CDRLS.pdf

CONTRACT DATA REQUIREMENTS LIST Form Approved

(1 Data Item) 0MB 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 thfs 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 0MB control number. Please do not return your form to the above organization.

Send completed form to the Government Issuing Contractlng Officer for the Contract/PR No. listed In Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

TOP TM OTHER

NOTI

D. SYSTEMIITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3, SUBTITLE

TEST/INSPECTION REPORT HYDROSTATIC TEST REPORT

4. AUTHORITY (D,ila Ac:qulsft/on Document No.) 5, CONTRACT REFERENCE 6, REQUIRING OFFICE

OI-NDTl-80809B PER CONTRACT PURCHASING ACTIVITY

7 0D250REQ 9. DIST STATEMENT 10 FREQUENCY 12. DATI: OF FIRST SUBM:SSION 14. DISTR.BUTION

REQUIRED

DD ONE/R SEE BLOCK 16 b. COPIES

B. APP CODE D 11. AS OF DATE 13. DATE OF SUBSEQUENT a ADDRESSEE ORAFT FINAi.

SUBM1SSION

N/A N/A N/A ~eg Rtp,

16. REMARKS N4523A 0 1 0

Block 9: Distribution Statement D. Distribution authorized to DoO and DoD contractors only.

Administration and operations only, effective 7/22/2020. Other U.S. requests shall be referred to COMNAVSEASYSCOM.

Block 12; Personnel Qualifications and Test Procedures, when ordered on separate contract line item, shall be submitted and approved before testing unless otherwise specified in contract.

Block 12 - Certification/Data Report documentation shall be attached in the Wide Area Workflow r,NAWF) e-Business Suite. Acceptance/Rejection of Certification/Data Report documentation will be accomplished with the corresponding material and will not be accomplished prior to shipment of material.

Document No.: 0203-1011 15 To!al 0 1 0

G. PREPARED BY H. DATE l. APPROVED BY J. DATE

/s/ Matthew Swanson 7/22/2020 ts/ Richard Hawkins 7/22/2020

DD FORM 1423-1, FEB 2001 Page of Pages tLUTIUATm l'D"l'M.NUCl

0002AA A

A001

(1 Data Item) 0MB 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 informatlon, iJ1Cluding suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-01 BB). 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 0MB 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. B. EXHIBIT C. CATEGORY:

TOP TM OTHER

NDTI

0. SYSTEMIITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3.SUBmLE

TEST/INSPECTION REPORT HYDROSTATIC TEST REPORT

4. AUTHORITY (Dara Acqu/s/1/on Docum&nl No.} 5. CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-NDTI-B08098 PER CONTRACT PURCHASING ACTIVITY

7 D0250REQ 9. 01ST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. OISTRJBIITION

REQUIRED

DD ONE/R SEE BLOCK 16 b. COPIES

8. APP CODE D 11 AS OF DATE 13. DATE OF SUBSEQUENT a. AOORESSEI! DRAFT FINAL

SUBMISSION

N/A N/A NIA Rog flopt

16. REMARKS N4523A 0 1 0

Block 9: Distribution Statement D. Distribution authorized to DoD and DoD contractors only.

Administration and operations only, effective 7/2212020. Other U.S. requests shall be referred to COMNAVSEASYSCOM.

Block 12: Personnel Qualifications and Test Procedures, when ordered on separate contract line item, shall be submitted and approved before testing unless otherwise specified In contract.

Block 12- Certification/Data Report documentation shall be attached in the Wlde Area Workflow ~AWF) e-Buslness Suite. Acceptance/Rejection of Certification/Data Report documentation will be accomplished with the corresponding material and will not be accomplished prior to shipment of material.

