Attachment (I) TGI_38K4244102A01_c0v1.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.: S/A98418K FDN & HVAC AY A 0 0

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

DDG-105 USS DEWEY K42

CU PHASE TITLE:

(RE) F/O - S/A 98418K, ACCOMP STRL, SMTL, FALSE DK, & RGRS FOR HF TERM MOD

PREPARING ACTIVITY:

PREPARED BY: CODE PHONE DATE

KAZUHIRO KOMAKI 231A 315-243-6808 09-AUG-2025

APPROVED BY: CODE PHONE DATE

YUUJI NAKAMURA 231A 315-243-6041 09-AUG-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:

This work affects a fire zone boundary. Fabrication and/or staging of a non-flammable closure is required.

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.: S/A98418K FDN & HVAC AY A 0

FOUO

SHIP: DDG-105 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 J-1 M1-5

1. SCOPE/PURPOSE

1.1 Title: Structural, Sheet Metal, False Deck, and Rigging Work for S/A 98418K High Frequency (HF) Terminal Modification (MOD) Upgrade; accomplish

1.2 Location of Work:

1.2.1 Radio Transmitter Room (2-157-1-C)

1.2.2 05 Level Weather, Antenna Platform, Frames between 242 and 246, Starboard (Stbd)

1.2.3 04 Level Weather, Frames between 242 and 246, Stbd

1.2.4 Uptake Engine Room No. 2 (02-242-0-Q)

1.2.5 Passage (01-158-1-L)

1.2.6 Tomahawk Equipment Room (2-153-2-C)

1.3 Identification:

1.3.1 Quantity (One Lot), Structural, Sheet Metal, and False Deck Work for S/A 98418K HF Terminal MOD Upgrade

Remarks: See 2.3 through 2.7 for material and details.

1.3.1.1 Quantity (One EA), Foundation for Battle Short Switch (SYM 801.2)

Remarks: See Sheet 7A of 2.4 and 2.7 for material and details.

1.3.1.2 Quantity (One EA), Foundation for Rotary Switch (SYM 851)

Remarks: See Sheet 7A of 2.4 and 2.7 for material and details.

1.3.1.3 Quantity (Up to 2 EA), Unused Bracket and Stud for Cableway, Bonding, and Miscellaneous Equipment

Material: Steel Remarks: See Note 5.4.4

1.3.1.4 Quantity (Up to 8 EA), Stud for Cableway, Bonding, and Miscellaneous Equipment

Material: Steel, CRES316, Steel, and Aluminum Alloy Weld Joint Design: PT1S.1 of MIL-STD-22D Fillet Weld Size: 1/8 Inch Remarks: See Note 5.4.5

1.3.2 Quantity (One Lot), Electronics Equipment of Electronics System for S/A 98418K HF Terminal MOD Upgrade

Location: Onboard Ship shown on 2.4 to/from Pier Side, Shop, and/or Naval Information Warfare Center (NIWC) Yokosuka, Japan.

FOUO

SHIP: DDG-105 CHG/VER: 0/0

1.4 Security Classification: - 1.2.1 and 1.2.6

1.4.1 Spaces

1.5 Initial Condition: None.

1.6 Contractor work start date: 3/30/2026

1.7 Contractor work completion date: 6/20/2026

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 DWG 184-

8990547 HF Terminal MOD Upgrade FDN

MODS & ML

A Y AL

L

4 DWG 441-

8990548

HF Terminal MOD Upgrade CNSLD

ELEC DWG & ML

A Y AL

L

5 DWG 512-

8990550

HF TERMINAL MOD UPGRADE

HVAC MODS & ML

A Y AL

L

6 LAR

98418/DDG5

4/1229835

Material Information for Split Riser - Y AL L

7 PDD 441-

ELM-250384

SUPPLEMENTAL INFO FOR HF

TERMINAL MOD UPGRADE

- Y AL

L

8 DWG 100-

7060386

UNIT STRL ARR DWG ASSY UNIT

E Y 3-

9 DWG 100-

7060387

UNIT STRUCTURAL ARR DWG

ASSY UNIT 2140

D Y SE

E N

OT

E

10 DWG 180-

7060549

FDN ARR DWG DSGN ZONE 4520

BKLT NO.1

D Y 4B 8A 1-5

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 Not Applicable.

5. PROCEDURE:

5.1 Accomplish the structural work, sheet metal work, and false deck work listed in 1.3.1 in accordance with 2.3 through 2.7, using 2.8 through 2.10 for guidance. See 5.4.3 through 5.4.7.

