Appendix F Template.pdf

24 November 2015 Appendix F – AE2100 QEC Structure Inspection

Appendix F - Page 1 of 48

UNCLASSIFIED/FOR OFFICIAL USE ONLY

QEC S/N: LMG7169- Performed at: TMMC Date:

Removed from Engine S/N: KC-130J Event BUNO:

Instrument Type Instrument S/N Probe Type Probe S/N Cs -137

Efficiency (%)

Nominal Minimum Detectible

Activity (MDA)

Calibration Date

LAM12 1309LAM12008 N/A N/A N/A

*All items within this document were frisked for radioactive contamination in accessible locations. Some items were also swiped/swabbed depending on geometry or presence of loose debris (ex. dirt) to obtain a removable (loose) contamination value. The highest reading was placed in data column.

_____No loose contamination above 1,000 dpm/100 cm2, fixed contamination above 5,000 dpm/100 cm2, or 15,000 dpm total activity per component was found on any component.

X X X Radiation Safety Officer Surveyor Reviewer Signature/Printed Name/Date Signature/Printed Name/Date Signature/Printed Name/Date

X X X Signature/Printed Name/Date Signature/Printed Name/Date Signature/Printed Name/Date

X X X Signature/Printed Name/Date Signature/Printed Name/Date Signature/Printed Name/Date

Appendix F - Page 2 of 48

UNCLASSIFIED/FOR OFFICIAL USE ONLY

Inspection Requirements:

List all of the equipment used for the inspection on Page 1.

Circumferential items/features shall be inspected at a minimum of three locations with up to a 360 degree inspection as available. Reading from circumferential location with highest reading shall be recorded.

Inspection surface points that exceed 0.5 inch from the survey instrument probe shall be wiped, and the wipe shall be analyzed for radioactivity.

This inspection has instances where multiple items share the same figure and description; survey all items and record the highest value.

For parts with a large surface area describe the dimensions and location of the area(s) that exhibits contamination in excess of 5,000 dpm/100 cm2.

Part numbers are representative numbers listed for reference only. Refer to applicable C-130 publications for alternate part numbers.

“N/R” used throughout this document signifies “not required”. “N/A” used throughout this document signifies “not applicable”.

For item surveys which have an Item # “All Assy”, items shall be hand frisked as an assembly and record the highest hand frisk survey reading in the initial Survey block.

For items requiring LAM 12 survey, if hand frisk survey readings are below limits, items shall also be surveyed in the LAM 12 bulk counter as an assembly and record the reading in the Initial LAM 12 survey block.

If bulk counter and hand frisk survey readings are within the limits on page 1 of this appendix, then further disassembly is not required and the “All Assy” reading shall be applied to all parts in the table.

If hand frisk survey or LAM 12 survey readings are above the limits, then follow approved DECON procedures identified in the plan, record individual item survey data, and circle any parts on the diagram that are quarantined.

Appendix F - Page 3 of 48

UNCLASSIFIED/FOR OFFICIAL USE ONLY

Inspection Requirements: (continued)

For item surveys which have an Item # “All Assy” and require LAM 12 survey, if all of the items identified will not fit in the LAM 12 simultaneously, annotate on the survey page accordingly, and use the LAM 12 results ID column to differentiate between “lots” of parts surveyed.

If hand frisk survey or LAM 12 survey readings are above the limits, then follow approved DECON procedures identified in the plan, record individual item survey data, and circle any parts on the diagram that are quarantined.

If contamination is found on items not specifically identified in the tables, then manually annotate survey location and values on the bottom of the survey sheet.

Apply any transmission factors to the LAM 12 results as deemed appropriate for the component being surveyed and ensure the transmission factor is recorded on the LAM 12 survey form. As a guide, use the following transmission factors:

Thickness of Metal Transmission Factor

0.5 inch 0.75

1.0 inch 0.50

2.0 inch 0.25

For items surveyed utilizing the LAM 12 bulk counter, insert the LAM 12 results ID number in the applicable results ID column of the survey sheet and attach applicable LAM 12 printouts to the inspection package. Annotate appendix page, figure number, item number, and applied transmission factors on each LAM 12 printout.

Appendix F - Page 4 of 48

UNCLASSIFIED/FOR OFFICIAL USE ONLY

SUPPLEMENTAL QUARANTINE PARTS LIST SHEET INSTRUCTIONS

One sheet is provided. Attach additional sheets, as necessary.

Enter engine S/N from Page 1, module (QEC, PGB, GMAD, torquemeter, or power section), and last survey date.

In the Appen. - Page # column, enter the appendix letter, followed by a “–“, then the appendix page number.

Enter the figure #, item #, and description from the applicable survey sheet, in the applicable columns.

Enter the P/N and S/N identified on the part, in the applicable columns. If the part is not serialized, enter “N/A” in the S/N column.

Enter final survey measurement, final loose measurement, final LAM 12 results ID, and final LAM 12 measurement from the applicable DECON sheet, in the applicable columns.

In the space provided in page footer, enter the page number of the applicable quarantine page.