Document No.: 0203-1013 15 Total 0 1 0

G. PREPARED BY H. DATE I. APPROVED BY J. DATE

Isl Matthew Swanson 7/22/2020 1s1 Richard Hawkins 7/22/2020

DD FORM 1423-1, FEB 2001 Page of Pages

17. tlliCI -- 1LU1111AftD tatAL Mlsa:

B

B001

0004AA

(1 Data Item) 0MB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 11 O 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 0MB 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. B. EXHIBIT C. CATEGORY:

TOP TM OTHER

NOTI

D. SYSTEMIITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE

TEST/INSPECTION REPORT HYDROSTATIC TEST REPORT

4. AUTHORITY (Ditta Acquisition Documenl No.} 5. CONTRACT REFERENCE 6, REQUIRING OFFICE

DI-NDTl-80809B PER CONTRACT PURCHASING ACTIVITY

7. 00 250 REC 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REOUIREO

DD ONE/R SEE BLOCK 16 b. COPIES

8.APPCOOE D 11.ASOFOATE 13. DATE OF SUBSEQUENT s. ADDRESSEE DRAFT FINAL

SUBMISSION

N/A NIA NIA Reg Ro;,r

16. REMARKS N4523A 0 1 0

Block 9: Distribution Statement D. Distribution authorized to DoD and DoD contractors only.

Administration and operations only, effective 7/22/2020. Other U.S. requests shall be referred to COMNAVSEASYSCOM.

Block 12: Personnel Qualifications and Test Procedures, when ordered on separate contract line item, shall be submitted and approved before testing unless otherwise specified in contract.

Block 12- Certification/Data Report documentation shall be attached in the Wide Area Workflow ry,JAWF) a-Business Suite. Acceptance/Rejection of Certification/Data Report documentation will be accomplished with the corresponding material and will not be accomplished prior to shipment of material.

Document No.: 0203-1014 15 Total a 1 0

G. PREPARED BY H.DATE I. APPROVED BY J. DATE

Isl Matthew Swanson 7/22/2020 1s1 Richard Hawkins 7/22/2020

DD FORM 1423-1, FEB 2001 Page of 1 Pages lLUTIUATm TOTM. NaCl

C

C001

0006AA

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 (0704-01 BB). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing lo comply with a collection of information if it does not display a currently valid 0MB control number. Please do not return your form to the above organization.

Send completed form to the Government Issuing Contracting Officer for the ContractlPR No. llsted In Block E.

A. CONTRACT LINE ITEM NO. B.EXHIBIT C. CATEGORY:

TOP TM OTHER

NDTI

D. SYSTEMIITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3.SUBTITLE

TEST/INSPECTION REPORT HYDROSTATIC TEST REPORT

4. AUTHORITY (Data Acquisition Doeumenl No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-NDTI-BOB09B PER CONTRACT PURCHASING ACTIVITY

7 DD 250REQ 9. DIST STATEMENT 10. FREQUENCY 12 DATE OF FIRST SUBMISSION 14 DISTRIBUTION

REQUIRED

DD ONE/R SEE BLOCK 16 b. COPIES

B. APP CODE D 11 ASOFDATE 13, DATE OF SUBSEQUENT a. AODRESSE.E DRAFT FINAL

SUBM'SSION

NIA N/A NIA Reg Rep,

16. REMARKS N4523A 0 1 0

Block 9: Distribution Statement 0. Distribution authorized to DoO and DoD contractors only.

Administration and operations only, effective 7/2212020. Other U.S. requests shall be referred to COMNAVSEASYSCOM.

Block 12: Personnel Qualifications and Test Procedures, when ordered on separate contract line item, shall be submitted and approved before testing unless otherwise specified in contract.

Block 12 - Certification/Data Report documentation shall be attached in the Wide Area Workflow (Y'JAWF) a-Business Suite. Acceptance/Rejection of Certification/Data Report documentation will be accomplished with the corresponding material and will not be accomplished prior to shipment of material.

I

Document No.: 0203-1015 15. Tolal 0 1 0

G. PREPARED BY H.OATE I. APPROVED BY J. DATE

Isl Matthew Swanson 7/2212020 1s1 Richard Hawkins 7/22/2020

DD FORM 1423-1, FEB 2001 Page of Pages

11.HTWMffD TilT AL ,_.

