Appendix G Template.pdf

24 November 2015 Appendix G - AE2100 QEC Dolly and Preservation Bag Inspection

Appendix G - Page 1 of 16

UNCLASSIFIED/FOR OFFICIAL USE ONLY

QEC Dolly P/N: _______________ S/N: _______________ Performed at: TMMC QEC S/N: LMG7169- Removed from Engine S/N:

Date: ______________ 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 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 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 G - Page 2 of 16

UNCLASSIFIED/FOR OFFICIAL USE ONLY

Inspection Requirements:

*Refer to NAVAIR 03-20KWD-2, Instructions With Parts Breakdown and Available Accessories Dolly, Q.E.C (Quick Engine Change Dolly) and NAVAIR 01-75GAJ-13JG-00-1, Technical Manual Job Guide Preservation, for additional information as required. These instructions detail the inspection of the C-130J QEC bag and QEC dolly.

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 survey instrument probe shall be wiped, and the wipe 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.

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

Appendix G - Page 3 of 16

UNCLASSIFIED/FOR OFFICIAL USE ONLY

Inspection Requirements: (continued)

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.

If 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 readings are above the limits, then followed 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.

Appendix G - Page 4 of 16

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 N/A

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

Appendix G – Page __________ of 16

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 G - Page 6 of 16

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 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 G – Page __________ of 16

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:

Appendix G - Page 8 of 16

UNCLASSIFIED/FOR OFFICIAL USE ONLY

FIGURE 1. QEC DOLLY, QEC BAG, AND QEC ASSEMBLY.

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 G - Page 9 of 16

UNCLASSIFIED/FOR OFFICIAL USE ONLY

FIGURE 1. QEC DOLLY, QEC BAG, AND QEC ASSEMBLY.

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)

1* QEC BAG FORWARD (OR UPPER)

SECTION (EXTERNAL)

ATL-1175-

001G N/R N/R

2 QEC BAG ZIPPER ATL-1175-

001G N/R N/R

3 QEC BAG VELCRO STRIP ATL-1175-

001G N/R N/R

4* QEC BAG AFT (OR LOWER) SECTION

(EXTERNAL) (SEE FIGURE 3)

ATL-1175-

001G N/R N/R

5 DESICCANT (NOT ILLUSTRATED) MIL-D-3464,

TYPE II N/R N/R

* There are two different styles of the C-130 QEC bag: the two piece bag with forward and aft sections is illustrated, and the two piece bag with upper and lower sections is not illustrated.

* Also refer to Appendix G FIGURE 3. AFT PRESERVATION BAG INSTALLATION AND PRESERVATION BAG INTERNAL INSPECTION.

Manually annotate all other external survey locations

Appendix G - Page 10 of 16

FIGURE 2. ATTACHING HARDWARE

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 G - Page 11 of 16

UNCLASSIFIED/FOR OFFICIAL USE ONLY

FIGURE 2. ATTACHING HARDWARE

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)

1 NUT, UPPER MOUNTING 200-000-133 N/R N/R

2 WASHER UPPER MOUNTING AN960-1616 N/R N/R

3 BOLT UPPER MOUNTING BS31-1-8-6.5 N/R N/R

4 NUT, LOWER MOUNTING 200-000-131 N/R N/R

5 WASHER LOWER MOUNTING AN960-1216 N/R N/R

6 BOLT LOWER MOUNTING BS31-3/4-10-

6.5 N/R N/R

Appendix G - Page 12 of 16

FIGURE 3. AFT PRESERVATION BAG INSTALLATION AND PRESERVATION BAG INTERNAL INSPECTION

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 G - Page 13 of 16

UNCLASSIFIED/FOR OFFICIAL USE ONLY

FIGURE 3. AFT PRESERVATION BAG INSTALLATION AND PRESERVATION BAG INTERNAL INSPECTION

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)

1A* QEC BAG FORWARD (OR UPPER)

SECTION (INTERNAL) (SEE FIGURE 1)

ATL-1175-

001G N/R N/R

1B* QEC BAG AFT (OR LOWER) SECTION

(INTERNAL) (SEE FIGURE 1)

ATL-1175-

001G N/R N/R

ALL

ASSY

RUBBER SHEET MOUNT CONE

ITEMS 2 - 5 N/A N/R N/R

2** RUBBER SHEET LEFT UPPER MOUNT

CONE (FORWARD) 8632K46 N/R N/R

3** RUBBER SHEET LEFT LOWER

MOUNT CONE (FORWARD) 8632K46 N/R N/R

4** RUBBER SHEET RIGHT UPPER

MOUNT CONE (FORWARD) 8632K46 N/R N/R

5** RUBBER SHEET RIGHT LOWER

MOUNT CONE (FORWARD) 8632K46 N/R N/R

* There are two different styles of the C-130 QEC bag: the aft section of the two piece bag with forward and aft sections is illustrated, and the two piece bag with upper and lower sections is not illustrated. Also refer to Appendix G, figure 1.

** Removal of rubber sheets from the bag is not required unless contamination is found.

Appendix G - Page 14 of 16

FIGURE 4. QEC DOLLY

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 G - Page 15 of 16

UNCLASSIFIED/FOR OFFICIAL USE ONLY

FIGURE 4. QEC DOLLY

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)

1* RUBBER SHEET LEFT UPPER MOUNT

CONE (AFT, 2 EACH) 8632K46 N/R N/R

2** CLIP, ENGINE MOUNT UPPER (71670)

(2 EACH) 200-952-101 N/R N/R

3* RUBBER SHEET LOWER MOUNT

CONE (AFT, 2 EACH) 8632K46 N/R N/R

4** CONE, ENG. MT. LOWER (SEE FIG. 3-

1 B (2 EACH)) 200-951-101 N/R N/R

N/A QEC DOLLY AND WHEEL ASSY N/A N/R N/R

5** QEC DOLLY, UPPER SECTION 200-000-101 N/R N/R

6** QEC DOLLY LOWER SECTION 200-000-101 N/R N/R

7** ASSEMBLY, WHEEL (71670) (4 EACH) 200-000-117 N/R N/R

* Removal of rubber sheets from bag is not required unless contamination is found

** Disassembly not required.

Manually annotate all other external survey locations.

Appendix G - Page 16 of 16

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