FOUO C04.11 - Exhibit A - Caisson 5 - 32 CDRLs and 32 DIDs.pdf

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DD FORM 1423-1, FEB 2001

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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:

TDP ________ TM _______ OTHER

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

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

1_DATA_ITEM_NO: A003

2_TITLE_OF_DATA_ITEM: CERTIFICATION/DATA REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MISC-80678*

5_CONTRACT_REFERENCE: SOW Para. C-2.0

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(See Block 16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16*

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16*

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16_REMARKS: BLOCK 4:

Preparation Instructions Block: Delete paragraphs 10.1, 10.2.2, 10.2.3, 10.2.4.

Paragraph 10.2.1, Delete after the word Objective evidence, "may", Delete after the words "such items as", spectrographs, radiographs, material sampling, analysis"

BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12, and 13: Submit report within 2 working days of completion of each inspection and test.

BLOCK 14: Media requirement. Report shall be a legible copy submitted in approved transferable media to the SUPERVISOR.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 6/30/20

1_APPROVED_BY:

J_DATE: 7/10/20

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0002

B_EXHIBIT: A

TDP:

TM:

OTHER: MISC

DSYSTEMITEM: CAISSON 5

E_CONTRACTPR_NO: N4523A21R1056

FCONTRACTOR: TBD

of_pages: 1

Reset:

2020-06-30T10:57:33-0700

LEWIS.ANNA.DEE.1160801243

2020-07-10T06:14:45-0700

LANGHAM.MATTHEW.ALLEN.1095218454

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 and Communications 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

1_DATA_ITEM_NO: AO19

2_TITLE_OF_DATA_ITEM: HYDROSTATIC TEST REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-QCIC-82089

5_CONTRACT_REFERENCE: SOW Para. C-2.0

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(See Block 16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK16*

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK16*

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16_REMARKS: BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12 and 13: Submit report within 2 working days of each test.

BLOCK 14: Media requirement. Report shall be a legible copy submitted in approved transferable media to the SUPERVISOR.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 6/30/20

1_APPROVED_BY:

J_DATE: 7/10/20

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0002

B_EXHIBIT: A

TDP:

TM:

OTHER: QCIC

DSYSTEMITEM: CAISSON 5

E_CONTRACTPR_NO: N4523A21R1056

FCONTRACTOR: TBD

of_pages: 1

Reset:

2020-06-30T12:18:19-0700

LEWIS.ANNA.DEE.1160801243

2020-07-10T06:24:35-0700

LANGHAM.MATTHEW.ALLEN.1095218454

Source: https://assist.dla.mil -- Downloaded: 2016-02-24T13:38Z Check the source to verify that this is the current version before use.

Source: https://assist.dla.mil -- Downloaded: 2016-02-24T13:38Z

DATA ITEM DESCRIPTION

Title: HYDROSTATIC TEST REPORT

Number: DI-QCIC-82089 Approval Date: 20161208

AMSC Number: N9749 Limitation: N/A

DTIC Applicable: No GIDEP Applicable: No

Preparing Activity: SH Project Number: QCIC-2017-002

Applicable Forms: N/A

Use/Relationship: The report is used to document and provide Objective Quality Evidence

(OQE) evidence of the contractor’s Hydrostatic Test. It is used by the Government to certify the hydraulic system.

This DID contains the format and content preparation instructions for the data product generated by the specific and discrete task requirement as delineated in the contract.

Requirements:

1. Format. The Report shall be in contractor’s format.

2. Content. The Report shall contain:

a. Test result.

b. Clear description of the work requirement.