D

D001

0008AA

The public reporting burden for this collection of infonnation 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 infonnation. Send comments regarding this burden estimate or any other aspect of this collection of lnfonnation, 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 lnfonnation if it does not display a currently valid 0MB 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. 8. EXHIBIT C. CATEGORY:

TDP TM OTHER

NDTI

D. SYSTEM(ITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITl.E OF DATA ITEM 3, SUBTITLE

TEST/INSPECTION REPORT HYDROSTATIC TEST REPORT

4, AUTHORITY (Data AcqulsH/on Document No.) 5. CONTRACT REFERENCE 6, REQUIRING OFFICE

DI-NDTl-80809B PER CONTRACT PURCHASING ACTIVITY

7 DD 250 f\EQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14 DISTRIBUTION

REQUIRED

DD ONE/R SEE BLOCK 16 b COPIES

8.APPCODE D 11 ASOF DATE. 13. DATE OF SUBSEQUENT a. ADDRESSEE DRAFT FINAL

SUBMISSION

N/A N/A N/A ROIi Rop-

16 REMARKS N4523A 0 1 0

Block 9: Distribution Statement D. Distribution authorized lo DoD and DoD contractors only.

Administration and operations only, effective 7/22/2020. Other U.S. requests shall be referred to COMNAVSEASYSCOM.

Block 12: Personnel Qualifications and Test Procedures, when ordered on separate contract line Item, shall be submitted and approved before testing unless otherwise specified In contract.

Block 12. Certification/Data Report documentation shall be attached in the Wide Area Workflow (YVAWF) a-Business Suite. Acceptance/Rejection of Certification/Data Report documentation will be accomplished with the corresponding material and will not be accomplished prior to shipment of material.

Document No.: 0203-1016 15, Total 0 1 0

G. PREPARED BY H.DATE I. APPROVED BY J. DATE

/s/ Matthew Swanson 7/22/2020 1s1 Richard Hawkins 7/22/2020

DD FORM 1423-1, FEB 2001 Page of Pages

11,-;1 - 1Lt:11"111Aff0 TOTAi. f'lltlC!.

E

E001

0010AA

The public reporting burden for this collection of information is estimated to average 11 O 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 0MB 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. B. EXHIBIT C. CATEGORY:

TOP TM OTHER

NDTI

D. SYSTEM[ITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE

TEST/INSPECTION REPORT HYDROSTATIC TEST REPORT

4. AUTHORITY (Dattt Acqu/s/1/011 Oocume111 No.} 5, CONTRACT REFERENCE 6. REQUIRING OFFICE

D I-NDTl-808098 PER CONTRACT PURCHASING ACTIVITY

7 DD250REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

DD ONE/R SEE BLOCK 16 b. COPIES

B.APP CODE D 11 AS OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE DRAFT FINAL

SUBMISSION

NIA N/A NIA Rog Rop-

16, REMARKS N4523A 0 1 0

Block 9: Distribution Statement D. Distribution authorized to DoO and DoD contractors only.

Administration and operations only, effective 7/22/2020. Other U.S. requests shall be referred to COMNAVSEASYSCOM.

Block 12: Personnel Qualifications and Test Procedures, when ordered on separate contract line item, shall be submitted and approved before testing unless otherwise specified in contract.

Block 12- Certification/Data Report documentation shall be attached in the Wide Area Workflow r,JVAWF} e-Business Suite. Acceptance/Rejection of Certification/Data Report documentation will be accomplished with the corresponding material and will not be accomplished prior to shipment of material.

Document No.: 0203-1017 15. Total 0 1 0

G. PREPARED BY H.DATE I. APPROVED BY J. DATE

Isl Matthew Swanson 7/22/2020 1s1 Richard Hawkins 7/22/2020

DD FORM 1423-1, FEB 2001 Page of Pages tLESTUiaATG TOTALP'fUC!

F

F001

0012AA

The public reporting burden for this collection of infonnation is estimated to average 110 hours per response, including the lime 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 0MB control number. Please do not return your form to the above organization.

