENT LIST:

1. ENCLOSURE-01 (3819P25507A01-Map.pdf) saved on 24-APR-2025 0000.

2. ENCLOSURE-02 (3819P25507A01-QAJ20A.docx) saved on 24-APR-2025 0000.

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

YAGINUMA ,TAKEHIDE 8-76-0-E 8 U

JO: KO: TOTAL MAN HRS: PLANNING ACCEPTANCE:

3819P25507 A01

TOTAL MAT’L COST TOTAL DURATION:

CU PHASE DESCRIPTION:

The purpose of this TGI is to accomplish the Radiographic Test (RT) inspection of 1B boiler feed water piping for supporting of TGI No. 3819P25507R01.

Location of Work:

Fire Room (8-76-0-E)

TASK NAME

SHOP TSD/WC TS CREW# MHRS

HIGH RAD

HOURS

RC

GRID#

5.2 QA

CFM:

(cost for radiographic test of each welded joint and MISC.)

Process Funding Document.

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:

25511 MN FEED 8-76-0-E PP A 0 0

CU PHASE TITLE:

*F/O - ACCOMPLISH THE RADIOGRAPHIC TEST INSPECTION FOR TGI NO. 3819P25507R01

MATERIAL REFERENCES

REF

NO.

DOCUMENT/DRAWING

NUMBER

DOCUMENT/DRAWING TITLE REV

JOB ORDER: KEY OP:

3819P25507 A01

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

NOTES:

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 MN FEED 8-76-0-E PP A 0

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

3819P25507 A01

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 MN FEED 8-76-0-E PP A 0

Takahiro.Shibano.ja Text Box

ENCLOSURE-01

Takahiro.Shibano.ja_1 Text Box 3819P25507A01

Takahiro.Shibano.ja_2 Text Box

SHEET 1 OF 1

3819P25507A01 ENCLOSURE-02-1 TOTAL 3

REPORT OF RT OPERATIONS AND EVALUATION PAGE _1_ OF _2_

QA FORM J20A (FRONT)

2. SHIP AND HULL NO.:

USS BLUE RIDGE (LCC-19)

3. JOB ORDER/KEY OP.:

3819P25507/A01

4. CU PHASE TITLE:

*F/O - ACCOMPLISH THE RADIOGRAPHIC TEST INSPECTION

FOR TGI NO. 3819P25507R01

5. RT PERFORMED BY: 6. SPECIMEN MATERIAL:

[] CSTL [] CRES [] CUNI [] AL [] OTHER:

7. TM: 8. TS: 9. JOINT ID

PJ-1

10. WELD TYPE:

[] Butt [] W/backing [] Backing removed [] Con insert [] Other:

11. REPAIR NO.

[] Orig. [] R-

12. INSPECTION PROCEDURE(S):

13. ACCEPTANCE STANDARD

[] MIL-STD 2035 [] MIL-STD 1689 [] Other: [] Class 1 [] Class 2 [] Class 3

14. PENETRAMETER:

SIZE: GROUP: []02 []1 []4 []Other:

15. PENETRAMETER PLACEMENT

[] Source side [] Film Side [] On/off [] Separate block

16. PENETRAMETER TYPE:

[] MIL-Type [] ASTM-Type

17. QUALITY LEVEL

[] 2-2T [] 2-4T []Other:

18. RT COVERAGE REQUIRED:

[] 60 DEG [] 360 DEG [] 100% [] Other:

19. EXPOSURE TECHNIQUE:

[] SWE/SWV [] DWE/SWV [] DWE/DWV [] O [] S

20. FILM TYPE: [] Fuji IX-80 [] Fuji IX-100 [] Other:

21. FILM LOAD

[] Single [] Double [] Other:

22. INTENSIFYING SCREENS:

[] Pb Oxide [] Pb Foil

23. FRONT FILTER Tm:

[] N/A

24. BACK FILTER Tm:

25. RADIATION SOURCE:

[] X-ray [] Ir-192 [] Se-75 [] Co 60

26. VOLTAGE / CURIES: 27. FSS / SOURCE DIM.: 28. SFD:

Min: Act:

29. BEAM ANGLE:

30. SHIM MATERIAL: []N/A

GROUP: []02 []1 []4 []Other:

31. SHIM THICKNESS: []N/A 32. FILM ID: []N/A 33. MASKING

[] Used [] Not Used

34. RADIOGRAPHIC SHOOTING SKETCH

Depict the following: (1) Direction of radiation (2) Placement of penetrameter (3) Location of location marker (4) Location of shims (if used)

(5) Location of Pb "B" (6) Location & thickness of back filter (7) Location of film (8) Blocking/masking technique used (if applicable)

STANDARD

SET-UPS

[ ] TECH 1

SWE/SWV

[ ] TECH 2

DWE/SWV

[ ] TECH 3

DWE/DWV (O)

