Attachment_3_-_Sample_Dossier_Packet.pdf

A-7A

152647

SFD FILES-

DOCUMENTS,

PICTURES

Example Dossier Packet Contents

1. CD/DVD

2. Aircraft Safe For Display Certificate (1 pg)

3. NHHC Aircraft Static Display Condition Certificate (2 pgs)

4. Aircraft Reclamation and Demilitarization Procedures (1pg)

5. Aircraft Safe For Public Display Checklist and Certification (1 pg)

6. Statement of Work Completed Form (1 pg)

7.

8.

Ionizing Radiation Safety Survey Form (1 pg) Radioactive Material Disposal Inventory Record (1 pg)

9. Ionizing Radiation Survey Detector Calibration Form (for each instrument used) (1 pg)

10.

HAZWASTE Bill Of Lading / Manifests (2 pgs)11.

Listing of Instructions, Procedures, and Publications [used for this aircraft] (1 pg)

Item 1

YOUR COMPANY NAME

HERE

p

.Aircreft Sa.ft far q)fspfay Certificate The following aircraft has been inspected; is free from all non-radioactive HAZMAT and HAZWASTE; and is certified as Safe for Public Display IAW the specifications set forth in the contract.

To: CONTRACT OFFICER'S REPRESENTATIVE FOR SFD INSPECTION PROGRAM

Identification: A-7A Buno 152647

Location: School Board of Alachua County

Custodian: School Board of Alachua County

Current Point of Contact: POC NAME HERE POC CONTACT INFORMATION

ADDRESS

PHONE

EMAIL

Completion Date: 04 September 2018

Signed: QUALIFIED AND AUTHORIZED

COMPANY SIGNATORY

TITLE

COMPANY ADDRESS, PHONE,

EMAIL

Item 2

NAVHISTHERIT AGECOMINST Page 1of2 Pre-Decisional document, further distribution is not authorized

NAVAL HISTORY AND HERITAGE COMMAND

Aircraft Static Display Condition Certificate

AIRCRAFT NM1 E I AIRCRAFT MODEL I NN/>M ACCESSION NW BER

Corsair II A-7A 1995.031.001

/ LOAN srARTDATE /LOAN END DATE

8/1/2015 811/2020 I BUREAU NLM BER

152647 rERTIFK:ATE NUMBER

ALACHUA01

BORROWER NA'<IE BORROWER LOCATION RADHAZ

School Board of Alachua County 3700 Northeast 53rd Street, Gainesville, FL 32609 PRES-08-18-05

NN/>M LOAN AGREEMENT Nll\1BER POINT OF CONT ACT I TELEPHONE Nll\1 BER

N43 Ser 10-355 Thomas Cowart, Facilities Maintenance Manager 352-955-7400Ext1413

I. GENERAL CONDITION AND APPEARANCE REMARKS

A Loan Agreement and Most Oves[{]No Recent Pictures Reviewed

B. Aircraft Bureau Number IZJ vesONo Matches Loan Agreement

C. Conditions Met Per Loan 0ves[:2}o Agreement Refer to noted discrepancies below

D. Display Attributed to NNAM [ZJvesDo

E. Concerns General Safety or [ZJvesONo Left main landing gear strut is cracking. Station #7 external fuel tank is only supported by one lug. See additional comments

Environmental Compliance (List all instances/examples) in Section V.

F. General Status EXCELLENT GOOD POOR NEGLECTED I N/A I H. Aircraft Location:

I. Mooring Present

F.1 Maintained and Painted x I I Olnside 0Restoration Facility [ZJ0n Display IZlves 0 No

F.2 Evidence of Upkeep x [ZJoutside IZJPedestal, Pad Maintained0 In Storage Remarks:

F.3 Pedestal Condition x

IZJ Mounted IZJ Clean area, no debris Coordinates:

Aircraft mounted

F.4 Security x IZJ Pedestal(s) IZJ Gravel 29.8334895, on 3 stanchions

F.5 Propellers and Blades 0Hanging IZJ Concrete pad(s) -82.5907178 and secured with 3

G. Overall Condition x I I IZJGround IZJ Tires off ground turnbuckles

II. FOCUSED ASSESSMENT DISCLAIMER: THIS INSPECTION DOES NOT EVALUATE OR CERTIFY ANY MOUNTING APPARATUS.

�CM'.Jf4ftllf�j• Clear Entire Form

CRITERIA REMARKS

1 Dirty or Dusty, Excessive None

2 Fungus, Moss, Mold, or Mildew Mold - radome (2.2.1-2.2.2), left wing (2.2.3-2.2.4), right wing and station #8 pylon (2.2.5-2.2.6)

Damage I Deposits From Animal Nesting or Wastes, The bee nests in the photos represent over 20 nests located on and in this aircraft (2.3.1-2.3.3). Bird Nest- right

Insects, etc. gun compartment (2.3.4-2.3.5). All accessible nests were removed during the inspection.