End of DI-QCIC-82089

Source: https://assist.dla.mil -- Downloaded: 2017-01-10T14:43Z

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 and Communications 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

1_DATA_ITEM_NO: A004

2_TITLE_OF_DATA_ITEM: Environmental Compliance Report

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MGMT-82052

5_CONTRACT_REFERENCE: SOW Para. C-2.0/ NSI 009-02

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(SEE BLK16)

10_FREQUENCY: MTHLY*

11_AS_OF_DATE: SEE BLOCK16*

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK16*

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK16*

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16_REMARKS: BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 11, 12 and 13: Submit report no later than 10 days after the end of the month throughout the availability.

BLOCK 14: Media requirement. Report shall be a legible copy submitted in approved transferable media to the SUPERVISOR.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 6/30/20

1_APPROVED_BY:

J_DATE: 7/9/20

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0002

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: CAISSON 5

E_CONTRACTPR_NO: N4523A21R1056

FCONTRACTOR: TBD

of_pages: 1

Reset:

2020-06-30T11:25:36-0700

LEWIS.ANNA.DEE.1160801243

2020-07-09T12:32:39-0700

LANGHAM.MATTHEW.ALLEN.1095218454

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 and Communications 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

1_DATA_ITEM_NO: A020

2_TITLE_OF_DATA_ITEM: INCIDENT REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MGMT-82071

5_CONTRACT_REFERENCE: SOW Para. C-2.0/ NSI 009-74

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(See Block 16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16*

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16*

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16_REMARKS: BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12, and 13: Report shall be submitted within 24 hours of investigation completion.

BLOCK 14: Media requirement. Report shall be a legible copy submitted in approved transferable media to the SUPERVISOR.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 6/30/20

1_APPROVED_BY:

J_DATE: 7/10/20

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0002

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: CAISSON 5

E_CONTRACTPR_NO: N4523A21R1056

FCONTRACTOR: TBD

of_pages: 1

Reset:

2020-06-30T12:19:44-0700

LEWIS.ANNA.DEE.1160801243

2020-07-10T06:25:36-0700

LANGHAM.MATTHEW.ALLEN.1095218454

Title: INCIDENT REPORT

Number: DI-MGMT-82071

AMSC Number: N9720

DTIC Applicable: No

Preparing Activity: SH

Approval Date: 20161003

Limitation: N/A

GIDEP Applicable: No

Project Number: MGMT-2016-058

Use/Relationship: This DID will be used to describe each accident, electrical shock, and fire that requires medical treatment.

This DID contains the format and content preparation instructions for the data product generated by the discrete task requirement as delineated in the contract.

Format. The report shall be similar to that of Figure 1.

Content. The report shall contain all the information contained in Figure 1.

Source: https://assist.dla.mil -- Downloaded: 2017-01-05T15:48Z

DI-MGMT-82071

Figure 1

INCIDENT REPORT

Report #

INITIAL REPORT REQUESTED UPDATE FINAL REPORT

TYPE OF INCIDENT:

NAME(S) OF INJURED (if applicable):

INCIDENT DATE: TIME: COMPANY:

SUPERVISOR:

LOCATION OF INCIDENT: TYPE OF INJURY OR FIRE:

CAUSE OF INCIDENT: EQUIPMENT INVOLVED:

WORK ITEM NUMBER: CONTRACT NUMBER:

WITNESS AND/OR INDIVIDUALS INVOLVED

NAME(S) DEPT. COMPANY

DESCRIPTION OF INCIDENT

INVESTIGATED BY (NAME): TITLE:

SIGNATURE OF INVESTIGATOR: DATE:

DISPOSITION OF INJURED (if applicable)

IMMEDIATE CORRECTIVE ACTION

FIGURE 1 (continued)

LONG TERM CORRECTIVE ACTION

INVESTIGATED BY (NAME): TITLE:

SIGNATURE OF INVESTIGATOR: DATE:

INCIDENT REPORT

Report #

ROOT CAUSE ANALYSIS

FIGURE 1 (continued) Incident Report Instructions

REPORT NUMBER- Unique tracking number created by contractor

TYPE OF INCIDENT- Injury, fire or near miss

NAME(S) OF INJURED- Self Explanatory

INCIDENT DATE: - Self Explanatory

TIME: - Self Explanatory

COMPANY: - Prime and subcontractors involved

SUPERVISOR – Supervisor of employee(s) involved

LOCATION OF INCIDENT: - Base/Yard, Ship name and hull number, space number and compartment name TYPE OF

INJURY OR FIRE – i.e. broken arm, laceration to head or Class A, B, C fires, smoldering

CAUSE OF INJURY – i.e. Equipment failure, PPE, process

EQUIPMENT INVOLVED – Equipment working on and equipment being used to cause incident WORK

ITEM NUMBER – Work Item being accomplished when incident occurred

CONTRACT NUMBER: - Contract Number assigned by government agency i.e. RMC, Alteration Installation Team

(AIT) Sponsor.

WITNESS AND/OR INDIVIDUALS INVOLVED – Name, company of witnesses and or individuals involved with the incident.

DESCRIPTON OF INCIDENT OR NEAR MISS – Short description of events leading up to incident and extent of injuries and or damage to equipment.

DISPOSITION OF INJURED – i.e. Transported to hospital via ambulance or POV, transported to clinic, released from hospital, name of hospital or clinic, limited duty or loss time (if known).

IMMEDIATE CORRECTIVE ACTION – i.e. Scene/space secured, ship notified (who and when), RMC notified (who and when) clean-up of blood, equipment secured fire debris cleaned up.

INVESTIGATED BY – Self Explanatory.

TITLE – Self Explanatory.

SIGNATURE OF INVESTIGATOR – Self Explanatory.

DATE – Self Explanatory.

LONG TERM CORRECTIVE ACTION – What action(s) were taken so that incident does not reoccur, i.e. training, safety stand down or process/policy change?

ROOT CAUSE ANALYSIS – Process by which you will identify the cause or contributing factors of the incident.

Note: Attach additional information as necessary.

End of DI-MGMT-82071

Title: ENVIRONMENTAL COMPLIANCE REPORT

Number: DI-MGMT-82052 Approval Date: 20160712

AMSC Number: N9682 Limitation: N/A

DTIC Applicable: N/A GIDEP Applicable: N/A

Office of Primary Responsibility: SH Project Number: MGMT-2016-039

Use/relationship: This DID will report the material usage at Naval Facilities to identify that the

Contractor is operating in compliance with environmental law.

This DID contains the format content preparation instructions for the data product generated by the specific and discrete task requirement as delineated in the contract.

1. Format. The report shall be in the contractor’s format.

2. Content. The report shall include the following items based upon category of the material:

2.1 Paint, solvent, adhesive, and nonskid usage records shall include the following:

a. Product manufacturer, identification and color

b. Net daily paint usage in gallons, paint application method (airless spray, HVLP, brush/ roller) per paint type,

c. Amount of paint disposed as hazardous waste

d. Density of mixed paint

e. Net daily onsite solvent usage in gallons used for equipment cleaning and surface preparation

f. Net amount of adhesives in unit of measure (ounces, quart, gallons or pound)

g. Product material safety data sheet (MSDS)

h. Technical data sheet

i. VOC certification for paint and nonskid product

j. Government site location

k. Applicable local Air Pollution Control District (APCD) permit number

l. Date, and ship’s name

2.2 The report shall include the abrasive blast grit materials used and shall specify the following:

a. Manufacturer of abrasive blast grit and MSDS

b. Abrasive blast grit usage certification

c. Amount and hourly usage of the abrasive blast grit

d. Permit associated with the abrasive blasting equipment

Source: https://assist.dla.mil -- Downloaded: 2016-07-20T12:47Z

DI-MGMT-82052

2.3 The report shall include welding operation information and shall specify the following:

a. Welding rod manufacturer

b. Specific product used in welding application

c. MSDS

d. Usage in pounds

e. Type of welding application

2.4 The report shall identify the portable internal combustion (IC) engine greater than 50

Brake horsepower operation information and shall also include:

a. Amount of fuel used in gallons and the hours of operation

b. IC engine permit number and site location

End of DI-MGMT-82052

Source: https://assist.dla.mil -- Downloaded: 2016-07-20T12:47Z

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 and Communications 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