[ ] TECH 4

DWE/DWV (S)

NOTE: REFERENCE TO A STANDARD SETUP IS ACCEPTABLE

35. REMARKS:

36. RADIOGRAPHER DATE (DATE OF EXPOSURE): 37. REPORT NUMBER:

3819P25507A01 ENCLOSURE-02-1 TOTAL 3

REPORT OF RT OPERATIONS AND EVALUATION PAGE _2_ OF _2_

QA FORM J20A (BACK)

38. RADIOGRAPHIC INTERPRETATION OF JOINT NO.: __________ 39. REMARKS AND INDICATION

DETAILS:

(a) LOCATION MARKERS (INCREMENTS)

(b) PENETRAMETER PLACEMENT

(c) REQ. T-HOLE VISIBLE

(d) DENSITY (PENE AND AOI)

(e) BACKSCATTER CONTROL (LEAD “B’)

(1) CRACK

(2) SLAG/OXIDE

(3) POROSITY

(4) LACK OF PENETRATION

(5) LACK OF FUSION

(6) MELT THROUGH

(7) BURN THROUGH

(8) ROOT OXIDATION

(9) CRATER PIT

(10) TUNGSTEN INCLUSION

(11) ROOT SURFACE CONCAVITY

(12) ROOT SURFACE CONVEXITY

(13) UNDERCUT

(14) ROOT CENTER LINE CREASE

(15) INCOMPLETE INSERT MELT

(16) QUESTIONABLE DISCONTINUITY

(17) FILM ARTIFACTS

(18) BASE METAL INDICATIONS

(19) INADVERTENT RADIOGRAPHY

(20)

(21)

(22)

40. INTERPRETATION KEY:

(1) Blocks left blank – condition is NOT present on the film

(2) Blocks marked O – condition is present on the film and is acceptable.

(3) Blocks marked X – condition is present on the film and rejectable.

(4) Blocks marked with prepared notes (①,②, etc.) – condition present and see applicable note(s).

41. PREPARED NOTES

① Visually verified as an acceptable surface condition.

② Engineering evaluation required/requested via CFR.

③ Artifacts (Crimp or pressure marks, processing marks, finger prints, streaks, etc.) present on film and do not interfere with interpretation.

④ Film superimposed for interpretation, evaluation.

⑤

⑥

42. REMARKS

43. CONDITION FOUND REPORTS (CFR) NUMBER(s) SUBMITTED: []N/A

44. FINAL DISPOSITION

[ ] ACCEPT [ ] REJECT

45. RT INSPECTOR DATE 46. REPORT NUMBER:

THE PERSON DESIGNATED TO SIGN FOR AN ACTION VERIFIES, BASED ON PERSONAL OBSERVATION OR CERTIFIED RECORDS, AND CERTIFIES BY HIS/HER SIGNATURE THAT THE ACTION HAS BEEN PERFORMED IN ACCORDANCE WITH THE SPECIFIED REQUIREMENTS.

3819P25507A01 ENCLOSURE-02-2 TOTAL 3

QA FORM J20A (FRONT)

2. SHIP AND HULL NO.:

USS BLUE RIDGE (LCC-19)

3. JOB ORDER/KEY OP.:

3819P25507/A01

4. CU PHASE TITLE:

*F/O - ACCOMPLISH THE RADIOGRAPHIC TEST INSPECTION

FOR TGI NO. 3819P25507R01

5. RT PERFORMED BY: 6. SPECIMEN MATERIAL:

[] CSTL [] CRES [] CUNI [] AL [] OTHER:

7. TM: 8. TS: 9. JOINT ID

PJ-2

10. WELD TYPE:

[] Butt [] W/backing [] Backing removed [] Con insert [] Other:

11. REPAIR NO.

[] Orig. [] R-

12. INSPECTION PROCEDURE(S):

13. ACCEPTANCE STANDARD

[] MIL-STD 2035 [] MIL-STD 1689 [] Other: [] Class 1 [] Class 2 [] Class 3

14. PENETRAMETER:

SIZE: GROUP: []02 []1 []4 []Other:

15. PENETRAMETER PLACEMENT

[] Source side [] Film Side [] On/off [] Separate block

16. PENETRAMETER TYPE:

[] MIL-Type [] ASTM-Type

17. QUALITY LEVEL

[] 2-2T [] 2-4T []Other:

18. RT COVERAGE REQUIRED:

[] 60 DEG [] 360 DEG [] 100% [] Other:

19. EXPOSURE TECHNIQUE:

[] SWE/SWV [] DWE/SWV [] DWE/DWV [] O [] S

20. FILM TYPE: [] Fuji IX-80 [] Fuji IX-100 [] Other:

21. FILM LOAD

[] Single [] Double [] Other:

22. INTENSIFYING SCREENS:

[] Pb Oxide [] Pb Foil

23. FRONT FILTER Tm:

[] N/A

24. BACK FILTER Tm:

25. RADIATION SOURCE:

[] X-ray [] Ir-192 [] Se-75 [] Co 60

26. VOLTAGE / CURIES: 27. FSS / SOURCE DIM.: 28. SFD:

Min: Act:

29. BEAM ANGLE:

30. SHIM MATERIAL: []N/A

GROUP: []02 []1 []4 []Other:

31. SHIM THICKNESS: []N/A 32. FILM ID: []N/A 33. MASKING

[] Used [] Not Used

34. RADIOGRAPHIC SHOOTING SKETCH

Depict the following: (1) Direction of radiation (2) Placement of penetrameter (3) Location of location marker (4) Location of shims (if used)

(5) Location of Pb "B" (6) Location & thickness of back filter (7) Location of film (8) Blocking/masking technique used (if applicable)

STANDARD

SET-UPS

[ ] TECH 1

SWE/SWV

[ ] TECH 2

DWE/SWV

[ ] TECH 3

DWE/DWV (O)

[ ] TECH 4

DWE/DWV (S)

NOTE: REFERENCE TO A STANDARD SETUP IS ACCEPTABLE

36. RADIOGRAPHER DATE (DATE OF EXPOSURE): 37. REPORT NUMBER:

3819P25507A01 ENCLOSURE-02-2 TOTAL 3

QA FORM J20A (BACK)

38. RADIOGRAPHIC INTERPRETATION OF JOINT NO.: __________ 39. REMARKS AND INDICATION

DETAILS:

(a) LOCATION MARKERS (INCREMENTS)

(b) PENETRAMETER PLACEMENT

(c) REQ. T-HOLE VISIBLE

(d) DENSITY (PENE AND AOI)

(e) BACKSCATTER CONTROL (LEAD “B’)

(1) CRACK

(2) SLAG/OXIDE

(3) POROSITY

(4) LACK OF PENETRATION

(5) LACK OF FUSION

(6) MELT THROUGH

(7) BURN THROUGH

(8) ROOT OXIDATION

(9) CRATER PIT

(10) TUNGSTEN INCLUSION

(11) ROOT SURFACE CONCAVITY

(12) ROOT SURFACE CONVEXITY

(13) UNDERCUT

(14) ROOT CENTER LINE CREASE

(15) INCOMPLETE INSERT MELT

(16) QUESTIONABLE DISCONTINUITY

(17) FILM ARTIFACTS

(18) BASE METAL INDICATIONS

(19) INADVERTENT RADIOGRAPHY

(20)

(21)

(22)

40. INTERPRETATION KEY:

(1) Blocks left blank – condition is NOT present on the film

(2) Blocks marked O – condition is present on the film and is acceptable.

(3) Blocks marked X – condition is present on the film and rejectable.

(4) Blocks marked with prepared notes (①,②, etc.) – condition present and see applicable note(s).

41. PREPARED NOTES

① Visually verified as an acceptable surface condition.

② Engineering evaluation required/requested via CFR.

③ Artifacts (Crimp or pressure marks, processing marks, finger prints, streaks, etc.) present on film and do not interfere with interpretation.

④ Film superimposed for interpretation, evaluation.

⑤

⑥

42. REMARKS

43. CONDITION FOUND REPORTS (CFR) NUMBER(s) SUBMITTED: []N/A

44. FINAL DISPOSITION

[ ] ACCEPT [ ] REJECT

45. RT INSPECTOR DATE 46. REPORT NUMBER:

THE PERSON DESIGNATED TO SIGN FOR AN ACTION VERIFIES, BASED ON PERSONAL OBSERVATION OR CERTIFIED RECORDS, AND CERTIFIES BY HIS/HER SIGNATURE THAT THE ACTION HAS BEEN PERFORMED IN ACCORDANCE WITH THE SPECIFIED REQUIREMENTS.

3819P25507A01 ENCLOSURE-02-3 TOTAL 3

QA FORM J20A (FRONT)

2. SHIP AND HULL NO.:

USS BLUE RIDGE (LCC-19)

3. JOB ORDER/KEY OP.:

3819P25507/A01

4. CU PHASE TITLE:

*F/O - ACCOMPLISH THE RADIOGRAPHIC TEST INSPECTION

FOR TGI NO. 3819P25507R01

5. RT PERFORMED BY: 6. SPECIMEN MATERIAL:

[] CSTL [] CRES [] CUNI [] AL [] OTHER:

7. TM: 8. TS: 9. JOINT ID

PJ-5

10. WELD TYPE:

[] Butt [] W/backing [] Backing removed [] Con insert [] Other:

11. REPAIR NO.

[] Orig. [] R-

12. INSPECTION PROCEDURE(S):

13. ACCEPTANCE STANDARD

[] MIL-STD 2035 [] MIL-STD 1689 [] Other: [] Class 1 [] Class 2 [] Class 3

14. PENETRAMETER:

SIZE: GROUP: []02 []1 []4 []Other:

15. PENETRAMETER PLACEMENT

[] Source side [] Film Side [] On/off [] Separate block

16. PENETRAMETER TYPE:

[] MIL-Type [] ASTM-Type

17. QUALITY LEVEL

[] 2-2T [] 2-4T []Other:

18. RT COVERAGE REQUIRED:

[] 60 DEG [] 360 DEG [] 100% [] Other:

19. EXPOSURE TECHNIQUE:

[] SWE/SWV [] DWE/SWV [] DWE/DWV [] O [] S

20. FILM TYPE: [] Fuji IX-80 [] Fuji IX-100 [] Other:

21. FILM LOAD

[] Single [] Double [] Other:

22. INTENSIFYING SCREENS:

[] Pb Oxide [] Pb Foil

23. FRONT FILTER Tm:

[] N/A

24. BACK FILTER Tm:

25. RADIATION SOURCE:

[] X-ray [] Ir-192 [] Se-75 [] Co 60

26. VOLTAGE / CURIES: 27. FSS / SOURCE DIM.: 28. SFD:

Min: Act:

29. BEAM ANGLE:

30. SHIM MATERIAL: []N/A

GROUP: []02 []1 []4 []Other:

31. SHIM THICKNESS: []N/A 32. FILM ID: []N/A 33. MASKING

[] Used [] Not Used

34. RADIOGRAPHIC SHOOTING SKETCH

Depict the following: (1) Direction of radiation (2) Placement of penetrameter (3) Location of location marker (4) Location of shims (if used)

(5) Location of Pb "B" (6) Location & thickness of back filter (7) Location of film (8) Blocking/masking technique used (if applicable)

STANDARD

SET-UPS

[ ] TECH 1

SWE/SWV

[ ] TECH 2

DWE/SWV

[ ] TECH 3

DWE/DWV (O)

[ ] TECH 4

DWE/DWV (S)

NOTE: REFERENCE TO A STANDARD SETUP IS ACCEPTABLE

36. RADIOGRAPHER DATE (DATE OF EXPOSURE): 37. REPORT NUMBER:

3819P25507A01 ENCLOSURE-02-3 TOTAL 3

QA FORM J20A (BACK)

38. RADIOGRAPHIC INTERPRETATION OF JOINT NO.: __________ 39. REMARKS AND INDICATION

DETAILS:

(a) LOCATION MARKERS (INCREMENTS)

(b) PENETRAMETER PLACEMENT

(c) REQ. T-HOLE VISIBLE

(d) DENSITY (PENE AND AOI)

(e) BACKSCATTER CONTROL (LEAD “B’)

(1) CRACK

(2) SLAG/OXIDE

(3) POROSITY

(4) LACK OF PENETRATION

(5) LACK OF FUSION

(6) MELT THROUGH

(7) BURN THROUGH

(8) ROOT OXIDATION

(9) CRATER PIT

(10) TUNGSTEN INCLUSION

(11) ROOT SURFACE CONCAVITY

(12) ROOT SURFACE CONVEXITY

(13) UNDERCUT

(14) ROOT CENTER LINE CREASE

(15) INCOMPLETE INSERT MELT

(16) QUESTIONABLE DISCONTINUITY

(17) FILM ARTIFACTS

(18) BASE METAL INDICATIONS

(19) INADVERTENT RADIOGRAPHY

(20)

(21)

(22)

40. INTERPRETATION KEY:

(1) Blocks left blank – condition is NOT present on the film

(2) Blocks marked O – condition is present on the film and is acceptable.

(3) Blocks marked X – condition is present on the film and rejectable.

(4) Blocks marked with prepared notes (①,②, etc.) – condition present and see applicable note(s).

41. PREPARED NOTES

① Visually verified as an acceptable surface condition.

② Engineering evaluation required/requested via CFR.

③ Artifacts (Crimp or pressure marks, processing marks, finger prints, streaks, etc.) present on film and do not interfere with interpretation.

④ Film superimposed for interpretation, evaluation.

⑤

⑥

42. REMARKS

43. CONDITION FOUND REPORTS (CFR) NUMBER(s) SUBMITTED: []N/A

44. FINAL DISPOSITION

[ ] ACCEPT [ ] REJECT

45. RT INSPECTOR DATE 46. REPORT NUMBER:

THE PERSON DESIGNATED TO SIGN FOR AN ACTION VERIFIES, BASED ON PERSONAL OBSERVATION OR CERTIFIED RECORDS, AND CERTIFIES BY HIS/HER SIGNATURE THAT THE ACTION HAS BEEN PERFORMED IN ACCORDANCE WITH THE SPECIFIED REQUIREMENTS.