4 Other Deposits: (leaves, sticks, trash, etc ... . ) None

5 Disintegrating or Rotting Component, Sections, Items Deteriorating - sealant on windscreen frame (2.5.1-2.5.2)

Corrosion I Crystalline Deposits or Formations I Corrosion- left fuselage (2.6.1 -2.6.4), nghl fuselage and refueling probe {2.6.5-2.6.6), topside fuselage {26.7-2.6 8), left and nght "Mngs (2.6.9-2.610), left main landing

Oxidation I Blistering gear bay (2.6.11-2.6 12). ng:ht ma111 landlng: gear bay door (2.6.13-2.6.14). aft fuselage (2.6.15-2.6.16), tailhook (2.6.17). nght s:de vertical stab1llzer (2.6 18-2.6.19)

Paint/Decals (chipping, cracking, peeling, fading, Paint - Chipping - leftwmg bp (2. exhaust cowling (2. Fading - stalions #1, ft2, #7. and #3 external fuel tank. fins i2 5 7). Decals Pee�ng - stat #2

7 external fuel lank (2.7 8-2.7.9) nght side intake (2. Decals Fading- lefl.and ngtlt fuselage ( 112- 13). nght aru:.I left side vertical slabl!tzer 14 15). Dec.al missing, defacing, graffiti) on left Side vertical staMtzer replaced � requested by "borrower" (2.7 .16)

8 Missing Parts, Pieces, or Sections of Aircraft Missing - panel fuselage underside with fabricated panel installed (2.8.1-2.8.2), gravity refuel cap with fabricated panel installed (2.8.3-2.8.4), fasteners left fuselage (2.8.5) and fuselage underside (2.8.6)

9 Physical Distortion (warped ,bent, dented, or crushed) Dented - canopy frame (2.9.1-2.9.2)

Canopy/Cockpit Access (open, closed, ajar, leaking, Ganopyopan(2101} CaoopyCIOS&dandreclfi!d{21022105) let'l�'WJhl�caoopy,ell�"'.aotlles'tif"KNOOand;:ianelssecureod(210S.21011) Boaningladdersecuted(21012·21013) secured, locked, inaccessible)

Inappropriately Wetted Areas (inside cockpit, None elsewhere)

I

Item 3 pg 1

NAVHISTHERITAGECOMINST Page 2 of 2 Pre-Decisional document, further distribution is not authorized

AIRCRAFT NAME AIRCRAFT MODEL NNAM ACCESSION NUMBER LOAN START DATE LOAN END DATE BUREAU NU\1 BER CERTIFK:ATE NUMBER

Corsair II A-7A 1995.031.001 8/112015 81112020 152647 ALACHUA01

All Other Accesses, Panels, Ports, and Doors (open, All panels, hatches, and access ports are secure. Ammo can access panel secured (2.12.1-2.12.3). Ram Air closed, secured, ajar) Turbine (RAT) access door secured (2.12.4-2.12.6).

Visible Damage (from movement, shipment, fire, None smoke, water, natural acts, other)

Foreign Material Exclusion(FME) Covers {installed, All FME covers installed (2.14.1-2.14.2) missing, damaged, loose, insufficient)

Structural Cracking (fuselage, wing, tail, blade, Crack in left main landing gear strut (2.15.1-2.15.2). See additional comments in Section V.

stabilizer, etc ... )

Brittle/Broken Components, Pieces, Items, Sections Broken panel fuselage underside (2.16.1-2.16.2) (anything)

Repairs Failing, Not Well Done, or Inappropriate (duct None tape, foam)

Cosmetic Stains {grease, oil, weather, oxidation, . Cosmetic Stains - left side intake (2.18.1 ), aft fuselage (2.18.2-2.18.3), left fuselage (2.18.4) corrosion, other)

Tires' Condition {sufficiently inflated, rotted, cracked, landing gear is if) neglected condition 'Nith dirt. bee nests, corrosmn, and slrudura! cracking. All tires sufficiently mflated for display. {1.12.1·1.14.9). Nose landmg gear

19 safety pm mstalled and safety wired (2.19.1·2.19.3). Left and right mam landmg gear have strut collars mstalled (2.19.4-2.19.7). Crack m left mam landmg gear strut etc .... ) 12.15.1-2.152).