1_DATA_ITEM_NO: A005

2_TITLE_OF_DATA_ITEM: Contractor Furnished Material (CFM) Report

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MGMT-82049

5_CONTRACT_REFERENCE: SOW Para C 2.0 / NSI 009-01

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(SEE BLK16)

10_FREQUENCY: MTHLY*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: 30DAC*

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK16*

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16_REMARKS: BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10: Report will be updated and submitted monthly through the contract period of performance.

BLOCK 12 and 13: The report shall be delivered 30 days after contract award. Revisions to be submitted monthly until end of availability.

BLOCK 14: Media requirement. Report shall be a legible copy submitted in approved transferable media to the SUPERVISOR.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 6/30/20

1_APPROVED_BY:

J_DATE: 7/9/20

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0002

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: CAISSON 5

E_CONTRACTPR_NO: N4523A21R1056

FCONTRACTOR: TBD

of_pages: 1

Reset:

2020-06-30T11:33:41-0700

LEWIS.ANNA.DEE.1160801243

2020-07-09T12:31:56-0700

LANGHAM.MATTHEW.ALLEN.1095218454

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 and Communications 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

1_DATA_ITEM_NO: A021

2_TITLE_OF_DATA_ITEM: ULTRASONIC TEST (UT) REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-NDTI-82095*

5_CONTRACT_REFERENCE: SOW Para. C-2.0

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(See Block 16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16*

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16*

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total_draft: 0 total_repro: 0

16_REMARKS: BLOCK 4:

Title Block: Delete "Ultrasonic".

Use/Relationship Block: After the phrase "The", delete "Ultrasonic".

Use/Relationship Block: After the phrase "Test", delete "(UT)".

Use/Relationship Block: After the phrase "the results of", delete "Ultrasonic".

Requirements Block: After the phrase "Format. The", delete "UT".

Requirements Block: After the phrase "Content. The", delete "UT".

BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12, and 13: Submit each report within 2 working days of test

BLOCK 14: Media requirement. Report shall be a legible copy submitted in approved transferable media to the SUPERVISOR.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 6/30/20

1_APPROVED_BY:

J_DATE: 7/10/20

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0002

B_EXHIBIT: A

TDP:

TM:

OTHER: NDTI

DSYSTEMITEM: CAISSON 5

E_CONTRACTPR_NO: N4523A21R1056

FCONTRACTOR: TBD

of_pages: 1

Reset:

2020-06-30T12:22:35-0700

LEWIS.ANNA.DEE.1160801243

2020-07-10T06:26:24-0700

LANGHAM.MATTHEW.ALLEN.1095218454

Title: Contractor Furnished Material (CFM) Report

Number: DI-MGMT-82049 Approval Date: 20160705

AMSC Number: N9678 Limitation: N/A

Preparing Activity: SH Project Number: MGMT-2016-041

Use/Relationship: This DID will be used to identify Contractor Furnished Material (CFM) to accomplish the Work Items that are not already on hand.

by the discrete task requirement as delineated in the contract.

2. Content. The report shall contain the following information:

a. Contract number

b. Contractor’s purchase order number

c. Description of material

d. Quantity ordered

e. Date scheduled to be ordered

f. Date ordered

g. Date required to meet production schedule

h. Proposed receipt date

i. A summary listing any problem areas

j. Date submitted to the SUPERVISOR

k. Alteration number

l. Drawing and piece number

m. Date received

n. Work Item number

End of DI-MGMT-82049

Source: https://assist.dla.mil -- Downloaded: 2016-07-12T13:40Z

Title: Ultrasonic Test (UT) Report

Number: DI-NDTI-82095 Approval Date: 20161208

AMSC Number: N9756 Limitation: N/A

Preparing Activity: SH Project Number: NDTI-2017-002

Use/Relationship: The Ultrasonic Test (UT) Report will document the results of Ultrasonic

Testing. It will provide the Government with evidence of structural damage and deterioration.

