EX-CHAMPION DISPOSAL PACKET 12-16-2021.pdf

INACTIVE SHIPS MAINTENANCE

OFFICE BREMERTON, WA

2450 WYCOFF WAY (BLDG 550)

BREMERTON, WA 98314

Ser 00/046 16 Dec 21

From: Director, Naval Sea Systems Command, Inactive Ships On-Site Maintenance Office, Bremerton, WA, 98314

To: Commander, Naval Sea Systems Command (SEA 21I), 1333 Isaac Hull Avenue SE Stop 2701, Washington Navy Yard, DC 20376-2701

Via: Director, Naval Sea Systems Command, Inactive Ships Management Office, Portsmouth, VA 23702-1009

Subj: SHIP DISMANTLEMENT PROGRAM REPORTING LETTER FOR EX-CHAMPION

(MCM-4)

Ref: (a) NAVSEA INACTSHIPOFF ltr 4770 Ser N32/039 dtd 12 Jul 21

Encl:

(b) OPNAVINST 4770.5

(c) INACTSHIPOFFINST 4770.3H

(d) DoDM 4160.28-M Vl, Defense Demilitarization:

Administration Manual of 9 Aug 2017

(e) DoDM 4160.28-M V2, Defense Demilitarization:

Demilitarization Coding of 9 Mar 2017

(f) DoDM 4160.28-M V3, Defense Demilitarization:

Procedural Guidance, of 7 Jun 2011

(1) Low-Level Radioactive Material Survey and Removal Report

(2) Declassification Survey Report

(3) Demilitarization Survey Report

(4) Condition of Sale Items

(5) Liquid Load Survey Report

(6) Mercury Survey Report

(7) Rodent Free Certification

(8) Certification of Refrigerant Removal Report

(9) Equipment Containing Hydraulic Fluid (l0)Final Walk-Through Inspection (ll)List of Equipment Not Included in Sale (12)Digital Photographs

1. The following information is forwarded for use in preparation of EX-CHAMPION per references (a) through (d).

a. The vessel is in the custody of INACTSHIPMAINTO and is located at Pier 9, NAVAL BASE SAN DIEGO.

b. Official to be contacted by prospective bidders:

(!) Name: BRYSON, THOMAS

(2) Address: 2450 WYCOFF WAY, BLDG 550, BREMERTON, WA

98314-5250

(3) Telephone number: ( 3 6 0) 4 76 -3 551, ( 3 60) 8 01-5203 ( C)

(4) Fax number: (360) 476-8665

(5) E-Mail Address: thomas.e.bryson6.civ@us.navy.mil

c. EX-CHAMPION is available for inspection by appointment only, Monday through Friday, excluding holidays, between the hours of 0730 to 1500. Appointments must be made five

(5) days in advance.

d. It is the opinion of the custodian that the hull of EX CHAMPION is in fair condition. It is recommended that prospective bidders inspect the hull and make their own determination of the suitability of this vessel for usage or tow.

e. Vessel Characteristics are as follows:

(!) Builder: MARINETTE MARINE, WISCONSIN

(2) Date Constructed: 28 JUNE 1984

(3) Dimensions: LENGTH, 224 FEET; BEAM, 39 FEET;

(4) Current Displacement: APPROX 1,267 TONS

(5) Draft: FWD 9ft 6in, MID 11ft 0in, AFT 11ft 0in

(6) Vessel Metallurgical Description: N/A WOODEN

,FIBERGLASS HULL

(7) Status of propellers: INTACT

(8) Status of rudders: LOCKED

(9) Status of anchors: INTACT

(10) Describe any issues that may affect towing:

NONE

f. Supply System materials and stores were off-loaded at inactivation. No additional inventory or offload of materials was tasked.

g. Navy Curator Items have been removed from the vessel and shipped to the Navy Curator in accordance with references

(a) through (c)

h. Stripping requirements have not been completed Material of Navy interest remains onboard, and is scheduled to be removed during FY 2022.

i. The vessel has been declassified in accordance with reference (c) .

j. The vessel's hull number and hull name have been obliterated in accordance with reference (c).

a. Enclosure (1) provides the removal and decontamination actions of all known low-level radioactive materials.

Include in the sale catalog that naturally occurring radiation sources, e.g., fire brick, terrazzo deck, porcelain, etc., remain on board.

b. Enclosure (2) certifies that no classified material remains aboard the vessel and that all hull markings (name and number) have been painted out. The following declassified documentation is available.