5.1.1 Fabricate each new foundation listed 1.3.1.1 and 1.3.1.2 in accordance with 2.4 and 2.7.

5.1.2 Remove each existing bracket and stud listed 1.3.1.3.

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SHIP: DDG-105 CHG/VER: 0/0

5.1.3 Install each new stud, bonding, and miscellaneous equipment listed 1.3.1.4.

5.1.2 Accomplish the requirements of 009-012 of 2.1, including Table 2, Columns A, C, and D, Lines One through 7.

5.2 Provide rigging service for removal and installation of each existing and new electronics equipment listed in 1.3.2 to support SRF-JRMC production onboard work, using 2.4 for guidance.

5.3 Accomplish the requirements of 009-032 of 2.1 for each new and disturbed surface.

5.4 Notes:

5.4.1 Planner: Code 231A K. Komaki, 243-6808

Planner: Code 233 T. Saito, 080-9350-1459 Planner: Code 233 Y. Shinohara, 080-9350-1451

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

5.4.3 Removal and installation of electrical/electronics equipment and cable will be covered by TGI No(s).

38K4244102U01, 38K4244102U02, 38K4244102R01, and 38K4244102R02 (SRF-JRMC TGI).

5.4.4 SRF-JRMC Shops, X51EO, X51C, and X67O will identify unused bracket and stud for removal.

5.4.5 SRF-JRMC Shops, X51EO, X51C, and X67O will direct exact location for installation of new stud and support for cableway and equipment which is not designated in referenced drawing.

5.4.6 Naval Information Warfare Center (NIWC) Yokosuka, Japan will provide one person on-site to resolve any technical issues that may arise.

5.4.7 NIWC Yokosuka, Japan Technical Representative:

Point of Contact: Mr. Shawn Coursen. 243-7818 Email Address: shawn.w.coursen.civ@us.navy.mil

5.4.8 WPC will copy the following pages in reference.

REF. 2.9: Pages 6-12, 5B-12, and 3-13

5.4.9 JCN EXSA-ZCE7 is related to this TGI.

5.5 Government Furnished Material (GFM):

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

5.6 SRF-JRMC will provide the following service work: (TGI No. 38K4244102S02).

5.6.1 [C740] Crane and crane rigging service.

5.6.2 [X99E] Utility service, electrical.

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

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

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

5.6.6 [C133] QA inspection for (G) symbol(s).

FOUO

J-1

SHIP: DDG-105 CHG/VER: 0/0

APPENDIX "J"

TGI JOB SUMMARY INFORMATION SHEET

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

VERSION:

CASREP

CAT:

S/A98418K FDN & HVAC AY A 0 0

CU PHASE TITLE:

(RE) F/O - S/A 98418K, ACCOMP STRL, SMTL, FALSE DK, & RGRS FOR HF TERM MOD

PRIMARY COMPONENT:

COMPONENT UNIT LIST (FOR ASSEMBLIES):

05LVL & ABV EXTERIOR MS CMPT 2-157-1-C MS VNT RS 01-171-1 DT

ATTACHMENT LIST:

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

YAGINUMA ,TAKEHIDE

JO: KO: TOTAL MAN HRS: TOTAL DURATION: PLANNING ACCEPTANCE:

38K4244102 A01

TOTAL MAT’L COST

CU PHASE DESCRIPTION:

The purpose of this TGI is to accomplish structural, sheet metal, false deck, and rigging work for S/A 98418K high frequency terminal modification upgrade.

Location of Work:

Radio Transmitter Room (2-157-1-C) Communication Center (2-126-1-C) 05 Level Weather, Antenna Platform, Frames between 242 and 246, Starboard (Stbd) 04 Level Weather, Frames between 242 and 246, Stbd Uptake Engine Room No. 2 (02-242-0-Q) Passage (01-158-1-L) Combat Information Center (1-126-0-C) Tomahawk Equipment Room (2-153-2-C) Auxiliary Machinery Room No. One (4-126-0-E)

TASK NAME

SHOP TSD/WC TS CREW# MHRS

HIGH RAD

HOURS

RC

GRID#

5.1 SFTR , WELD , QA , SMTL , CARP , ELEX , PNTR

RGRS

22 KE PC 0

5.2 ELEC s, RGRS , INSL 22 KE PC 0

5.3 PNTR , QA 22 KE PC 0

Structure Work CFM: for all paints, thinner, grits including disposal cost, fire watch cost, asbestos sampler cost and analysis cost for compartment insulation, and misc such as electrode, gases, plastic bags, and other consumable.