Engine S/N Module Module S/N Date

FRISK Surveyor's Signature/Printed Name/Date FRISK Reviewer's Signature/Printed Name/Date

LAM 12 Surveyor's Signature/Printed Name/Date LAM 12 Reviewer's Signature/Printed Name/Date

Appendix F – Page __________ of 48

UNCLASSIFIED/FOR OFFICIAL USE ONLY

QUARANTINED PARTS LIST

Appen

Page# Figure # Item # Description P/N S/N Final Survey

(dpm/100 cm2)

Final Loose/ Swipe (dpm/

100 cm2)

Final LAM 12 Results

ID

Final LAM 12 Survey (dpm total activity)

Appendix F - Page 6 of 48

UNCLASSIFIED/FOR OFFICIAL USE ONLY

SUPPLEMENTAL DECON SHEET INSTRUCTIONS

Attach sheet(s) as required following the frisk/LAM 12 initial survey page and before applicable LAM 12 survey sheets.

Enter the survey date, meter, probe, engine S/N, LAM 12 survey date, LAM 12 S/N, background, and Beta efficiency.

In the DECON Method column, annotate method of decontamination used (such as wipe, wash tank, etc.); provide additional comments as required.

Enter the figure number and item number that corresponds to the applicable survey page.

At the bottom of the page annotate survey plan page followed by “–“ then number of Supplemental DECON sheets.

Add detailed findings in the “Additional Comments” section, to include, but not limited to, areas on each component with the highest survey readings.

Survey Date Meter P/N 2224 Meter S/N

Probe P/N 43-93 Probe S/N

QEC S/N

LMG7169-

LAM 12 Survey Date LAM 12 S/N

1309LAM12008

Background (cpm) (field intentionally left blank)

FRISK Surveyor's Signature/Printed Name/Date FRISK Reviewer's Signature/Printed Name/Date

LAM 12 Surveyor's Signature/Printed Name/Date LAM 12 Reviewer's Signature/Printed Name/Date

Appendix F – Page __________ of 48

UNCLASSIFIED/FOR OFFICIAL USE ONLY

SUPPLEMENTAL DECON SHEET

FIGURE NUMBER:

Item # Initial Survey

(dpm/100 cm2)

Final Survey (dpm/100 cm2)

Initial Loose/ Swipe

(dpm/100 cm2)

Final Loose/ Swipe

(dpm/100 cm2)

Initial LAM 12 Results ID

Initial LAM 12 Survey (dpm total activity)

Final LAM 12 Results ID

Final LAM 12 Survey (dpm total activity)

DECON

Method

Quarantined?

(Y or N)

ADDITIONAL COMMENTS:

Survey Date Meter P/N 2224 Meter S/N

Probe P/N 43-93 Probe S/N

QEC S/N

LMG7169-

LAM 12 Survey Date N/A

LAM 12 S/N

N/A

Background (cpm) (field intentionally left blank)

FRISK Surveyor's Signature/Printed Name/Date FRISK Reviewer's Signature/Printed Name/Date

LAM 12 Surveyor's Signature/Printed Name/Date N/A

LAM 12 Reviewer's Signature/Printed Name/Date N/A

Appendix F - Page 9 of 48

UNCLASSIFIED/FOR OFFICIAL USE ONLY

QEC Structure Inspection Guide

Item # Description P/N Initial Survey (dpm/100 cm2)

Initial Loose/ Swipe

(dpm/100 cm2)

Initial LAM 12 Results ID

Initial LAM 12 Survey (dpm total activity)

DECON

Performed?

(Y or N)

Quarantined?

(Y or N)

FORWARD LEFT ACCESS PANEL

PP4L EXTERIOR AND INTERIOR

SURFACES

3357988-1 N/R N/R

FORWARD RIGHT ACCESS PANEL

PP4R EXTERIOR AND INTERIOR

SURFACES

357988-2 N/R N/R

3 PROPELLER CONTROLS ACCESS

DOOR H14 (IF PRESENT) 342176-31 N/R N/R

DIAPHRAGM ASSY, ENG COWLING

BAFFLE, UPPER (LEFT AND RIGHT)

FORWARD SURFACE

345538L 345538R N/R N/R

SCOOP ASSY, ENGINE AIR INTAKE

(SURVEY IN PGB VICINITY AS

SHOWN)

3350042-1 N/R N/R

6 GEARBOX COOLING AIR INLET

LOUVERS H11 (IF PRESENT)

342176-8 342176-9 N/R N/R

Note: Part numbers are representative numbers listed for reference only; refer to NAVAIR KC-130J Illustrated Parts Breakdown (IPB), 01-75GAJ-4-54-1, 01-75GAJ-4-71-1, or 01-75GAJ-4-72-1 for alternate part numbers.

Note: Part number list is not comprehensive; inspect all accessible components in area shown.

Survey Date Meter P/N 2224 Meter S/N

Probe P/N 43-93 Probe S/N

QEC S/N

LMG7169-

LAM 12 Survey Date N/A

LAM 12 S/N

N/A

Background (cpm) (field intentionally left blank)

FRISK Surveyor's Signature/Printed Name/Date FRISK Reviewer's Signature/Printed Name/Date

LAM 12 Surveyor's Signature/Printed Name/Date N/A

LAM 12 Reviewer's Signature/Printed Name/Date N/A

Appendix F - Page 11 of 48

UNCLASSIFIED/FOR OFFICIAL USE ONLY

QEC Structure Inspection Guide

Item # Description P/N Initial Survey (dpm/100 cm2)

Initial Loose/ Swipe

(dpm/100 cm2)

Initial LAM 12 Results ID

Initial LAM 12 Survey (dpm total activity)

DECON

Performed?

(Y or N)

Quarantined?