(1) Booklet of General Plans

(2) Damage Control Book and Plates

(3) Tank Conversion Tables

(4) Docking Plans

c. Enclosure (3) provides the certification of completion of demilitarization as required by the DoD Demilitarization Manual, references (d} through (f}.

d. Enclosure (4) provides any remaining condition of sale requirements.

e. Enclosure (5) Water, fuel, and lube oil tanks have been pumped to (low suction/empty} as shown in enclosure (5). Include in the sales catalog a 30-45 day opportunity for bidders to verify tank soundings and to obtain fuel and lube oil samples. The amount and type of any fixed ballast remaining on board is also shown in enclosure (5) .

f. Enclosure (6) provides the inventory of all equipment which contains mercury. This is a visual survey that is based on the best available knowledge of the inspector.

g. Enclosure (7) provides the rodent free certification

h. Enclosure (8) provides a list of system where refrigerant remains and/or has been removed and an inventory of those small, sealed systems remaining on board.

i. Enclosure (9) provides and inventory of remaining systems containing hydraulic fluid

j. Enclosure (10) provides the final walk-through inspection reporting letter.

k. Enclosure (11) provides the list of equipment not part of the vessel that will be removed prior to sale.

1. Enclosure (12) provides electronic digital photographs of Ex CHAMPION. And will be forwarded via separate correspondence for posting on DLA websi te.

2. Ex-CHAMPION (MCM-4) is ready in all respects for the ship dismantlement program.

Thomas Bryson Director

Copy to: NAVSEA INACTSHIPOFF PORTSMOUTH VA

DATE: 24 Sept 21

RADIOLOGICAL SURVEY REPORT

SHIP/CRAFT: EX-CHAMPION HULL NO: MCM-4

This report certified that a Survey for Radiological Emitters has been accomplished on board the above named Ship/Craft in accordance with INACTSHIPOFFINST

5104.1 with the following results:

X Vessel was found free of all radiological emitters and certified

RADSAFE.

__ All radiological emitters were removed and vessel is certified RADSAFE.

See attached inventory.

__ RADCON Survey has been accomplished on subject vessel. Radiological Emitters essential for the operation of the vessel, have been inventoried and tagged. See attached inventory.

Conducted By:

Isaac Cantu Marine Inspector II

�Tw-.

Reviewed By:

Kamal Bell Quality Assurance Manager

Approved By Tim Brorson Project Manager

ENCLOSURE (1)

INACTSHIPOFFINST 5104. l E

9 SEP 16

RADIOACTIVE MATERIAL SURVEY LOG

DATE/TIME: 9/24/21 I 1:45 SURVEYOR(S): ISAAC CANTU

HULL NUMBER: MCM-4 HULL NAME: CHAMPION

RADIAC USED: (I) DT-640A (1) IM-253D SERIAL NUMBER: l9443/I0446

CALIBRATION DATE: 19443 EXP,06/16/22 - 10446 EXP,06/I6/22

BACKGROUND RADIATION (KCPM): 284

. LOCATION COMPARTMENT NAiv!E MATERIAL

(BULLSEYE) FOUND

COMP.NO. (YIN)

03 LVL 03 LEVEL N

03-40-0-M MAST N

03-58-0-S STACK N

02-28-0-C PILOT HOUSE N

02-28-1-D STBD WEATHER DECK FR 54 N

AFT

02-28-2-D PORTWEATHER DECK FR 54 N

AFT

02-33-1-D STARBOARD BRIDGEWING N

02-33-2-D PORT BRIDGEWING N

02-35-0-M ARMORY N

02-35-1-C ! CHARTROOM N

02-35-2-L l CIC PASSAGEWAY N

02-38-1-Q FAN ROOM N

• 02-38-2-L WATCHSTANDER HEAD N

02-41-2-Q CMCOFFICE N

02-44-0-C COMBAT INFORMATION N

CENTER

02-44-1-Q FAN ROOM ! N

02-59-1-Q NIGHT VISION LOCKER N

: 02-59-2-Q UNREP LOCKER N

01-26-2-D FOC'SLE N

01-28-01-L CO STATEROOM N

01-28-0-L CO/XO STATEROOM N

01-28-1-D STARBOARD 01 LEVEL N

01-28-2-L XO STATEROOM N

01-28-2-D PORT 0 l LEVEL N

01-33-2-L PORT QUARTERDECK N

01-36-0-L JO HEAD N

01-37-1-A FORWARD STOREROOM N

01-37-2-L PASSAGE N

01-37-3-Q SAR LOCKER N

01-41-1-L STARBOARD STATEROOM N

01-41-2-L PORT STATEROOM N

01-41-3-A TEST EQUIPMENT LOCKER N

01-48-1-L STARBOARD QUARTERDECK N

01-48-2-Q LINEN LOCKER N

0l-48-4-Q CLEANING GEAR LOCKER N

01-50-1-L RADIO PASSAGEWAY N

01-52-0-C RADIO N

Page 2 of5

NOMENCLATURE SOURCE

(COMPONENT, INTENSITY

MODEL, (CPM)

