Exhibit A001 Test.Inspection Report.pdf

CONTRACT DATA REQUIREMENTS LIST (CDRL)

(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. B. EXHIBIT C. CATEGORY:

0003, 0004, 0005, AND 0006 A TDP TM _____ OTHER NDTI

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

MK54 COLD GAS FES TBD N/A

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE GROUP

A001 TEST/INSPECTION REPORT

WRITTEN TEST REPORT FOR QUALITY

PERFORMANCE- COLD GAS MACHINED PARTS

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

TOTAL PRICE

DI-NDTI-80809B SOW, SEE BLK 16 N00253

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

DD REQUIRED ASREQ SEE BLK 16

a. ADDRESSEE

b. COPIES

8. APP CODE

D, SEE BLK 16

11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM.

Draft

Final

A N/A SEE BLK 16 Reg Repro

16. REMARKS TECHNICAL POC 1 1

BLK 5: ALL WRITTEN TEST DATA REQUIREMENTS AS STATED ON SOW, TEST DATA SHEETS FOR

ASSEMBLY ACTUATE AND RESEAL CALIBRATION OF 4.5-7.0 PSI PRESSURE RANGE. SHALL

ACCOMPANY EACH DELIVERY OF MATERIAL, ENSURING CONFORMANCE TESTING

ACCOMPLISHED IAW WITH TECHNICAL REQUIREMENTS. A CERTIFICATE OF CONFORMANCE

SHALL ALSO ACCOMPANY EACH DELIVERY OF MATERIAL.

BLK 9: DISTRIBUTION AUTHORIZED TO THE U.S. DEPARTMENT OF DEFENSE AND DOD

CONTRACTORS ONLY; CRITICAL TECHNOLOGY 1/15/2012; OTHER REQUESTS FOR THIS

DOCUMENT SHALL BE REFERRED TO NUWC, DIVISION KEYPORT, CODE 323, WEAPONS

LOGISTICS SUPPORT BRANCH, TRACI SEELEY.

DESTRUCTION NOTICE-FOR UNCLASSIFIED, LIMITED DOCUMENTS, DESTROY BY ANY METHOD

THAT WILL PREVENT DISCLOSURE OF CONTENTS OR RECONSTRUCTION OF THE DOCUMENT.

BLKS 10-13: TEST DATA IS TO BE DELIVERED WITH EACH SHIPMENT OF MATERIAL

(PRODUCTION AND FIRST ARTICLE UNIT). (SEE SOW AND CLINS 0003, 0004, 0005, 0006 AND

CONTRACT FOR DELIVERY SCHEDULE).

BLK 14: DELIVERABLE FORMAT:

TEXT DOCUMENT: ADOBE PDF (.PDF, SEARCHABLE) OR MICROSOFT WORD (.DOC)

PRESENTATION: ADOBE PDF (.PDF, SEARCHABLE) OR MICROSOFT POWERPOINT (.PPT)

SPREADSHEET: MICROSOFT EXCEL (.XLS)

DISTRIBUTION ADDRESSEES AND ELECTRONIC MAILING ADDRESSES ARE PROVIDED BELOW:

1) NUWC DIVISION KEYPORT, TRACI SEELEY, LOGISTICS TECH POC, TRACI.SEELEY@NAVY.MIL.

2) NUWC DIVISION KEYPORT, PCO (CONTRACTING OFFICER), MONIQUE KLOSE,

MONIQUE.KLOSE@NAVY.MIL

3) NUWC DIVISION KEYPORT, CONTRACT SPECIALIST, JULIE THOMAS, JULIE.THOMAS@NAVY.MIL

4) NUWC DIVISION KEYPORT, MIKHAIL VAYNER ENGINEERING TECH POC,

MIKHAIL.VAYNER@NAVY.MIL,

MAILING ADDRESS:

COMMANDING OFFICER, NUWC DIVISION KEYPORT

610 DOWELL STREET

KEYPORT, WA 98345-7610

PCO 1 1

CONTRACT SPECIALIST 1 1

ENGINEER 1 1

15. TOTAL ▬▬▬▬► 4 4

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

TRACI SEELEY

16 Jul 2021

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED Page 1 of 1 Pages