(Y or N)

10 LEFT UPPER ACCESS PANEL PP2L 3352131-1 N/R N/R

11 EXTERIOR SKIN 3342140-1 N/R N/R

12 INTERIOR SKIN AND STIFFENERS 3352140-1 N/R N/R

13 COOLING VENT ASSEMBLY H1L 363971-11 N/R N/R

14 SUPPORT STRUT TUBE ASSEMBLY 362590-9 N/R N/R

Note: Part numbers are representative numbers listed for reference only; refer to NAVAIR KC-130J Illustrated Parts Breakdown (IPB), 01-75GAJ-4-54-1, Survey Date Meter P/N 2224 Meter S/N

Probe P/N 43-93 Probe S/N

QEC S/N

LMG7169-

LAM 12 Survey Date N/A

LAM 12 S/N

N/A

Background (cpm) (field intentionally left blank)

FRISK Surveyor's Signature/Printed Name/Date FRISK Reviewer's Signature/Printed Name/Date

LAM 12 Surveyor's Signature/Printed Name/Date N/A

LAM 12 Reviewer's Signature/Printed Name/Date N/A

Appendix F - Page 13 of 48

UNCLASSIFIED/FOR OFFICIAL USE ONLY

QEC Structure Inspection Guide

Item # Description P/N Initial Survey

(dpm/100 cm2)

Initial Loose/ Swipe

(dpm/100 cm2)

Initial LAM 12 Results ID

Initial LAM 12 Survey (dpm total activity)

DECON

Performed?

(Y or N)

Quarantined?

(Y or N)

20 RIGHT UPPER ACCESS PANEL PP2R 3352131-2 N/R N/R

21 EXTERIOR SKIN 3342140-2 N/R N/R

INTERIOR SKIN AND STIFFENERS

AND EXTERIOR OF FADEC COOLING

DUCT

3342140-2 3352183-1 N/R N/R

FADEC COOLING VENT OUTLET H1R

AND INTERIOR OF FADEC COOLING

DUCT. IF CONTAMINATION IS

DETECTED, REMOVE FADEC DUCT

FROM PANEL FOR COMPLETE

DECONTAMINATION.

363971-12 3352183-1 N/R N/R

24 SUPPORT STRUT TUBE ASSEMBLY 346054-9 N/R N/R

Note: Part numbers are representative numbers listed for reference only; refer to NAVAIR KC-130J Illustrated Parts Breakdown (IPB), 01-75GAJ-4-54-1, Survey Date Meter P/N 2224 Meter S/N

Probe P/N 43-93 Probe S/N

QEC S/N

LMG7169-

LAM 12 Survey Date N/A

LAM 12 S/N

N/A

Background (cpm) (field intentionally left blank)

FRISK Surveyor's Signature/Printed Name/Date FRISK Reviewer's Signature/Printed Name/Date

LAM 12 Surveyor's Signature/Printed Name/Date N/A

LAM 12 Reviewer's Signature/Printed Name/Date N/A

Appendix F - Page 15 of 48

UNCLASSIFIED/FOR OFFICIAL USE ONLY

QEC Structure Inspection Guide

Item # Description P/N Initial Survey

(dpm/100 cm2)

Initial Loose/ Swipe

(dpm/100 cm2)

Initial LAM 12 Results ID

Initial LAM 12 Survey (dpm total activity)

DECON

Performed?

(Y or N)

Quarantined?

(Y or N)

ENGINE OIL ACCESS PANEL H14

INNER SURFACE, MATING

SURFACES, AND HINGE

362539-1 N/R N/R

26 FADEC COOLING DUCT SEAL 697986-1 N/R N/R

Note: Part numbers are representative numbers listed for reference only; refer to NAVAIR KC-130J Illustrated Parts Breakdown (IPB), 01-75GAJ-4-54-1, Survey Date Meter P/N 2224 Meter S/N

Probe P/N 43-93 Probe S/N

QEC S/N

LMG7169-

LAM 12 Survey Date N/A

LAM 12 S/N

N/A

Background (cpm) (field intentionally left blank)

FRISK Surveyor's Signature/Printed Name/Date FRISK Reviewer's Signature/Printed Name/Date

LAM 12 Surveyor's Signature/Printed Name/Date N/A

LAM 12 Reviewer's Signature/Printed Name/Date N/A

Appendix F - Page 17 of 48

UNCLASSIFIED/FOR OFFICIAL USE ONLY

QEC Structure Inspection Guide

Item # Description P/N Initial Survey (dpm/100 cm2)

Initial Loose/ Swipe

(dpm/100 cm2)

Initial LAM 12 Results ID

Initial LAM 12 Survey (dpm total activity)

DECON

Performed?

(Y or N)

Quarantined?

(Y or N)

30 LEFT SIDE ACCESS PANEL H4L 3352132-1 N/R N/R

31 EXTERIOR SKIN 362570-2 N/R N/R

32 LEADING EDGE OF COOLING INLET

SCOOP ASSY. H10 335179-1 N/R N/R

33 INTERIOR SKIN AND STIFFENERS 362570-3 N/R N/R

HINGE LEAVES AND TANGS –

ROTATE HINGES TO EXPOSE MORE

AREA

362552-1 N/R N/R

35 SUPPORT STRUT 346054-9 N/R N/R

Note: Part numbers are representative numbers listed for reference only; refer to NAVAIR KC-130J Illustrated Parts Breakdown (IPB), 01-75GAJ-4-54-1, Survey Date Meter P/N 2224 Meter S/N

Probe P/N 43-93 Probe S/N

QEC S/N

LMG7169-

LAM 12 Survey Date N/A

LAM 12 S/N

N/A

Background (cpm) (field intentionally left blank)

FRISK Surveyor's Signature/Printed Name/Date FRISK Reviewer's Signature/Printed Name/Date

LAM 12 Surveyor's Signature/Printed Name/Date N/A

LAM 12 Reviewer's Signature/Printed Name/Date N/A

Appendix F - Page 19 of 48

UNCLASSIFIED/FOR OFFICIAL USE ONLY

QEC Structure Inspection Guide

Item # Description P/N Initial Survey (dpm/100 cm2)

Initial Loose/ Swipe

(dpm/100 cm2)

Initial LAM 12 Results ID

Initial LAM 12 Survey (dpm total activity)

DECON

Performed?