ISOTOPE)

NiA 143

NIA 125

NIA 145

NIA 100

NIA 121

N/A 112

N/A 83.4 N/A 116 N/A ! 141

NIA 92.4

N/A 122 N/A 95.4

NIA 139

N/A 120 N/A 90

N/A 112 N/A 125 N/A 128

NIA 106

N/A 125 N/A 93.6 N/A 121 N/A 93.4 N/A 130 N/A 126

NIA 99

NIA 113

N/A 96,6 N/A 120 N/A 148 N/A i 107 N/A 141 N/A 87 N/A 113 N/A 105 N/A i 110 N/A 146

ENCLOSURE (1)

i lNACTSHIPOFFINST 5104.1 E

RADIOACTIVE MA TERI AL SURVEY LOG

DATE/TIME: 9/24/21 11:45 SURVEYOR(S): ISAAC CANTU

I

HULL NUMBER: MCM-4 HULL NAME: CHAMPION

RADIAC USED: (1) DT-640A 11) IM-253D SERIAL NUMBER: 19443/10446

CALIBRATION DATE: 19443 EXP.06/16/22-10446 EXP.06/l6/22

BACKGROUND RADIATION (KCPM): 284

LOCATION COMPARTMENT NAME MATERIAL

(BULLSEYE) FOliND

COMP.NO. (Y /N)

01-52-1-Q EKMS VAULT N

01-54-1-Q ST AR BOARD AFFF STATION N

01-57-1-Q FAN ROOM N

01-57-2-C IC GYRO N

01-66-1-Q FILTER CLEANING SHOP N

01-69-2-Q FAN ROOM N

01-69-4-Q BOAT GEAR LOCKER ! N

01-72-1-Q MNS SHOP N

01-72-2-D PORT02 ½ N

01-76-2-Q 400 HZ N

01-77-1-Q EOD N

01-82-0-M SMALL ARMS MAGAZINF N

01-82-1-M DESTRUCTIVE MAGAZINE N

01-82-2-Q PORT AFFF ATATION N

01-86-0-D AFT 01 LEVEL N

! 01-41-0-L JO ANNEX N '

l-0-0-A FORWARD BOS'N LOCKER N

1-5-0-L FORWARD PASSAGEWAY N

1-5-2-Q • REPAIR II ANNEX N

1-7-1-Q REPAIR II N

1-7-2-A CBR STOREROOM N

1-11-2-A CANNED FOOD STORAGE N

1-14-0-L SONAR PASSAGEWAY N

1-14-1-L 9 MAN BERTHING N

1-14-2-L 15 MAN BERTHING N

1-21-1-Q SONAR FAN ROOM N

1-23-1-Q SONAR MAINTENANCE N

ROOM

1-28-0-L CPO PASSAGEWAY N

1-28-1-L 15 MAN HEAD N

1-28-2-L 40MAN HEAD N

1-28-3-L CPO HEAD N

1 -33-1-L CPO BERTHING N

1-33-2-L MEDICAL TREATMENT ROOM N

1-35-2-L i MEDICAL PASSAGEWAY N

1-38-2-A MEDICAL STOREROOM N

: 1-41-0-L MESS DECK N

1-41-1-Q CLEANING GEAR LOCKER N

1-41-2-L ! WARDROOM ' N

1-41-3-Q RELIGIOUS LOCKER N

Page 3 of5

NOMENCLATURE SOURCE

(COMPONEJ\T, INTENSITY

MODEL, (CPM)

ISOTOPE)

N/A 94.8 N/A 82.8 N/A 117 N/A 135 N/A 157 N/A ! 130 N/A 163 N/A 116 N/A 127

NIA 127

N/A 134 N/A 65.3 N/A 121 N/A 142 N/A 138

NIA 140

N/A 85.2 N/A 57 N/A 74.4 N/A 82.2 N/A 97.8 N/A 82.8 N/A 112 N/A 112 N/A 97.2 N/A 104 N/A 87.6

N/A 73.8 N/A 116 N/A 134 N/A 114 N/A 118 N/A ' 135 N/A 65.4 N/A 67.2 N/A 212

NIA 93

N/A I 223 N/A i 114

INACTSHIPOFFINST 5104.1 E

RADIOACTIVE MATERIAL SUiNEY LOG

DATE/TIME: 9/24/21 11 :45 SURVEYOR[S): ISAAC CANTU

HULL NUMBER: MCM-4 HULL NAME: CHAMPION

RADIAC USED: [1) DT-640A fl) IM-253D SERIAL NUMBER: 19443/10446

CALIBRATION DATE: 19443 EXP.06/16/22-10446 EXP.06/16/22

BACKGROUND RADIATION [KCPM): 284

LOCATION COMPARTMENT NAME MATERIAL

(BULLSEYE) FOUND

COMP.NO. (Y /N)

