1171768_SMW_REPORT.pdf

SURPLUS MATERIEL WORKSHEET

DATE

10 JUL 2013

I. REQUEST FOR EVALUATION

NSN

1560014976599WF

PART NUMBER

5006550-01

CAGE

12849

APPLICATION

F-16 Canopy Transparency

IMS

Lucas, Timothy J

OFFICE SYMBOL

416 SCMS / GUMAE

PHONE

801-775-4528

SURPLUS MATERIEL MAY BE AVAILABLE TO FULFILL THE GOVERNMENT'S NEEDS FOR THIS ITEM. AS A RESULT, AN EVALUATION MUST BE PERFORMED

IAW AFMC FAR SUPPLEMENT PART 5352.

THE EVALUATION ON THIS ITEM INDICATES SURPLUS MATERIEL WILL BE CONSIDERED IN THE FOLLOWING TYPES / CATEGORIES

II. EVALUATION CRITERIA (For types/categories deemed acceptable)

ACCEPT-

ABLE (Y/N)

P/N AND

MFG

VERIFI-

CATION

PRIOR

GOV'T

OWNER-

SHIP

100% END

ITEM

INSPECT

TEST AND

VERIFI-

CATION

VERIFI-

ABLE

DIMEN-

SIONS

LOCATION

INSPEC-

TION

TESTING

INITIAL

ACCEPT-

ABILITY

ITEMS

OVERHAUL

AND

CERTIFI-

CATION

OTHER

(Explain in Remarks)

Y X X X

N

N

N

Y X X

N

N

N

G O V T

S U R P L U S

NEW/UNUSED

NEW/RECONDITIONED

NEW/MODIFIED

USED/OVERHAULED

C O M M L

S U R P L U S

NEW/UNUSED

NEW/RECONDITIONED

NEW/MODIFIED

USED/OVERHAULED

SURPLUS EVALUATION CRITERIA (If Section 11a. indicates surplus materiel may be considered). (Fill in blanks as appropriate)

PART NUMBER VERIFICATION 12849(AFMCFARS 5352.211-9011) MFG 5006550-01P/N

PRIOR GOVERNMENT OWNERSHIP (AFMCFARS 5352.211-9015)

100% END ITEM INSPECTION (AFMCFARS 5352.211-9017)

TEST AND VERIFICATION (AFMCFARS 5352.211-9013) TECH ORDER NUMBER

VERIFIABLE DIMENSION (AFMCFARS 5352.211-9012) DESIGN ACTIVITY

DRAWING NUMBER

LOCATION OF INSPECTION TESTING (AFMCFARS 5352.211-9015)

INITIAL ACCEPTABILITY ITEMS (AFMCFARS 5352.211-9014) A QUANTITY OF ITEMS WILL BE TESTED FOR INITIAL ACCEPTANCE

TEST WILL BE CONDUCTED USING THE FOLLOWING CRITERIA (and location of testing)

OVERHAUL AND CERTIFICATION (AFMCFARS 5352.211-9010)

OTHER SPECIAL REQUIREMENTS (Explain)

Lucas, Timothy JNAME: 10 JUL 2013DATE:

To be inspected by ES/Engineer. Send all pertinent available paperwork with part. Any visual damage upon receipt will render part unacceptable. Part must meet all form, fit, and function requirements. If the part does not pass inspection, USAF will not purchase and part will be returned to provider.

REMARKS

JUSTIFICATION FOR UNACCEPTABLE SURPLUS MATERIEL

EVALUATOR

Lucas, Timothy J

OFFICE SYMBOL

416 SCMS / GUMAE

PHONE

801-775-4528 / 775-4528

COMPLETE DATE

10 JUL 2013

SIGNATURE

//SIGNED// Lucas, Timothy J

USER TYPE

Engineer

SIGNATURE DATE

10 JUL 2013

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