CDRL A002-Exhibit B Test and Inspection Report.docx

CONTRACT DATA REQUIREMENTS LIST

(1 DATA ITEM)

Form Approved OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO.

TBD

B. EXHIBIT

B

C. CATEGORY

TDP TM OTHER NDTI1

D. SYSTEM/ITEM

Low Pressure Resin Catch Tank

E. CONTRACT/PR NO.

TBD

F. CONTRACTOR

Energy Solutions

1. DATA ITEM NO

A002

2. TITLE OF DATA ITEM

TEST/INSPECTION REPORT

3. SUBTITLE

Test/Inspection Report

4. AUTHORITY (Data Acquisition Doc. No)

DI-NDTI-80809B (see block 16)

5. CONTRACT REFERENCE

SOW Para. 3.2.1.16, Para. 3.2.1.17, Para. 3.2.1.19, Para. 3.2.1.20, Para. 3.2.1.21, and Para. 3.2.1.22

6. REQUIRING OFFICE

NNSY Code 2380

7. DD 250 REQ

LT

9. DIST STATEMENT REQUIRED

B*

10. FREQUENCY

ASREQ*

12. DATE OF FIRST SUBMISSION

ASREQ*

14. DISTRIBUTION

8. APP CODE

N/A

11. AS OF DATE

See blk 16

13. DATE OF SUBSEQUENT SUBMISSION

ASREQ*

16. REMARKS

Block 4: DID shall be tailored as follows: Only the instructions in paragraphs 10.1, 10.2.1.g, 10.2.3.2.c, 10.2.6.1.a, 10.2.6.1.c, 10.2.6.1.e, 10.2.6.4.1, 10.2.6.5.b, and 10.2.7.3 apply..

Block 9: DISTRIBUTION B. Distribution to U.S. Government Agencies and their contractors (administrative and operational use, 13 November 2020). Other requests for this document shall be referred to Norfolk Naval Shipyard, Portsmouth, VA.

Blocks 10, 11, 12, and 13: Submission is required for each tank. Submittal of the test/inspection report shall be made prior to delivery of the low pressure resin catch tank to the end user.

Block 14: Data submission shall be via email attachment to the NNSY addressees listed below. The data format shall be PDF.

ADDRESSEE LIST, NNSY C/2380

Scott Young, Code 2380 Phone 757-396-1899 Email scott.a.young4@navy.mil

Stephen Barush, Code 2380 Phone 757-396-1898 Email stephen.barush@navy.mil18. ESTIMATED

TOTAL PRICE

17. PRICE

GROUP

G. PREPARED BY

H. DATE

6/1/2021

I. APPROVED BY

J. DATE