(Y or N)

Quarantined?

(Y or N)

40 RIGHT SIDE ACCESS PANEL H4R 3352133-1 N/R N/R

41 EXTERIOR SKIN 362571-17 N/R N/R

42 LEADING EDGE OF COOLING SCOOP

ASSY. INLET H10 3352179-2 N/R N/R

43 INTERIOR SKIN AND STIFFENERS 362571-49 N/R N/R

HINGE LEAVES AND TANGS –

ROTATE HINGES TO EXPOSE MORE

AREA

362552-1 N/R N/R

45 SUPPORT STRUT 364054-9 N/R N/R

Note: Part numbers are representative numbers listed for reference only; refer to NAVAIR KC-130J Illustrated Parts Breakdown (IPB) 01-75GAJ-4-54-1, Survey Date Meter P/N 2224 Meter S/N

Probe P/N 43-93 Probe S/N

QEC S/N

LMG7169-

LAM 12 Survey Date N/A

LAM 12 S/N

N/A

Background (cpm) (field intentionally left blank)

FRISK Surveyor's Signature/Printed Name/Date FRISK Reviewer's Signature/Printed Name/Date

LAM 12 Surveyor's Signature/Printed Name/Date N/A

LAM 12 Reviewer's Signature/Printed Name/Date N/A

Appendix F - Page 21 of 48

UNCLASSIFIED/FOR OFFICIAL USE ONLY

QEC Structure Inspection Guide

Item # Description P/N Initial Survey (dpm/100 cm2)

Initial Loose/ Swipe

(dpm/100 cm2)

Initial LAM 12 Results ID

Initial LAM 12 Survey (dpm total activity)

DECON

Performed?

(Y or N)

Quarantined?

(Y or N)

50 UPPER ACCESS PANEL HINGE BEAM

ALL SURFACES 362546-1 N/R N/R

51 UPPER FORWARD ACCESS PANEL

CHANNEL ALL SURFACES 342875 N/R N/R

52 LEFT HINGES – REMOVE PINS AND

INSPECT ALL SURFACES OF HINGES

363807-1 362565-3/-4 N/R N/R

53 RIGHT HINGES – REMOVE PINS AND

INSPECT ALL SURFACES OF HINGES

342875 362565-3/-4 N/R N/R

Note: Part numbers are representative numbers listed for reference only; refer to NAVAIR KC-130J Illustrated Parts Breakdown (IPB) 01-75GAJ-4-54-1, Survey Date Meter P/N 2224 Meter S/N

Probe P/N 43-93 Probe S/N

QEC S/N

LMG7169-

LAM 12 Survey Date N/A

LAM 12 S/N

N/A

Background (cpm) (field intentionally left blank)

FRISK Surveyor's Signature/Printed Name/Date FRISK Reviewer's Signature/Printed Name/Date

LAM 12 Surveyor's Signature/Printed Name/Date N/A

LAM 12 Reviewer's Signature/Printed Name/Date N/A

Appendix F - Page 23 of 48

UNCLASSIFIED/FOR OFFICIAL USE ONLY

QEC Structure Inspection Guide

Item # Description P/N Initial Survey

(dpm/100 cm2)

Initial Loose/ Swipe

(dpm/100 cm2)

Initial LAM 12 Results ID

Initial LAM 12 Survey (dpm total activity)

DECON

Performed?

(Y or N)

Quarantined?

(Y or N)

60 ENGINE AIR INTAKE ASSEMBLY 3350042-1 N/R N/R

61 OUTER SKINS 352863-3L

352863-3R N/R N/R

62 ENGINE AIR INTAKE LIP 3352135-1 OR

3352135-9 N/R N/R

63 ENGINE AIR INTAKE DUCT INTERIOR

AND EXTERIOR 3352137-1 N/R N/R

64 GEAR BOX DRAIN ACCESS PANELS

AND HINGES PP7L AND PP7R

351575L AND

351575R N/R N/R

65 INTERIOR AREA ACCESSIBLE

BEHIND PP7L AND PP7R OPENING 343603-7 N/R N/R

INNER SKIN SURFACES AND FRAMES

ACCESSIBLE FROM FWD AND AFT

BULKHEAD OPENINGS.