1-44-1-Q WATER HEATER SPACE N

1-45-2-Q GALLEY N

1-56-2-L CPO MESS N

l-59-1-L AMR VESTIBULE N

1-59-3-Q SHIP'S OFFICE N

1-63-2-L REEFER DECKS N

l-63-4-A i FREEZE STOREROOM N

1-66-2-A CHILL STOREROOM N

l-68-2-A I DRY PROVISION N

STOREROOM

1-70-1-Q SUPPLY OFFICE N

1-71-2-Q LAUNDRY N

1-72-0-E REEFER MACHINERY ROOM N

1-75-2-Q R&A LOCKER N

1-76--1-Q GENERAL WORKSHOP N

1-77-0-C CENTRAL CONTROL STATION N

1-77-2-Q OIL LAB N

1-77-4-Q R&A REENTRY LOCKER N

1-78-1-L MMR VESTIBULE N i

1-78-1-L ENG PASSAGEWAY N

1-80-2-Q , LOG ROOM N '

1-83-1-L PASSAGE N

1-86-1-L ; FANTAIL N

1-87-1 L DOG HOUSE N

1-87-2-L . DECON PASSAGEWAY N

1-87-4-Q R&A ANNEX N

1-89-2-L AFT DECON STATION N

1-89-4-Q PLASTIC STORAGE N

, 2-0-0-A ' FLAM STOREROOM N

2-14-0-L CREWS REC N

• 2-18-2-L 6 MAN BERTHING N

2-23-0-Q GATX N

2-23-2-Q FAN ROOM N

2-28-0-L 40 MAN BERTHING N

2-86-0-E UCHS N

2-91-0-A SUPPLY STOREROOM N

2-91-2-A PASSAGE N

2-99-0-A SWEEP GEAR N

I 2-104-1-E . OILY WATER SEPARATOR i N

ROOM

Page 4 ofS

NOMENCLATURE SOURCE

(COMPONENT, INTENSITY

MODEL, (CPM)

ISOTOPE)

N/A 107 N/A 226 N/A 126 N/A 105 N/A 106 N/A 103 N/A 83.4 N/A 58,8 N/A 138

N/A 196 N/A 104 N/A 120 N/A 103 N/A 82.8 N/A 75 N/A 140 N/A 99.4 N/A 143 N/A 143 N/A 156 N/A 164 N/A i 23 N/A 160 N/A i 87 N/A 85,2 N/A 92.4 N/A 90 N/A 74.4 N/A 114 N/A 127 N/A 95.4 N/A 140 N/A 122 N/A 89.4 N/A 80.4 N/A 94.2

NIA 135

NIA 53.5

ENCLOSURE (I)

RADIOACTIVE MATERIAL SURVEY LOG

DATE/TIME: 9/24/21 11 :45 SURVEYOR(S) : ISAAC CANTU

HULL NUMBER: MCM-4 HULL NAME: CHAMPION

RADIAC USED: (1) DT-640A (1) IM-253D SERIAL NUMBER: 19443/10446

CALIBRATION DATE: 19443 EXP.06/16/22- 10446 EXP.06/16/22

BACKGROUND RADIATION (KCPM): 284

INACTSHIPOFFINST 5104.1 E

9 SEP 16

LOCATION COMPARTMENT NAME MATERIAL NOMENCLATURE SOURCE

(BULLSEYE)

COMP.NO.

2-107-0-E AFT STEERING

3-14-0-E BOW THRUSTER

3-28-0-E PUMP ROOM

3-41-0-E AMR

3-63-0-E MMR

1-63-01 -L PASSAGE

01-41-01-L PASSAGE

02-71-1-D STBD 02 ½

RSO/ARSO (Print): 1j I(;,, SllJ,JL; "'flf ,l/

RSO/ARSOSignature: +~

FOUND

(Y /N)

N N N N N N N N

(COMPONENT, INTENSITY

MODEL, (CPM)

ISOTOPE)

N/A 83.4 N/A 94.2 N/A 102 N/A 151 N/A 144 N/A 120 N/A 100 N/A 277

DATE: 10/2:s IJ-..1 I I

DATE: 23 Sept 21

DECLASSIFICATION SURVEY REPORT

SHIP/CRAFT: EX-CHAMPION HULL NO: MCM-4

THIS REPORT CERTIFIES THAT A DECLASSIFICATION INSPECTION HAS

BEEN ACCOMPLISHED ONBOARD THE ABOVE NAMED SHIP/CRAFT

PER INACTSHIPOFFINST 4 770.3H WITH THE FOLLOWING RES UL TS:

X DECLASSIFICATION SURVEY ACCOMPLISHED AND NO

CLASSIFIED MATERIAL WAS FOUND TO BE ONBOARD.