1. Format. The UT Report shall be in contractor’s format.

2. Content. The UT report shall include the following:

a. Contractor’s name and address.

b. Contract number.

c. Work item number.

d. Paragraph number.

e. Date of report.

f. Test results.

End of DI-NDTI-82095

Source: https://assist.dla.mil -- Downloaded: 2017-01-05T18:03Z

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 and Communications 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

1_DATA_ITEM_NO: A006

2_TITLE_OF_DATA_ITEM: TOXIC AND HAZARDOUS SUBSTANCES PROCESS PROCEDURE

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-SAFT-82053

5_CONTRACT_REFERENCE: SOW PARAGRAPH C-2.0

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: A*

DIST_STATEMENT: D(SEE BLK16)

10_FREQUENCY: ASGEN*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16

addressee1: PSNS & IMF C/411 draft1: 1 reg1: 1 repro1:

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16_REMARKS: BLOCK 8: Government requires 5 working days to review and comment. Contractor has 5 working days to incorporate any changes and return to Government at least 5 working days prior to start of required process. Updated or changed procedures shall be submitted at least 3 working days prior to implementation for review and acceptance.

BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12, and 13: Technical changes required after the start of work and require a revision that includes any change to work scope, work location, work sequence, material, inspections, repair processes, references, or change which otherwise alters any technical aspect of the work shall be submitted within one day of identifying.

BLOCK 14: Media requirement. Report shall be a legible copy submitted in approved transferable media to the SUPERVISOR.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 6/30/20

1_APPROVED_BY:

J_DATE: 7/10/20

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0002

B_EXHIBIT: A

TDP:

TM:

OTHER: SAFT

DSYSTEMITEM: CAISSON

E_CONTRACTPR_NO: N4523A21R1056

FCONTRACTOR: TBD

of_pages: 1

Reset:

2020-06-30T11:35:46-0700

LEWIS.ANNA.DEE.1160801243

2020-07-10T06:15:40-0700

LANGHAM.MATTHEW.ALLEN.1095218454

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 and Communications 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

1_DATA_ITEM_NO: A022

2_TITLE_OF_DATA_ITEM: Non-Destructive Testing Training Program

3_SUBTITLE:

4_AUTHORITY_Data_Acquisit: DI-NDTI-81936

5_CONTRACT_REFERENCE: SOW Para. C-2.0

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: A*

DIST_STATEMENT: D(SEE BLK16)

10_FREQUENCY: CP/RQ*

11_AS_OF_DATE: SEE BLOCK16

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK16*

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK16*

addressee1: PSNS&IMF,C/411* draft1: 1 reg1: 1 repro1:

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16_REMARKS: BLOCK 8 : The report shall be delivered NLT 10 work days after contract award. Government requires 10 days to review and comment prior to initiation of production work. Contractor has 5 days to incorporate any changes and return to Government.

BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12 and 13: Subsequent submissions shall be submitted for review and acceptance prior to use as changes/updates occur.