Send comoleted form to the Government Issuing Contracting Officer for the Contract/PR No. listed In Block E.

A. CONTRACT LINE ITEM NO. 8. EXHIBIT C. CATEGORY:

TOP ™ OTHER

NDTI

D. SYSTEMIITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3, SUBTITLE

TEST/INSPECTION REPORT HYDROSTATIC TEST REPORT

4. AUTHORITY (Data Acquls/1/on Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-NDTI-B0809B PER CONTRACT PURCHASING ACTIVITY

7. 0D250REO 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBM,SSION 14. DISTRIBUTION

REQUIRED

DD ONE/R SEE BLOCK 16 b, COPIES

S. APPCODE D 11 ASOFOATE 13. DATE OF SUBSEQUENT

SUBMISSION

a. ADDRESSEE DRAFT FlNAL

N/A N/A N/A Rog Ropr

16. REMARKS N4523A 0 1 0

Block 9: Distribution Statement D. Distribution authorized to DoD and DoD contractors only.

Administration and operations only, effective 7/22/2020. Other U.S. requests shall be referred to COMNAVSEASYSCOM.

Block 12: Personnel Qualifications and Test Procedures, when ordered on separate contract line item, shall be submitted and approved before testing unless otherwise specified in contract.

Block 12 - Certification/Data Report documentation shall be attached in the Wide Area Workflow 0JVAWF) e-Buslness Suite. Acceptance/Rejection of Certification/Data Report documentation will be accomplished with the corresponding material and will not be accomplished prior to shipment of material.

Document No.: 0203-1018 15. Total 0 1 0

G. PREPARED BY H.DATE 1. APPROVED BY J. DATE

Isl Matthew Swanson 7/22/2020 1s1 Richard Hawkins 7/22/2020

DD FORM 1423-1 , FEB 2001 Page of Pages

"·""""' altOU ..

11.Hntll,UED toTAL,,...

G

G001

0014AA

(1 Data Item) 0MB 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 regardmg th:s 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 famng to comply with a col'ection of information if it does not display a currently valid 0MB control number. Please do not return your fonn 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. a.EXHIBIT C. CATEGORY:

TOP TM OTH! R

NDTI

D. SYSTEM)ITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITU: OF OATA ITEM 3. SUBTTTl..E

TEST/INSPECTION REPORT HYDROSTATIC TEST REPORT

4. AUTHORITY (D•t• Acquls/1/on Document No,} 5. CONTRACT REFERENCE &. REQUIRING OFFICE

DI-NDTl-808098 PER CONTRACT PURCHASING ACTIVITY

1 002so Rea 9. DIST STATEMENT 10 FREQUENCY 12 OA TE OF FIRST SUBMISSION f◄ DISTRIBUTION

REQUIRED

DD ONE/R SEE BLOCK 16 b COPIES

8. Af'P COOE D 11 AS OFOATE •3 DATE OF SUBSEQUENT • AOORESSEE DRAFT FINAi.

SUBMISSION

N/A N/A N/A R",j Repr

16 REMARKS N4523A 0 1 0

Block 9; Distribution Statement D. Distribution authorized to DoD and DoD contractors only.

Administration and operations only, effective 7/22/2020. Other U.S. requests shall be referred to COMNAVSEASYSCOM.

Block 12: Personnel Qualifications and Test Procedures, when ordered on separate contract line item, shall be submitted and approved before testing unless otherwise specified in contract.

Block 12 • Certification/Data Report documentation shall be attached in the Wide Area Workflow r,JAWF) e•Business Suite. Acceptance/Rejection of Certification/Data Report documentation will be accomplished with the corresponding material and will not be accomplished prior lo shipment of material.

Document No.: 0203-1019 15 Total 0 1 0

G. PREPARED BY H.DATE I. APPROVED BY J.DATE

ts/ Matthew Swanson 7/22/2020 tst Richard Hawkins 7/22/2020

DD FORM 1423-1, FEB 2001 Page of Pages

---'la UJ.PRICI.