Conducted By:

Isaac Cantu

Marine Inspector

Kamal Bell

Quality Assurance Manager

PAGE l OF l

Approved By

Tim Brorson

ENCLOSURE (2)

DATE: 30 Sept 21

DEMILITARIZATION SURVEY REPORT

SHIP/CRAFT: EX- CHAMPION HULL NO: MCM- 4

DEMILIT ARIZA TI ON COMPLETE FOR THIS VESSEL:

IDJLL NAME AND NUMBERS HA VE BEEN OBLITERATED.

11kl& Reviewed By:

Kamal Bell Quality Assurance Manager

Approved By Tim Brorson Project Manager

ENCLOSURE (3)

DATE: 12 Oct 21

CONDITION OF SALE

SHIP/CRAFT: EX- CHAMPION HULL NO: MCM-4

No condition of sale to report per INACTSHIPOFFINST 4770.3H.

Kamal Bell

Quality Assurance Manager

Timothy Brorson

ENCLOSURE (4)

DATE: 16 Dec 21

LIQUID LOAD SURVEY REPORT

SHIP/CRAFT: EX- CHAMPION HULL NO.:MCM 4

This report certifies that a liquid load survey has been accomplished on board the above named ship/craft with the following information pertaining:

1. Complete liquid load Survey see attached

1L/V{ ) � ..,� Reviewed By:

Kamal Bell Quality Assurance Manager

Approved By Tim Brorson

PAGE 1 OF 3 Enclosure ( 5)

TANK # LEVEL QUANTITY

UNIT OF

MEASURE

3-29-1-F 5'4.5" 3100 GALLONS

3-29-2-F 0'0" 0 GALLONS

3-34-1-F 5'6" 4550 GALLONS

3-34-2-F 0'0" 0 GALLONS

FLUID DESCRIPTION

FRESH WATER

EMPTY

FRESH WATER

EMPTY

7650 GALLONS

TANK # LEVEL QUANTITY

UNIT OF

MEASURE FLUID DESCRIPTION

3-84-1-F 0'0" 0 GALLONS EMPTY

3-85-2-F 0'0" 0 GALLONS EMPTY

0 GALLONS

TANK # LEVEL QUANTITY

UNIT OF

MEASURE

2-27-2-F 0'0" 0 GALLONS

2-27-4-F 0'0" 0 GALLONS

2-87-1-F 3'5" 750 GALLONS

2-87-2-F 0'0" 0 GALLONS

2-87-3-F 3'8" 750 GALLONS

2-87-4-F 0'0" 0 GALLONS

FLUID DESCRIPTION

EMPTY

EMPTY

FRESH WATER

EMPTY

FRESH WATER

EMPTY

1500 GALLONS

TANK # LEVEL QUANTITY

UNIT OF

MEASURE

3-43-1-W 8'9" 2380 GALLONS

3-43-2-W 0'0" 0 GALLONS

FLUID DESCRIPTION

FRESH WATER

EMPTY

2380 GALLONS

EX-CHAMPION (MCM-12)

LIQUID LOAD LIST

FINAL

FUEL STORAGE

FUEL OIL SERVICE TANKS

POTABLE WATER

TOTAL

TOTAL

TOTAL

LUBE OIL STORAGE AND SETTLING

TOTAL

PAGE 2 OF 3 Enclosure ( 5)

TANK # LEVEL QUANTITY

UNIT OF

MEASURE FLUID DESCRIPTION

3-61-1-F 0'0" 0 GALLONS EMPTY

3-61-2-F 0'0" 0 GALLONS EMPTY

3-67-1-F 0'0" 0 GALLONS EMPTY

3-67-2-F 0'0" 0 GALLONS EMPTY

2-104-3-F 0'0" 0 GALLONS EMPTY

0 GALLONS

TANK # LEVEL QUANTITY

UNIT OF

MEASURE FLUID DESCRIPTION

3-81-1-F 0'0" 0 GALLONS EMPTY

3-81-2-F 0'0" 0 GALLONS EMPTY

0 GALLONS

TOTAL 11530

TOTAL: 11530

FRESH

WATER 11530

SALT WATER 0

TOTAL

WASTE OIL

HYDRAULIC OIL

TOTAL

PAGE 3 OF 3 Enclosure ( 5)

DATE: 27 Sept 21

MERCURY SURVEY REPORT

SHIP/CRAFT: EX-Champion HULL NO.: MCM-4

This report certifies that a survey for Mercury containing components has been accomplished onboard the above named ship/craft with the following results:

NIA

X

Mercury Survey was accomplished and no mercury containing components were found.