BLOCK 14: Media requirement. Report shall be a legible copy submitted in approved transferable media to the SUPERVISOR.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 6/30/20

1_APPROVED_BY:

J_DATE: 7/10/20

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0002

B_EXHIBIT: A

TDP:

TM:

OTHER: NDTI

DSYSTEMITEM: CAISSON 5

E_CONTRACTPR_NO: N4523A21R1056

FCONTRACTOR: TBD

of_pages: 1

Reset:

2020-06-30T12:24:21-0700

LEWIS.ANNA.DEE.1160801243

2020-07-10T06:27:17-0700

LANGHAM.MATTHEW.ALLEN.1095218454

Title: TOXIC AND HAZARDOUS SUBSTANCES PROCESS PROCEDURE

Number: DI-SAFT-82053 Approval Date: 20160712

AMSC Number: N9683 Limitation: N/A

Office of Primary Responsibility: SH Project Number: SAFT-2016-011

Use/relationship: This DID will be used to identify materials that may contain toxic or hazardous substances that are to be used, removed, or distributed during work operations and the process/procedure for the removal or disruption of existing toxic or hazardous substances.

1. Format. The report shall be in contractor’s format.

2. Content. The report shall include the following:

a. Toxic or hazardous substance

b. Exposure monitoring

c. Method of compliance

d. Respiratory protection

e. Protective clothing

f. Housekeeping

g. Hygiene facilities and practices

h. Medical surveillance

i. Employee information and training

j. Signs

k. Recordkeeping

End of DI-SAFT-82053

Source: https://assist.dla.mil -- Downloaded: 2017-03-10T18:39Z

Title: NON-DESTRUCTIVE TESTING TRAINING PROGRAM

Number: DI-NDTI-81936 Approval Date: 20130827

AMSC Number: N9421 Limitation: N/A

Office of Primary Responsibility: AS/AIR 4.8.8.8

Use/relationship: American Society for Nondestructive Testing (ASNT) TC1A establishes the requirements for a written practice to describe the training program for qualifying Non-

Destructive Training (NDT) personnel.

This DID contains the format, content, and intended use information for the data product resulting from the work task described in the contract Statement of Work (SOW).

1. Reference Documents. ASNT TC-1A.

2. Format. Contractor format.

3. Content.

3.1. Title Page, containing the following:

a. Title/identification of the system/component/program/project.

b. Title of CDRL and CDRL number

c. Contract number.

d. Preparing activity or contractor’s title.

e. Security classification, when required.

f. Distribution Statement.

3.2. Table of Contents

3.3 Content. As a minimum, the supplier shall have in place a compliant Non-Destructive

Testing program in accordance with ASNT TC-1A. Accordingly, specific objective evidence shall be provided to demonstrate compliance.

3.3.1 NDT Training Program Written Practice: The supplier shall have a documented written practice for his/her Non-destructive Testing activities in accordance with ASNT-TC-1A.

The supplier shall provide evidence that the training program is properly established by way of submitting a copy of the program or making reference to the same via a statement of compliance including, if applicable, where the program exists within their quality program and/or operating procedures (i.e. excerpt from a Table of Contents; cover page of the program document, reference to a procedure number, etc).

3.3.2 Level III Examiner: When NAVSEA S9074-AQ-GIB-010/248 is specified, the supplier shall have under their employ a Level III examiner available to approve the Welding

Training program. If a Level III examiner is not directly employed by the supplier, the use of an

Source: https://assist.dla.mil -- Downloaded: 2016-08-02T13:37Z

DI-NDTI-81936

accredited sub-contractor is permissible. The supplier shall provide evidence that this requirement has been met by providing a copy of the Level III examiner’s credentials.

4. End of DI-NDTI-81936.

Source: https://assist.dla.mil -- Downloaded: 2016-08-02T13:37Z

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 and Communications 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

1_DATA_ITEM_NO: A007

2_TITLE_OF_DATA_ITEM: Report, Production or Delivery Problems(s)

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MGMT-81178

5_CONTRACT_REFERENCE: SOW Para. C-2.0/NSI 009-01

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(See Block 16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16*

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16*

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16_REMARKS: BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12, and 13: Report Delivery is deferred and delivery instructions shall be provided by SUPERVISOR when data has been determined.