H

H001

0016AA

CONTRACT DATA REQUIREMENTS UST Form Approved

(1 Data Item) 0MB No 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the rme for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and review:ng the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of infonnation, 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 lo any penalty for failing to comply with a coifection of information if it does not display a currently valid 0MB control number. Please do not return your fonn to the above organization.

Send comoleted form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. 8. EXHIBIT C. CATEGORY:

TOP TM OTHER

NDTI

D. SYSTEMIITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM J. SUBTlTLE

TEST/INSPECTION REPORT HYDROSTATIC TEST REPORT

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFACE

DI-NDTl-808098 PER CONTRACT PURCHASING ACTIVITY

7 DO 2SOREQ 9. DIST STATEMENT 10. FREQUENCY 12 DATE OF FIRST SUBMISSION 14 DISTRIBUTION

REQUIRED

DD ONE/R SEE BLOCK 16 b. COPIES

8. APP CODE D 11. ASOFDATE 13. DATE OF SUBSEQUENT a. ADDRESSEE DRAFT FINAi.

SUBMISSION

N/A NIA NIA Reg Rtpr

16.REMARKS N4523A 0 1 0

Block 9: Distribution Statement D. Distribution authorized to DoD and DoD contractors only.

Administration and operations only, effective 7/2212020. Other U.S. requests shall be referred to COMNAVSEASYSCOM.

Block 12: Personnel Qualifications and Test Procedures, when ordered on separate contract line item, shall be submitted and approved before testing unless otherwise specified In contract.

Block 12 • Certification/Data Report documentation shall be attached in the Wide Area Workflow r,NAWF) a-Business Suite. Acceptance/Rejection of Certification/Data Report documentation will be accomplished with the corresponding material and will not be accomplished prior to shipment of material.

Document No.: 0203-1020 15. Tolal 0 1 0

G. PREPARED BY H.DATE I. APPROVED BY J. DATE

Isl Matthew Swanson 7/22/2020 /s/ Richard Hawkins 712212020

DD FORM 1423-1, FEB 2001 Page of Pages

\&. tlTIMATEI ....... ,,_

J

J001

0018AA

The public reporting burden for this collection of infonnation 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 infonnation, including suggestions for reducing the burden, lo 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 0MB 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 ln Block E.

A. CONTRACT LINE ITEM NO. 8. EXHIBIT C. CATEGORY:

TOP TM OTHER

NDTI

D. SYSTEMIITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE

TEST/INSPECTION REPORT HYDROSTATIC TEST REPORT

4. AUTHORITY (Data Acquls/Uon Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFACE

DI-NDTl-808098 PER CONTRACT PURCHASING ACTIVITY

7 DD250REQ 9. DIST STATEMENT 10. FREQUENCY 12 DATE OF FIRST SVBMISSION 14. DISTRIBUTION

REQUIRED

DD ONE/R SEE BLOCK 16 b. COPIES

B. APP CODE D 11. AS OF DATE 13. DATE OF SUBSEQUENT

SUBMISS ON

•. ADDRESSEE D11,\l'T FINAL

N/A N/A NIA R~ ROIi<

16.REMARKS N4523A 0 1 0

Block 9: Distribution Statement D. Distribution authorized to DoD and DoD contractors only.

Administration and operations only, effective 7/22/2020. Other U.S. requests shall be referred to COMNAVSEASYSCOM.

Block 12: Personnel Qualifications and Test Procedures, when ordered on separate contract line item, shall be submitted and approved before testing unless otheiwise specified In contract.

Block 12 - Certification/Data Report documentaUon shall be attached in the Wide Area Workflow 0/'JAWF) e-Business Suite. Acceptance/Rejection of Certification/Data Report documentation will be accomplished with the corresponding material and will not be accomplished prior to shipment of material.