Mercury Survey was accomplished and mercury containing components found. See attached inventory list:

X There are Yes X /No __ 1,155 fluorescent light

,5itl1!2:5 ining on tills craft.

Conducted By:

Isaac Cantu Marine Inspector

;Jb;u/h- Kamal Bell Quality Assurance Manager

PAGE 1 OF4

Approved By TimBrorson

ENCLOSURE (6)

Ex-Champion (MCM 4) Mercury Inventory

September 13-24,2021

1,2 heat sensor 2 0.6 01-28-01-L CO STATEROOM

3,4 heat sensor 2 0.6 01-28-2-L XO STATEROOM

5,6 heat sensor 2 0.6 01-37-1-A FORWARD STOREROOM

7,8 heat sensor 2 0.6 01-41-1-L STARBOARD STATEROOM

9,10 heat sensor 2 0.6 01-41-2-L PORT STATEROOM

11, 12 heat sensor 2 0.6 01-41-3-A TEST EQUIPMENT LOCKER

13,14,15 heat sensor 3 0.6 01-52-0-C RADIO

16,17 heat sensor 2 0.6 01-54-1-Q STARBOARD AFFF STATION

18, 19 heat sensor 2 0.6 01-57-1-Q FAN ROOM

20,21 heat sensor 2 0.6 01-57-2-C IC GYRO

22,23 heat sensor 2 0.6 01-66-1-Q FILTER CLEANING SHOP

24 heat sensor 1 0.6 01-69-2-Q FAN ROOM

25,26 heat sensor 2 0.6 01-72-1-Q MNS SHOP

27 heat sensor 1 0.6 01-76-2-Q 400 HZ

28,29 heat sensor 2 0.6 01-77-1-Q EOD

30,31 heat sensor 2 0.6 01-82-0-M SMALL ARMS MAGAZINE

32,33 heat sensor 2 0.6 01-82-1-M DESTRUCTIVE MAGAZINE

34,35 heat sensor 2 0.6 01-82-2-Q PORT AFFF STATION

36,37 heat sensor 2 0.6 02-28-0-C PILOT HOUSE

38,39 heat sensor 2 0.6 02-35-0-M ARMORY

40,41 heat sensor 2 0.6 02-35-1-C CHARTROOM

42,43 heat sensor 2 0.6 02-38-1-Q FAN ROOM

44,45 heat sensor 2 0.6 02-41-2-Q CMC OFFICE

46,47,48, heat sensor 5 0.6 02-44-0-C

COMBAT INFORMATION

49,50 CENTER

51,52 heat sensor 2 0.6 02-44-1-Q FAN ROOM

53,54 heat sensor 2 0.6 1-0-0-A FORWARD BOS'N LOCKER

55 heat sensor 1 0.6 1-11-2-A CANNED FOOD STORAGE

56,57 heat sensor 2 0.6 1-14-1-L 9 MAN BERTHING

58,59,60 heat sensor 3 0.6 1-14-2-L 15 MAN BERTHING

61 heat sensor 1 0.6 1-23-1-Q

SONAR MAINTENANCE

ROOM

62 heat sensor 1 0.6 1-33-1-L CPO BERTHING

63,64 heat sensor 2 0.6 1-33-2-L

MEDICAL TREATMENT

ROOM

65 heat sensor 1 0.6 1-35-2-L MEDICAL PASSAGEWAY

66,67,68, heat sensor 4 0.6 1-41-0-L MESS DECKS

70,71 heat sensor 2 0.6 1-41-2-L WARDROOM

72,73 heat sensor 2 0.6 1-41-3-Q RELIGIOUS LOCKER

74,75,76 heat sensor 3 0.6 1-45-2-Q GALLEY

PAGE 2 OF 4 ENCLOSURE (6)