22 MQ CS 0 0 0

Electronics Work CFM: for fastener, cableway material, MISC and other consumable.

22 MQ CS 0 0 0

Electrical Work CFM: for fastener, cableway material, misc and other consumable.

22 MQ CS 0 0 0

Process Funding Document 10 CT OM 1 1 0

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M-1

SHIP: DDG-105 CHG/VER: 0/0

APPENDIX “M”

TGI MATERIAL LIST

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

VERSION:

CASREP

CAT:

S/A98418K FDN & HVAC AY A 0 0

CU PHASE TITLE:

(RE) F/O - S/A 98418K, ACCOMP STRL, SMTL, FALSE DK, & RGRS FOR HF TERM MOD

MATERIAL REFERENCES

REF

NO.

DOCUMENT/DRAWING

NUMBER

DOCUMENT/DRAWING TITLE REV

1 184-8990547 A 2 512-8990550 A

3 ELM 250384

JOB ORDER: KEY OP:

38K4244102 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

001 201

1 M PLATE,ME, 4F X 4F

ITEM NO. 201, 225, 228, 229,

253, & 254

ORDER FOR KTR

ORIG: C226 R.FUKUDA, 070-

7787-1968

9B 9515 014195026 NA 4 N 51865038 16/SF

002 202

1 M BAR,METAL, BAR, FLAT,

METAL, SPEC: MIL-S-22698

GRADE AH-36, SIZE: 3" W X

3/8" THK, MATL: HIGH TENSILE

STRENGTH STEEL,

ONE CONTINUOUS LENGTH

REQUIRED

ITEM NO. 202 & 203

ORDER FOR KTR

ORIG: C226 R.FUKUDA, 070-

7787-1968

9B 9510 LL9004326 NA 4 N 51927474 14/FT

NOTES:

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M-2

SHIP: DDG-105 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

003 204

1 M ANGLE, , ANGLE,

STRUCTURAL, 3" X 3" X

1/2"THK, STEEL, MIL-S-22698

GRADE AH-36

ONE CONTINUOUS LENGTH

REQUIRED

ITEM NO. 204 & 205

ORDER FOR KTR

ORIG: C226 R.FUKUDA, 070-

7787-1968

9B 9520 LL6991522 NA 4 N 51927477 6/FT

004 207 1 M BAR,METAL, ORDER FOR KTR

ORIG: C226 R.FUKUDA, 070-

7787-1968

9B 9510 014206167 NA 4 N 51865041 8/FT

005 208 1 M BAR,METAL, ORDER FOR KTR

ORIG: C226 R.FUKUDA, 070-

7787-1968

9B 9510 014206167 NA 4 N 51865042 8/FT

006 226

1 M ANGLE,ST, ITEM NO. 226 & 227

ORDER FOR KTR

ORIG: C226 R.FUKUDA, 070-

7787-1968

9B 9520 002777310 NA 4 N 51865046 4/FT

007 230 1 M BAR, METAL, BAR, METAL,

FLAT, 5" X 3/8"THK, STEEL,

HSLASS, ASTM A588 GR A.

ONE CONTINUOUS LENGTH

REQUIRED

ORDER FOR KTR

ORIG: C226 R.FUKUDA, 070-

7787-1968

9B 9510 LL9306144 NA 4 N 51927479 5/FT

008 213 1 M NUT,SELF, ORDER FOR KTR

ORIG: C226 R.FUKUDA, 070-

7787-1968

9B 5310 002119271 NA 4 N 51865049 6/EA

009 214 1 M SCREW, HEX CAP, SCREW,

HEX, CAP, SPEC: MIL-DTL-1222

TY-1, SIZE: 7/8-9UNC-2A X 2-

1/4" LG, MATL: ALLOY STEEL,

GRADE 5,

SURFACE TREATMENT SPEC:

ASTM B633 TY-II, ZINC

ELECTRODEPOSITED,

ORDER FOR KTR

ORIG: C226 R.FUKUDA, 070-

7787-1968

9B 5305 LL9309318 NA 4 N 51907460 6/EA

010 231

1 M ANGLE,STRUCTURAL, ITEM

NO. 231 & 232

ORDER FOR KTR

ORIG: C226 R.FUKUDA, 070-

7787-1968

9B 9520 013260078 NA 4 N 51865053 4/FT

011 248 1 M WASHER,F, ORDER FOR KTR

ORIG: C226 R.FUKUDA, 070-

7787-1968

9B 5310 001670804 NA 4 N 51865056 14/EA

012 249 1 M NUT,SELF, ORDER FOR KTR

ORIG: C226 R.FUKUDA, 070-

7787-1968

9B 5310 015527422 NA 4 N 51865061 14/EA

013 250 1 M BAR, METAL, BAR, METAL,

SPEC: MIL-S-22698 GRADE AH-

36 CL U, SIZE: 4" X 3/8" THK,

MATL: STEEL,

ONE CONTINUOUS LENGTH

REQUIRED

ORDER FOR KTR

ORIG: C226 R.FUKUDA, 070-

7787-1968

9B 9510 LL4866590 NA 4 N 51927475 3/FT

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M-3

SHIP: DDG-105 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

014 251 1 M PLATE,ME, 2F X 1F

ORDER FOR KTR

ORIG: C226 R.FUKUDA, 070-

7787-1968

9B 9515 002044622 NA 4 N 51865063 2/SF

015 252 1 M SCREW,CAP,HEX HEAD,

SCREW, CAP, HEX HEAD,

SPEC: MIL-DTL-1222, TYPE-I,

SIZE: 3/8-16UNC-2A X 1-1/2"

LG, MATL: CRES 316, COLD

WORKED,

FINISH: NO COATING,

ORDER FOR KTR

ORIG: C226 R.FUKUDA, 070-

7787-1968

9B 5305 LL4863045 NA 4 N 51907455 14/EA

016 258 1 M SCREW,CA, ORDER FOR KTR

ORIG: C226 R.FUKUDA, 070-

7787-1968

9B 5305 013720788 NA 4 N 51865065 30/EA

017 259 1 M NUT,SELF, ORDER FOR KTR

ORIG: C226 R.FUKUDA, 070-

7787-1968

9B 5310 015063676 NA 4 N 51865067 30/EA

018 260 1 M WASHER,, ORDER FOR KTR

ORIG: C226 R.FUKUDA, 070-

7787-1968

9Z 5310 LL9000295 NA 4 N 51867448 30/EA

019 261 1 M SHEET,ME, ORDER FOR KTR

ORIG: C226 R.FUKUDA, 070-

7787-1968

9B 9515 002044627 NA 4 N 51865068 1/SH

020 263

1 M PERFORATED SHEET,

PERFORATED SHEET, SIZE:

4FT X 8FT X 1/16" THK(16GA),

MATL: ASTM A240 CLASS 316L,

FINISH #2B, COLD ROLLED,

ANNEALED & DESCALED, 3/16"

DIA HOLES X 3/8" STAGGERED

CENTERS, COMPLETELY

DEGREASED.

BIW CAT# 42027-006, NAVSEA

DWG: 259-6218424 REV AD,

BIW DWG: 0450-BM-AI00-26.

ITEM NO. 263, 264, 265, & 266

9B 9515 LL9006537 NA 4 N 51927480 2/SH

021 902 1 M ANGLE,STRUCTURAL, ANGLE,

STRUCTURAL, 2-1/2" X 2" X

1/4" THK, ALUMINUM ALLOY

5456 H111, ASTM B221 (SAE-

AMS-QQ-A-200/7).

BIW CAT#: 56107-282

P/N: ASTM B221 ALLOY 5456

H111 (QQ-A-200/7 5456 H111)

ORDER FOR KTR

ORIG: C226 R.FUKUDA, 070-

7787-1968

9B 9540 LL4573214 NA 4 N 51927478 20/FT

022 903 1 M ANGLE,STRUCTURAL, ORDER

FOR KTR

ORIG: C226 R.FUKUDA, 070-

9B 9540 008922352 NA 4 N 51865070 10/FT

FOUO

M-4

SHIP: DDG-105 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

023 904 1 M BAR,BIMETALLIC, BAR,

BIMETALLIC TRANSITION

JOINT, ALUMINUM / STEEL,

3"W X 3/4"THK, CONSISTS OF

1/8" ALUMINUM 5456 H117 OR

5086 H32 BONDED TO 1/4"

ALUMINUM 1100 BONDED TO

3/8" STEEL ASTM A516 GR-55.

BIW CAT: 57001-046.