352863-3L N/R N/R

Note: Part numbers are representative numbers listed for reference only; refer to NAVAIR KC-130J Illustrated Parts Breakdown (IPB) 01-75GAJ-4-54-1, Survey Date Meter P/N 2224 Meter S/N

Probe P/N 43-93 Probe S/N

QEC S/N

LMG7169-

LAM 12 Survey Date N/A

LAM 12 S/N

N/A

Background (cpm) (field intentionally left blank)

FRISK Surveyor's Signature/Printed Name/Date FRISK Reviewer's Signature/Printed Name/Date

LAM 12 Surveyor's Signature/Printed Name/Date N/A

LAM 12 Reviewer's Signature/Printed Name/Date N/A

Appendix F - Page 25 of 48

UNCLASSIFIED/FOR OFFICIAL USE ONLY

QEC Structure Inspection Guide

Item # Description P/N Initial Survey (dpm/100 cm2)

Initial Loose/ Swipe

(dpm/100 cm2)

Initial LAM 12 Results ID

Initial LAM 12 Survey (dpm total activity)

DECON

Performed?

(Y or N)

Quarantined?

(Y or N)

70 OIL COOLER PAN ASSEMBLY 3350025-3 N/R N/R

71 OUTER SKINS 3350879-1 N/R N/R

72 OIL COOLER AIR INLET LIP 3352460-1 N/R N/R

73 OIL COOLER AIR INLET DUCT INNER

SKIN 3352463-1 N/R N/R

OIL COOLER ACCESS PANEL PP5

EXTERIOR, INTERIOR AND MATING

SURFACES

3350865-1 N/R N/R

75 OIL COOLER HOUSING COVER

INTERIOR 3350872-1 N/R N/R

76 OIL COOLER FLAP EXTERIOR SKIN 3352469-1 OR

-3 N/R N/R

77 DRAIN LINE GROMMET PP1 MS35489-14 N/R N/R

78 LEFT AND RIGHT DRAIN LINE

GROMMETS H7 MS35489-46 N/R N/R

Note: Part numbers are representative numbers listed for reference only; refer to NAVAIR KC-130J Illustrated Parts Breakdown (IPB) 01-75GAJ-4-54-1, Survey Date Meter P/N 2224 Meter S/N

Probe P/N 43-93 Probe S/N

QEC S/N

LMG7169-

LAM 12 Survey Date N/A

LAM 12 S/N

N/A

Background (cpm) (field intentionally left blank)

FRISK Surveyor's Signature/Printed Name/Date FRISK Reviewer's Signature/Printed Name/Date

LAM 12 Surveyor's Signature/Printed Name/Date N/A

LAM 12 Reviewer's Signature/Printed Name/Date N/A

Appendix F - Page 27 of 48

UNCLASSIFIED/FOR OFFICIAL USE ONLY

QEC Structure Inspection Guide

Item # Description P/N Initial Survey

(dpm/100 cm2)

Initial Loose/ Swipe

(dpm/100 cm2)

Initial LAM 12 Results ID

Initial LAM 12 Survey (dpm total activity)

DECON

Performed?

(Y or N)

Quarantined?

(Y or N)

80 OIL COOLER OUTLET DUCT SKINS 3350879-1 N/R N/R

81 OIL COOLER FLAP INNER SURFACE 3352465-1 N/R N/R

82 OIL COOLER FLAP ACTUATOR

BRACKET 3352467-1 N/R N/R

Note: Part numbers are representative numbers listed for reference only; refer to NAVAIR KC-130J Illustrated Parts Breakdown (IPB), 01-75GAJ-4-54-1, Survey Date Meter P/N 2224 Meter S/N

Probe P/N 43-93 Probe S/N

QEC S/N

LMG7169-

LAM 12 Survey Date N/A

LAM 12 S/N

N/A

Background (cpm) (field intentionally left blank)

FRISK Surveyor's Signature/Printed Name/Date FRISK Reviewer's Signature/Printed Name/Date

LAM 12 Surveyor's Signature/Printed Name/Date N/A

LAM 12 Reviewer's Signature/Printed Name/Date N/A

Appendix F - Page 29 of 48

UNCLASSIFIED/FOR OFFICIAL USE ONLY

QEC Structure Inspection Guide

Item # Description P/N Initial Survey

(dpm/100 cm2)

Initial Loose/ Swipe

(dpm/100 cm2)

Initial LAM 12 Results ID

Initial LAM 12 Survey (dpm total activity)

DECON

Performed?

(Y or N)

Quarantined?

(Y or N)

ALL ACCESSIBLE INTERIOR SKIN,

LONGERONS, INTERCOSTALS, AND

FORMER SURFACES OF OIL COOLER

PAN. CHECK ALL POCKETS WHERE

LOOSE DIRT CAN SETTLE OUT OF

AIRFLOW AND CHECK FRONT

SURFACES OF ALL FORMERS. IF

CONTAMINATION IS FOUND

DISASSEMBLE AS REQUIRED FOR

ADDITIONAL INSPECTION AND

DECONTAMINATION

3350879-1 3352463-1 3350872-1 3352455-1/-2 3352478-1 3352480-1

N/R N/R

Note: Part numbers are representative numbers listed for reference only; refer to NAVAIR KC-130J Illustrated Parts Breakdown (IPB) 01-75GAJ-4-71-1, 01-75GAJ-4-72-1, or drawing (98897) 3350025 for alternate part numbers.

Survey Date Meter P/N 2224 Meter S/N

Probe P/N 43-93 Probe S/N

QEC S/N

LMG7169-

LAM 12 Survey Date N/A

LAM 12 S/N

N/A

Background (cpm) (field intentionally left blank)

FRISK Surveyor's Signature/Printed Name/Date FRISK Reviewer's Signature/Printed Name/Date

LAM 12 Surveyor's Signature/Printed Name/Date N/A

LAM 12 Reviewer's Signature/Printed Name/Date N/A

Appendix F - Page 31 of 48

UNCLASSIFIED/FOR OFFICIAL USE ONLY

QEC Structure Inspection Guide

Item # Description P/N Initial Survey

(dpm/100 cm2)

Initial Loose/ Swipe

(dpm/100 cm2)

Initial LAM 12 Results ID

Initial LAM 12 Survey (dpm total activity)

DECON

Performed?