September 13-24,2021

77,78 heat sensor 2 0.6 1-56-2-L CPO MESS

79,80 heat sensor 2 0.6 1-59-3-Q SHIP'S OFFICE

2 0.6 1-68-2-A

DRY PROVISION

81,82 heat sensor

STOREROOM

83,84 heat sensor 2 0.6 1-70-1-Q SUPPLY OFFICE

85,86 heat sensor 2 0.6 1-71-2-Q LAUNDRY

87,88 heat sensor 2 0.6 1-7-1-Q REPAIR II

89,90 heat sensor 2 0.6 1-72-0-E REEFER MACHINERY ROOM

91,92 heat sensor 2 0.6 1-7-2-A CBR STOREROOM

93,94 heat sensor 2 0.6 1-76-1-Q GENERAL WORKSHOP

95 heat sensor 1 0.6 1-77-0-C CENTRAL CONTROL STATION

96,97 heat sensor 2 0.6 1-77-2-Q OIL LAB

98,99 heat sensor 2 0.6 1-80-2-Q LOG ROOM

100,101 heat sensor 2 0.6 2-0-0-A FLAM STOREROOM

102,103 heat sensor 2 0.6 2-14-0-L CREWS REC

104,105 heat sensor 2 0.6 2-18-2-L 6 MAN BERTHING

106,107 heat sensor 2 0.6 2-23-0-Q GATX

108,109 heat sensor 2 0.6 2-23-2-Q FAN ROOM

110,111, 112, 113, 114, 115, heat sensor 8 0.6 2-28-0-L 40 MAN BERTHING

116, 117

118 heat sensor 1 0.6 2-86-0-E UCHS

119,120, heat sensor 4 0.6 2-91-0-A SUPPLY STOREROOM

121, 122

123, 124, heat sensor 3 0.6 2-99-0-A SWEEP GEAR

126,127 heat sensor 2 0.6 2-104-1-E

OILY WATER SEPARATOR

ROOM

128, 129, heat sensor 4 0.6 2-107-0-E AFT STEERING

130, 131

132,133 heat sensor 2 0.6 3-14-0-E BOW THRUSTER

134,135 heat sensor 2 0.6 3-28-0-E PUMP ROOM

136, 137, 138, 139, 140, 141, heat sensor 10 0.6 3-41-0-E AMR

142, 143, 144, 145

146, 147, 148, 149, 150, 151, heat sensor 10 0.6 3-63-0-E MMR

152, 153, 154, 155

PAGE 3 OF4 ENCLOSURE (6)

September 13-24,2021

Floruescent bulbs NIA I, 155 All Spaces NIA

Quantity Heat Sensors 155

Weight Heat Sensors 93 lbs

Total Florescent Bulbs 1,155 total

PAGE4OF4 ENCLOSURE (6)

DATE: 27 Sept 21

RODENT / INSECT FREE INSPECTION REPORT

SHIP/CRAFT: EX-CHAMPION HULL NO.: MCM-4

This report certifies that a Rodent/ Insect Free survey has been accomplished onboard the above named ship/craft with the following results:

No rodent/ insects or evidence of rodent / insect were found.

Verified By:

Isaac Cantu Marine Inspector II

Approved By:

Tim Brorson Project Manager

�lb, Reviewed By:

Kamal Bell Quality Assurance Manager

ENCLOSURE (7)

DATE: 30 Sept 21

REFRIGERANT SURVEY REPORT

SHIP/CRAFT: EX-CHAMPION HULL NO: MCM-4

This report certifies that a Refrigerant Survey has been accomplished onboard the above named Ship/Craft with the following results:

X

X

All major sources of Refrigerant were removed from ship during inactivation.

An inventory was conducted listing all known equipment that contains

Refrigerant, Small units i.e. scuttlebutts, ice makers, juice machines etc.

See attached list.

A survey was conducted, no Refrigerant containing equipment was found .

Conducted By:

Isaac Cantu

Marine Inspector

JLt11idA Reviewed By:

Kamal Bell

Quality Assurance Manager

Approved By

Tim Brorson

PAGEJ0F3 ENCLOSURE (8)

COMPARTMENT # FRAME EQUIPMENT MANUFACTOR MODEL REFRIG. QUANTITY REMARKS

GALLEY 1-45-2-Q 1-53-2 COUNTER REEFER COPELAND AFEBC3E-1AA-103 R-134A UNKNOWN REMOVED

GALLEY 1-45-2-Q 1-53-3 GALLEY REEFER COPELAND AFE208E-1AA-103 R-134A UNKNOWN REMOVED MESSDECKS 1-41-0-L 1-63-1 GALLEY REEFER COPELAND AF27C3-1AA-959E R-134A UNKNOWN REMOVED

