CERTIFICATE OF COMPLIANCE.pdf

CERTIFICATE OF COMPLIANCE

Requisition Number N42158-5023-7324

MATERIAL IDENTIFICATION (COMPLETE APPLICABLE ITEMS)

CONTRACT NO. ORDER NO. N4215825QE028

ITEM NO. _______________________

NATIONAL/LOCAL STOCK NUMBER NSN/LSN ________________________

MANUFACTURER’S PART NO. ____________________________

MANUFACTURER’S SERIAL NO. __________________________

DRAWING AND PIECE NO. ______________________________

MANUFACTURER’S LOT/HEAT NOS. AS MARKED ON THE MATERIAL:

I ATTEST ALL ITEMS FURNISHED ON THIS CONTRACT ARE IN FULL COMPLIANCE WITH ALL

CONTRACT REQUIREMENTS.

SIGNATURE _________________________________ DATE _______

QUALITY ASSURANCE OFFICIAL

TITLE _________________________________

THE INSPECTION AND TEST REPORTS (AS APPLICABLE) PROVIDED REPRESENT THE ACTUAL

ATTRIBUTES OF THE ITEMS FURNISHED ON THIS CONTRACT AND INDICATE FULL COMPLIANCE

WITH ALL CONTRACT REQUIREMENTS.

REQ’D N/A

[ ] [ X ]

SIGNATURE _________________________________ DATE _________

QUALITY ASSURANCE OFFICIAL

TITLE ________________________________

“NOTE”: WHEN ITEM(S) HAVE BEEN SHIPPED, PLEASE COMPLETE CERTIFICATION(S) AND

RETURN. THIS WILL EXPEDITE RECEIPT AND PAYMENT.

MAIL TO:

NORFOLK NAVAL SHIPYARD

ATTN: CODE 2305.6, EXPEDITING SECTION

BLDG. 297

PORTSMOUTH, VA 23709-5000

DELIVER ONE (1) COPY WITH MATERIAL

ENCLOSURE (1