Document No.: 0203-1021 15 Total 0 1 0

G. PREPARED BY H.DATE I. APPROVED BY J. DATE

/s/ Matthew Swanson 7/22/2020 1s1 Richard Hawkins 7(22/2020

DD FORM 1423-1, FEB 2001 Page of Pages

1LEITIMAT[g

TOTALNUCI

K

K001

0020AA

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 (0704-01 BB). 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 ii does not display a currently valid 0MB control number. Please do not return your form to the above organization.

Send comoleted form to the Government Issuing Contracting Officer for the Contract/PR No. llsted in Block E.

A. CONTRACT LINE ITEM NO. 8. EXHIBIT C. CATEGORY:

TOP TM OTHER

NDTI

D. SYSTEMIITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. OATAITEM NO. 2. TITLE OF DATA rfEM J,SUBTm.E

TEST/INSPECTION REPORT HYDROSTATIC TEST REPORT

4, AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-NDTl-80B09B PER CONTRACT PURCHASING ACTIVITY

7, DD250REQ 9, DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION REQl,IIREO

DD ONE/R SEE BLOCK 16 b. COPIES

8. APPCODE D 11. ASOF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE DRAFT FINAL

SUBMlSSION

N/A NIA NIA Rog Repr

16. REMARKS N4523A 0 1 0

Block 9: Distribution Statement D. Distribution authorized to DoD and DoD contractors only.

Administration and operations only, effective 7/22/2020. Other U.S. requests shall be referred to COMNAVSEASYSCOM.

Block 12: Personnel Qualifications and Test Procedures, when ordered on separate contract line Item, shall be submitted and approved before testing unless otherwise specified in contract.

Block 12- Certification/Data Report documentation shall be attached ln the Wide Area Workflow (YVAWF) e-Business Suite. Acceptance/Rejection of Certification/Data Report documentation will be accomplished with the corresponding material and will not be accomplished prior to shipment of material.

Document No.: 0203-1022 15 Total 0 1 0

G. PREPARED BY H.DATE I. APPROVED BY J. DATE

/s/ Matthew Swanson 7/22/2020 1s1 Richard Hawkins 7/22/2020

DD FORM 1423-1. FEB 2001 Page of Pages

,r, -·-· tl.DTIMATED TOTAL P'fUC!.

L

L001

0022AA

(1 Data Item) 0MB No. 0704-01 BB

The public reporting burden for this collection of information is estimated to average 11 O 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 0MB control number. Please do not return your fonn to the above organization.

Send completed fonn to the Government Issuing Contracting Officer for the Contract/PR No. llsted In Block E.

A. CONTRACT LINE ITEM NO. 8. EXHIBIT C. CATEGORY:

TOP TM OTHER

NOTI

D. SYSTEM[ITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE

TEST/INSPECTION REPORT HYDROSTATIC TEST REPORT

4. AUTHORITY (Daw Acqu/silion Document No.} 5, CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-NDTl-808098 PER CONTRACT PURCHASING ACTIVITY

7 0D250REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

DD ONEIR SEE BLOCK 16 b.COP!ES

8.APPCODE D 11, AS OFOATE 13. DATE OF SUBSEQUENT a. ADDRESSEE DRAFT FINAL

SUBMISSION

NIA NIA NIA

Rog R•P'

16. REMARKS N4523A 0 1 0

Block 9: Distribution Statement D. Distribution authorized to OoD and DoD contractors only.

Administration and operations only, effective 7/22/2020. Other U.S. requests shall be referred to COMNAVSEASYSCOM.

Block 12: Personnel Qualifications and Test Procedures, when ordered on separate contract line item, shall be submitted and approved before testing unless otherwise specified In contract.

Block 12 - Certification/Data Report documentation shall be attached in the Wide Area Workflow 0/'JAWF) a-Business Suite. Acceptance/Rejection of Certification/Data Report documentation will be accomplished with the corresponding material and will not be accomplished prior to shipment of material.

Document No.: 0203~1023 15. Total 0 1 0

G. PREPARED BY H.DATE I. APPROVED BY J. DATE

Isl Matthew Swanson 7/2212020 1s1 Richard Hawkins 7/22/2020

DD FORM 1423-1, FEB 2001 Page of Pages

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