(Y or N)

Quarantined?

(Y or N)

100 LORD MOUNTS – FORWARD LEFT

AND RIGHT HAND LM-200-SA38 N/R N/R

101 LORD MOUNT - AFT LM-200-SA47 N/R N/R

Note: Part numbers are representative numbers listed for reference only; refer to NAVAIR KC-130J Illustrated Parts Breakdown (IPB) 01-75GAJ-4-71-1, or 01-75GAJ-4-72-1 for alternate part numbers.

Survey Date Meter P/N 2224 Meter S/N

Probe P/N 43-93 Probe S/N

QEC S/N

LMG7169-

LAM 12 Survey Date N/A

LAM 12 S/N

N/A

Background (cpm) (field intentionally left blank)

FRISK Surveyor's Signature/Printed Name/Date FRISK Reviewer's Signature/Printed Name/Date

LAM 12 Surveyor's Signature/Printed Name/Date N/A

LAM 12 Reviewer's Signature/Printed Name/Date N/A

Appendix F - Page 33 of 48

UNCLASSIFIED/FOR OFFICIAL USE ONLY

QEC Structure Inspection Guide

Item # Description P/N Initial Survey (dpm/100 cm2)

Initial Loose/ Swipe

(dpm/100 cm2)

Initial LAM 12 Results ID

Initial LAM 12 Survey (dpm total activity)

DECON

Performed?

(Y or N)

Quarantined?

(Y or N)

110 LEFT BEAM ASSEMBLY 3352162-7 N/R N/R

111 SKIN EXTERIOR SURFACES 362530 N/R N/R

ENGINE MOUNT ACCESS PANEL

PP9L INTERIOR, EXTERIOR, MATING

LIP

364021-1L N/R N/R

UPPER LONGERON ALL SURFACES

AND POCKETS (IF LONGERON IS

CONTAMINATED REMOVE FIRE

SHIELDS FOR INSPECTION)

362502-13 3352164-1 N/R N/R

LOWER LONGERON ALL SURFACES

AND POCKETS (IF LONGERON IS

CONTAMINATED REMOVE FIRE

SHIELDS FOR INSPECTION)

362501-7 N/R N/R

115 FRAMES AND STIFFENERS

3331872 3350911 3352165

N/R N/R

116 SKIN INTERIOR SURFACES 362530 N/R N/R

Note: Part numbers are representative numbers listed for reference only; refer to NAVAIR KC-130J Illustrated Parts Breakdown (IPB) 01-75GAJ-4-54-1, 01-75GAJ-4-71-1, 01-75GAJ-4-72-1, 01-75GAJ-4-54-1, or drawing (98897) 362530 for alternate part numbers.

Survey Date Meter P/N 2224 Meter S/N

Probe P/N 43-93 Probe S/N

QEC S/N

LMG7169-

LAM 12 Survey Date N/A

LAM 12 S/N

N/A

Background (cpm) (field intentionally left blank)

FRISK Surveyor's Signature/Printed Name/Date FRISK Reviewer's Signature/Printed Name/Date

LAM 12 Surveyor's Signature/Printed Name/Date N/A

LAM 12 Reviewer's Signature/Printed Name/Date N/A

Appendix F - Page 35 of 48

UNCLASSIFIED/FOR OFFICIAL USE ONLY

QEC Structure Inspection Guide

Item # Description P/N Initial Survey

(dpm/100 cm2)

Initial Loose/ Swipe

(dpm/100 cm2)

Initial LAM 12 Results ID

Initial LAM 12 Survey (dpm total activity)

DECON

Performed?

(Y or N)

Quarantined?

(Y or N)

LEFT FORWARD UPPER LONGERON

FIRE SHIELD AND HARDWARE

(REMOVE ONLY IF LONGERONS ARE

CONTAMINATED)

3352111-27 N/R N/R

LEFT AFT UPPER LONGERON FIRE

SHIELD AND HARDWARE (REMOVE

ONLY IF LONGERONS ARE

CONTAMINATED)

3352111-23 N/R N/R

LEFT LOWER LONGERON FIRE

SHIELD AND HARDWARE (REMOVE

ONLY IF LONGERONS ARE

CONTAMINATED)

3352111-15 N/R N/R

Note: Part numbers are representative numbers listed for reference only; refer to NAVAIR KC-130J Illustrated Parts Breakdown (IPB) 01-75GAJ-4-71-1, Survey Date Meter P/N 2224 Meter S/N

Probe P/N 43-93 Probe S/N

QEC S/N

LMG7169-

LAM 12 Survey Date N/A

LAM 12 S/N

N/A

Background (cpm) (field intentionally left blank)

FRISK Surveyor's Signature/Printed Name/Date FRISK Reviewer's Signature/Printed Name/Date

LAM 12 Surveyor's Signature/Printed Name/Date N/A

LAM 12 Reviewer's Signature/Printed Name/Date N/A

Appendix F - Page 37 of 48

UNCLASSIFIED/FOR OFFICIAL USE ONLY

QEC Structure Inspection Guide

Item # Description P/N Initial Survey (dpm/100 cm2)

Initial Loose/ Swipe

(dpm/100 cm2)

Initial LAM 12 Results ID

Initial LAM 12 Survey (dpm total activity)

DECON

Performed?