AMR 3-41-0-E 3-63-1 1 AC YORK RN62C R-134A UNKNOWN REMOVED

AMR 3-41-0-E 3-63-1 2 AC YORK RN62C R-134A UNKNOWN REMOVED

MNS SHOP 01-72-1-Q 01-72-1-Q MSN REEFER TECUMSEH AE-1023-E R-134A UNKNOWN REMOVED

MAIN BDS 1-33-2-L 1-35-4 MED REEFER TECUMSEH AE-1023-E R-134A UNKNOWN REMOVED

REEFER ROOM 1-72-O-E 1-75-1 1 REEFER YORK FN22A R-134A UNKNOWN REMOVED

REEFER ROOM 1-72-O-E 1-75-1 2 REEFER YORK FN22A R-134A UNKNOWN REMOVED

NOTE: *1AC & 2AC HAVE BEEN REMOVED PER ERS SYSTEM 08/2021

REFRIGERANT SURVEY

SHIP: __USS CHAMPION (MCM 4)______ DATE: ___23 SEPT 21________________

*ALL REFRIGERANT REMOVAL VERIFIED BY GLOBAL

SMALL SEALED REFRIGERANT CONTAINING SYSTEM ONBOARD

SHIP: USS CHAMPION MCM 4 DATE: 23 Sept 21

COMPARTMENT # FRAME EQUIPMENT MANUFACTOR MODEL REFRIG. QUANTITY REMARKS

1-41-0-L 1 50 MlLKCOOLER SlLVERKlNG R-134A 1

1-45-2-Q 2 50 COLDWELL COSPOLICH TRl0AG R-134A 1

1-45-2-Q 3/4 48 REFRIGERATOR/FREEZER COSPOLICH UCRl0Fl0 R-134A 2

1-41-0-Q 5 50 ICE MACHINE CORNELIUS R-134A 1

1-41-0-L 6 55

MESS DECK

MGR

ER-10-

R-134A 1

REFRIGERATOR 1368HNM

PAGE 3 OF3 ENCLOSURE (8)

Intact Intact Intact Intact

Intact

DATE: 28 Sept 21

HYDRAULIC SURVEY REPORT

SHIP/CRAFT: EX-CHAMPION HULL NO.: MCM-4

This report certifies that a survey for Hydraulic equipment has been accomplished onboard the above named ship/craft with the following results:

X Hydraulic oil is presumed to be present in various other deck equipment Such as Deck crane, Cable reels, and boat davits. See Attached Ships

Letter.

�AQb ReviewedBy: � Kamal Bell Quality Assurance Manager

PAGE 1 OF2

Approved By Tim Brorson

ENCLOSURE (9)

INACTIVE SHIPS MAINTENANCE

OFFICE BREMERTON, WA

2450 WYCOFF WAY (BLDG 550)

BREMERTON, WA 98314

FINAL WALK-THROUGH INSPECTION REPORTING LETTER

Ser 00/043

16 Dec 21

From: Director, Naval Sea Systems Command, Inactive Ships On

Site Maintenance Office, Bremerton, WA, 98314

To: Director, Naval Sea Systems Command, Inactive Ships

Management Office, Portsmouth, VA 23702-1009

Subj: FINAL WALK-THROUGH INSPECTION OF EX-CHAMPION (MCM-4)

Ref: (a) OPNAVINST 4770.5

(b) INACTSHIPOFFINST 4770.3H

(c) NAVSEA INACTSHIPOFF ltr 4770 Ser N32/039 dtd 12

July 2021

Encl: (11) Inventory of industrial plant equipment (IPE) and other equipment and material of value remaining on board (MCM-4) as of 28 September

1. A final walk-through inspection of subject vessel was conducted by ALAN PRICE in accordance with references

(a), (b) ,and(c). All disposal procedures have been completed in accordance with applicable instructions and guidlines. Stripping requirements have not been completed

Material of Navy interest remains onboard, and is scheduled to be removed during FY 2022.

Director

Enclosure (10)

DATE: 12 Oct 21

EQUIPMENT NOT INCLUDED IN SALE

SHIP/CRAFT: EX- CHAMPION HULL NO: MCM-4

1. Any equipment provided by Naval Base San Diego/ INACTSHIPMAINTO Bremerton including but not limited to gangways, shore power components, alarm system, fenders, mooring lines are not included in the sale of this vessel.

2. There is no Industrial Plant Equipment (IPE) of any value to the

Government remaining on board.

3. There is no other equipment or material of any value to the Government remaining on board.

Kamal Bell

Quality Assurance Manager

Timothy Brorson

Project Manager

ENCLOSURE (11)

EX-CHAMPION PHOTOS

PAGE1 OF 1 ENCLOSURE (12)