ONE CONTINUOUS LENGTH

REQUIRED

ORDER FOR KTR

ORIG: C226 R.FUKUDA, 070-

7787-1968

9B 9530 LL9309320 NA 4 N 51927481 2/FT

024 907 1 M TAPE, 4", ORDER FOR KTR

ORIG: C226 R.FUKUDA, 070-

7787-1968

9D 8305 LL4820191 NA 4 N 51867449 1/RO

025 909 1 M SCREW, M, ORDER FOR KTR

ORIG: C226 R.FUKUDA, 070-

7787-1968

9B 5305 LL9006424 NA 4 N 51867450 20/EA

026 910 1 M FERRULE, ORDER FOR KTR

ORIG: C226 R.FUKUDA, 070-

7787-1968

9B 5320 LL9006423 NA 4 N 51867451 20/EA

027 936 1 M PANEL, FALSE DECK, PANEL,

FALSE DECK, COMPOSITE,

CO-CURED BALSA CORE AND

PHENOLIC COMPOSITE, WITH

LONMAT FLOORING WEAR

SURFACE,

SPEC: MIL-PRF-32664, TYPE I,

CLASS 1, FORM 1, GROUP 1,

AREAL WEIGHT: 2, SIZE: 48" X

100" X 0.560-0.575"THK,

COLOR: SEMI-GLOSS BLUE

(M05.6 TYPE I BLUE MARBLE),

BIW CAT#: 57204-001,

9B 2090 LL9608383 NA 4 N 51927485 1/SH

028 938 1 M ADHESIVE,AIRCRAFT, ORDER

FOR KTR

ORIG: C226 R.FUKUDA, 070-

7787-1968

9B 1680 014313607 NA 4 N 51865072 4/EA

029 A00 1A

2 M SHEET,ME, ORDER FOR KTR

ORIG: C226 R.FUKUDA, 070-

7787-1968

9B 9535 002326872 NA 4 N 51865075 2/SH

030 A00 1B

2 M SHEET,ME, ITEM NO. A001B,

A001C, A002B, A003B, A004B, A004C, A006B, & A006C, ORDER FOR KTR

ORIG: C226 R.FUKUDA, 070-

7787-1968

9B 9535 010931648 NA 4 N 51865078 3/SH

031 A00 2A

2 M SHEET,ME, ITEM NO. A002A,

A003A, A004A, & A006A

ORDER FOR KTR

ORIG: C226 R.FUKUDA, 070-

7787-1968

9B 9535 002326866 NA 4 N 51865083 4/SH

032 1 3 M SHEET,METAL, ORDER FOR

KTR

ORIG: C226 R.FUKUDA, 070-

9B 9515 002388617 NA 4 N 1/PM

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M-5

SHIP: DDG-105 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

033 2 3 M PIPE, METAL, PIPE, METAL,

SIZE: 3/4"IPS, MATL: STEEL,

GALVANIZED,SCH 40,ASTM A-

53, TYPE S, GRADE

A,SEAMLESS,

ONE CONTINUOUS LENGTH

REQUIRED

ORDER FOR KTR

ORIG: C226 R.FUKUDA, 070-

7787-1968

LL4844982 NA 4 N 2/FT

100 M SOUND CO, ORDERED FOR

KTR

ORIG: C231A K. KOMAKI, 243-

9Q 5640 013715239 NA 4 N 10/SH

101 M SOUND CO, ORDERED FOR

KTR

ORIG: C231A K. KOMAKI, 243-

9Q 5640 013715238 NA 4 N 10/SH

102 M INSULATI, ORDERED FOR KTR

ORIG: C231A K. KOMAKI, 243-

9Q 5640 013713262 NA 4 N 10/SH

103 M INSULATI, ORDERED FOR KTR

ORIG: C231A K. KOMAKI, 243-

9Q 5640 013713263 NA 4 N 10/SH

104 M CAP,SNAP, ORDERED FOR

KTR

ORIG: C231A K. KOMAKI, 243-

9B 5325 007377648 NA 4 N

100/EA

105 M TAPE,TEX, ORDERED FOR

KTR

ORIG: C231A K. KOMAKI, 243-

9B 8315 002671632 NA 4 N 36/RO

106 M TAPE,TEX, ORDERED FOR

KTR

ORIG: C231A K. KOMAKI, 243-

9B 8315 002671633 NA 4 N 36/RO

107 M ADHESIVE, ORDERED FOR

KTR

ORIG: C231A K. KOMAKI, 243-

9B 8040 002738708 NA 4 Y 3/GL

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:

DDG-105 S/A98418K FDN & HVAC AY A 0

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

38K4244102 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:

DDG-105 S/A98418K FDN & HVAC AY A 0