(Y or N)

Quarantined?

(Y or N)

130 RIGHT BEAM ASSEMBLY 3352162-8 N/R N/R

131 SKIN EXTERIOR SURFACES 362530 N/R N/R

UPPER LONGERON ALL SURFACES

AND POCKETS (IF LONGERON IS

CONTAMINATED REMOVE FIRE

SHIELDS FOR INSPECTION)

362502-14 3352164-2 N/R N/R

LOWER LONGERON ALL SURFACES

AND POCKETS (IF LONGERON IS

CONTAMINATED REMOVE FIRE

SHIELDS FOR INSPECTION)

362501-8 3352163-2 N/R N/R

ALL ACCESSIBLE BEAM FRAMES AND

STIFFENERS. IF CONTAMINATION IS

FOUND DISASSEMBLE AS REQUIRED

TO DECONTAMINATE

3331872 N/R N/R

135 ACCESSIBLE SKIN INTERIOR

SURFACES 362530 N/R N/R

Note: Part numbers are representative numbers listed for reference only; refer to NAVAIR KC-130J Illustrated Parts Breakdown (IPB) 01-75GAJ-4-71-1, 01-75GAJ-4-72-1, 01-75GAJ-4-54-1, or drawing (98897) 362530 for alternate part numbers.

Survey Date Meter P/N 2224 Meter S/N

Probe P/N 43-93 Probe S/N

QEC S/N

LMG7169-

LAM 12 Survey Date N/A

LAM 12 S/N

N/A

Background (cpm) (field intentionally left blank)

FRISK Surveyor's Signature/Printed Name/Date FRISK Reviewer's Signature/Printed Name/Date

LAM 12 Surveyor's Signature/Printed Name/Date N/A

LAM 12 Reviewer's Signature/Printed Name/Date N/A

Appendix F - Page 39 of 48

UNCLASSIFIED/FOR OFFICIAL USE ONLY

QEC Structure Inspection Guide

Item # Description P/N Initial Survey (dpm/100 cm2)

Initial Loose/ Swipe

(dpm/100 cm2)

Initial LAM 12 Results ID

Initial LAM 12 Survey (dpm total activity)

DECON

Performed?

(Y or N)

Quarantined?

(Y or N)

ENGINE MOUNT ACCESS PANEL

PP9R INTERIOR SURFACE,

EXTERIOR SURFACE, MATING LIP

364021-1R N/R N/R

137 AFT LORD MOUNT COOLING AIR

INLET (IF PRESENT) 341306-3 N/R N/R

PP8R AND OR PP10R ANTI-ICE

VALVE ACCESS PANEL (IF PRESENT)

INTERIOR SURFACE, EXTERIOR

SURFACE, MATING LIP, HINGE

364080-2 364020-1 N/R N/R

Note: Part numbers are representative numbers listed for reference only; refer to NAVAIR KC-130J Illustrated Parts Breakdown (IPB) 01-75GAJ-4-71-1, 01-75GAJ-4-72-1, 01-75GAJ-4-54-1, or drawing (98897) 362530 for alternate part numbers.

Survey Date Meter P/N 2224 Meter S/N

Probe P/N 43-93 Probe S/N

QEC S/N

LMG7169-

LAM 12 Survey Date N/A

LAM 12 S/N

N/A

Background (cpm) (field intentionally left blank)

FRISK Surveyor's Signature/Printed Name/Date FRISK Reviewer's Signature/Printed Name/Date

LAM 12 Surveyor's Signature/Printed Name/Date N/A

LAM 12 Reviewer's Signature/Printed Name/Date N/A

Appendix F - Page 41 of 48

UNCLASSIFIED/FOR OFFICIAL USE ONLY

QEC Structure Inspection Guide

Item # Description P/N Initial Survey (dpm/100 cm2)

Initial Loose/ Swipe

(dpm/100 cm2)

Initial LAM 12 Results ID

Initial LAM 12 Survey (dpm total activity)

DECON

Performed?

(Y or N)

Quarantined?

(Y or N)

RIGHT FORWARD UPPER

LONGERON FIRE SHIELD AND

HARDWARE (REMOVE ONLY IF

LONGERONS ARE CONTAMINATED)

3352111-1 N/R N/R

RIGHT AFT UPPER LONGERON FIRE

SHIELD AND HARDWARE (REMOVE

ONLY IF LONGERONS ARE

CONTAMINATED)

3352111-3 N/R N/R

RIGHT LOWER LONGERON FIRE

SHIELD AND HARDWARE (REMOVE

ONLY IF LONGERONS ARE

CONTAMINATED)

3352111-17 N/R N/R

Note: Part numbers are representative numbers listed for reference only; refer to NAVAIR KC-130J Illustrated Parts Breakdown (IPB) 01-75GAJ-4-71-1, Appendix F - Page 42 of 48

UNCLASSIFIED/FOR OFFICIAL USE ONLY

Survey Date Meter P/N 2224 Meter S/N

Probe P/N 43-93 Probe S/N

QEC S/N

LMG7169-

LAM 12 Survey Date N/A

LAM 12 S/N

N/A

Background (cpm) (field intentionally left blank)

FRISK Surveyor's Signature/Printed Name/Date FRISK Reviewer's Signature/Printed Name/Date

LAM 12 Surveyor's Signature/Printed Name/Date N/A

LAM 12 Reviewer's Signature/Printed Name/Date N/A

Appendix F - Page 43 of 48

UNCLASSIFIED/FOR OFFICIAL USE ONLY

QEC Structure Inspection Guide

Item # Description P/N Initial Survey (dpm/100 cm2)

Initial Loose/ Swipe

(dpm/100 cm2)

Initial LAM 12 Results ID

Initial LAM 12 Survey (dpm total activity)

DECON

Performed?