BLOCK 14: Media requirement. Report shall be legible copy submitted in approved transferable media to the SUPERVISOR.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 1/14/21

1_APPROVED_BY:

J_DATE: 1/14/21

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0002

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: CAISSON 5

E_CONTRACTPR_NO: N4523A21R1056

FCONTRACTOR: TBD

of_pages: 1

Reset:

2021-01-14T14:56:59-0800

LANGHAM.MATTHEW.ALLEN.1095218454

2021-01-14T14:57:24-0800

LANGHAM.MATTHEW.ALLEN.1095218454

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 and Communications 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

1_DATA_ITEM_NO: A023

2_TITLE_OF_DATA_ITEM: PAINT PRESERVATION APPENDICES

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MISC-82120

5_CONTRACT_REFERENCE: SOW Para. C-2.0

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(See Block 16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK16*

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK16*

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16_REMARKS: BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12 and 13: Submit documents within 1 working day of completion of the following preservation operations: SSPC SP-1, Surface Profiles, Surface Conductivity/ Chloride and Top Coat Cure.

BLOCK 14: Media requirement. Report shall be a legible copy submitted in approved transferable media to the SUPERVISOR.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 6/30/20

1_APPROVED_BY:

J_DATE: 7/10/20

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0002

B_EXHIBIT: A

TDP:

TM:

OTHER: MISC

DSYSTEMITEM: CAISSON 5

E_CONTRACTPR_NO: N4523A21R1056

FCONTRACTOR: TBD

of_pages: 1

Reset:

2020-06-30T12:30:21-0700

LEWIS.ANNA.DEE.1160801243

2020-07-10T06:29:29-0700

LANGHAM.MATTHEW.ALLEN.1095218454

DATA ITEM DESCRIPTIOtIJ I

FmY14v@8d Oaura 07woIsa

: nlLs- 1. IDENTIFICATION NuMBER

RSPORT , PRODUCTION OR DELIVERY PROBLEM(S) DI-tKM~- al178

-XWW710NJFURFOSE

3.1 The report is used to inform the procuring activity of crises which have developad, or are developing, emd which have the potsmtial to stop, interrupt or severely impact the production or delivery of contract end itsma.

(continued on page 2)

5.OFFICEOP Pai66enYFfEFwJslelu’Tv(em 6b.GIDEP R5WIRE0

910328

‘4Pn.KaTloN/lNleRRElN10N5iaP

7.1 This data item description (DID) contains the format-and content prapsration instructions for the data prodnct generated by the specific sad discrete task requirsmemt sc delineated in the contract.

7.2 This DID is applicable to the acquisition of both hardvare and software systama, aubsystams, components and sqnipmant. It mey be applied to sny contract covering the acquisition of enpplies/sertices, the delivery of which, if stopped

(continwl Oa page 2) “VPROVAL UMITAIION 98. APPLICABLEFORME 9h AMECNUMBER i PREPaaAnori INSTRUCTION

10.1 FormSt. The report shell ha in contractor format.

10.2 Content. The report still confein the following:

10.2.1

10.2.2

Idamtificatioa. Tbe first page of the ieport shall contain the following:

n. Identification of the system/eampanemt/program/project/hull/ectivity involved.

b. Contract f7umber.

c. Preparing activity.

d. 8srial/idantific.stion mnmbar (assignsd by the preparin8 activity), and the date.

e. “’Securityclassification, when required.

Sady of Report. The report shall “contain .Scamplete, but concise, explemation as to the nature and cause of the crisis or problsm snd the current or potential In addition, impact on contract end itsm production, delivery, cost or sckdding.

the report ehall include the following as applicable snd appropriate:

(continued on page 2) i rIIETRISmON 57ATEMEW

Distribution Statement A: Approved for public release; distribution is 1imited.

i Form 1S60.JIJNSS m.iau ddo s am 017s01em PAGE ~ Or ~ PAGEs <m ,,m. .-.301-$ 641 lr— .nna,n-,w/cc,.,..,..“ICI,..,,, -’”- ‘---

Source: https://assist.