(Y or N)

Quarantined?

(Y or N)

150 CENTER MOUNT BEAM 362522 N/R N/R

151 AFT MOUNT BEAM

3331871

OR

363803-1

N/R N/R

152 DIAGONAL BRACE ASSEMBLY 363814-1 N/R N/R

Note: Part numbers are representative numbers listed for reference only; refer to NAVAIR KC-130J Illustrated Parts Breakdown (IPB) 01-75GAJ-4-71-1, 01-75GA4-54-1, or 01-75GAJ-4-72-1 for alternate part numbers.

Survey Date Meter P/N 2224 Meter S/N

Probe P/N 43-93 Probe S/N

QEC S/N

LMG7169-

LAM 12 Survey Date N/A

LAM 12 S/N

N/A

Background (cpm) (field intentionally left blank)

FRISK Surveyor's Signature/Printed Name/Date FRISK Reviewer's Signature/Printed Name/Date

LAM 12 Surveyor's Signature/Printed Name/Date N/A

LAM 12 Reviewer's Signature/Printed Name/Date N/A

Appendix F - Page 45 of 48

UNCLASSIFIED/FOR OFFICIAL USE ONLY

QEC Structure Inspection Guide

Item # Description P/N Initial Survey (dpm/100 cm2)

Initial Loose/ Swipe

(dpm/100 cm2)

Initial LAM 12 Results ID

Initial LAM 12 Survey (dpm total activity)

DECON

Performed?

(Y or N)

Quarantined?

(Y or N)

UPPER FIREWALL ASSEMBLY,

INSPECT AREAS ACCESSIBLE

WITHOUT REMOVING BEAMS OR

SUBSYSTEMS. IF CONTAMINATION

IS FOUND DISASSEMBLE AS

REQUIRED FOR ADDITIONAL

INSPECTIONS AND TO

DECONTAMINATE

362529 3352160 N/R N/R

LOWER FIREWALL ASSEMBLY,

INSPECT AREAS ACCESSIBLE

WITHOUT REMOVING BEAMS OR

SUBSYSTEMS. IF CONTAMINATION

IS FOUND DISASSEMBLE AS

REQUIRED FOR ADDITIONAL

INSPECTIONS AND TO

DECONTAMINATE

362537 N/R N/R

Note: Part numbers are representative numbers listed for reference only; refer to NAVAIR KC-130J Illustrated Parts Breakdown (IPB) 01-75GAJ-4-54-1, 01-75GAJ-4-71-1, 01-75GAJ-4-72-1, or drawings (98897) 362529, (98897) 3352160, or (98897) 362537 for alternate part numbers.

Appendix F - Page 46 of 48

UNCLASSIFIED/FOR OFFICIAL USE ONLY

FORWARD INLET DUCT,

SEE ITEM 63

INLET ANTI-ICE

FITTINGS AND DUCT,

SEE SUBSYSTEMS

APPENDIX C

TORQUE METER AND

SEALS, SEE

TORQUEMETER

APPENDIX I

Survey Date Meter P/N 2224 Meter S/N

Probe P/N 43-93 Probe S/N

QEC S/N

LMG7169-

LAM 12 Survey Date LAM 12 S/N

1309LAM12008

Background (cpm) (field intentionally left blank)

FRISK Surveyor's Signature/Printed Name/Date FRISK Reviewer's Signature/Printed Name/Date

LAM 12 Surveyor's Signature/Printed Name/Date LAM 12 Reviewer's Signature/Printed Name/Date

Appendix F - Page 47 of 48

UNCLASSIFIED/FOR OFFICIAL USE ONLY

QEC Structure Inspection Guide

Item # Description P/N Initial Survey (dpm/100 cm2)

Initial Loose/ Swipe

(dpm/100 cm2)

Initial LAM 12 Results ID

Initial LAM 12 Survey (dpm total activity)

DECON

Performed?

(Y or N)

Quarantined?

(Y or N)

ALL

ASSY

QEC STRUCTURE INSPECTION

GUIDE ITEMS 162, 163, AND 164 N/A

DUCT, ENGINE AIR AFT, UPPER HALF

INSPECT INNER AND OUTER

SURFACES OF DUCT ASSEMBLY.

3352144-1

DUCT, ENGINE AIR AFT, LOWER HALF

INSPECT INNER AND OUTER

SURFACES OF DUCT ASSEMBLY

3352136-1

164 INSPECT V-BAND CLAMP AND SEAL

COMPONENTS

348946, 3329882-5, 325-62-

1725SH,

42906

Note: Part numbers are representative numbers listed for reference only; refer to NAVAIR KC-130J Illustrated Parts Breakdown (IPB) 01-75GAJ-4-54-1, 01-75GAJ-4-71-1, 01-75GAJ-4-72-1, or drawings (98897) 362529, (98897) 3352160, or (98897) 362537 for alternate part numbers.

Appendix F - Page 48 of 48

UNCLASSIFIED/FOR OFFICIAL USE ONLY

THIS PAGE INTENTIONALLY LEFT BLANK