Propeller or Blade Condition {broken, cracked, Right wing aileron is secured with fabricated bracket (2.20.1-2.20.2). Speed brake secured with anchored, secured) screws (2.20.3-2.20.6). All other flight control surfaces previously secured.

Pedestal{s)-Mounting Hardware (cracks, crumbled, Aircraft is mounted on 3 stanchions and secured to the deck with 3 turnbuckles. Stanchions have dirt and corroded, loose) corrosion. (1.16.1-1.17.8), Concrete pad is in average condition with dirt and mold (1.18.1-1.18.7).

Engine{s)·How many, serial number if possible Engine installed (2.22). Serial number could not be located.

Condition {cracks, leaks, corroded, loose)

External Stores- location and type {drop tanks, bombs, S!alms #1, #2, #7, aod #8 are configured with empty exIBmal fuel tanks Sta!JOOs #3 and #6 pylons are mstalled BRUs are oot installed Stallons� and #5 are nol 1ristaHed

23 (1.15.1-1.15.10} Gr..nsnol installed (1.15.11.1.15 16) No CAfJs (2.23.1-2.2312) Bolls1nslalled msaretypinpoles (2.23 13-2.2324). leltandnghtg..nshave empt y ammo chutes missiles, etc.) Condition mstalled [223 25-2.2328) Ammo can not installed (223.29-2 23.30) Slabon tf7 external fuel lank is only scpported by one tug (2.23 31-2 23 34) See add1!ional comments 1n SectlOn V

No battery No fuel No hyd'"aultc nutd Nood (2 24.1). No oxygen (2242-2-24.5). Norutrogcn. No pressunled corrponents (2.24.6). No fire ex�uishers/bot!!es No AE. C1rcu1! breakers pul�d (as

24 Other appicablej (224.7.224 12) Tmhook installed and secured (224.13-2.24.18). Secured refueing probe {224 19-2.2420) Radarinstaled and radome secured (2 24 21-2 24 23)

Ill. REVIEWED NNAM SAFE FOR PUBLIC DISPLAY CHECKLIST AND CERTIFICATION FORM I James Breland

NAME I DATE

PROVIDE COMMENTS IN BLOCK V [{] Yes 0 No

04 SEP 18

IV. FORM REVIEW

Minimum number pictures taken and reviewed l...{J Yes [ jNo !All annotations and marks complete for sections II and Ill I./ j Yes [ I No

DISCLAIMER: THIS INSPECTION DOES NOT EVALUATE OR CERTIFY ANY MOUNTING APPARATUS.

V. ADDITIONAL NOTES AND COMMENTS

Aircraft exterior has mold, bee and bird nests, deteriorating components, corrosion, paint damage and decal damage, missing parts, physical distortion damage, broken components, and cosmetic stains. The interior is m average condition with a disarmed ejection seat, and most instruments and components installed. Landing gear 1s In neglected condition with dirt, bee nests, corrosion, and structural cracking. Aircraft stanchions have dirt and corrosion.

Concrete pad is in average condition with dirt and mold

Recommendations: Wash aircraft, treat for bee nests, repair deteriorating components, treat corrosion, repair pamt and decal damage, replace missing parts, repair physical distortion damage, repair broken components, clean cosmetic stains, and clean concrete pad.

Additional Comments: Left main landing gear strut is cracking; continued deterioration of the cracking could cause result in landing gear failure. PRES recommends Immediate Action on the repair of the left main landing gear.

The external fuel tank installed on station #7 is not properly secured to the aircraft; 1t is only secured with one lug. PRES recommends Immediate Action on the repair of the station #7 external fuel tank. Delay in repairs could result m aircraft damage and possible inJUI)'.

VI. IMMEDIATE ACTION

RECOMMENDED

Inspector I {Printed Name) James Breland

VII. IMMEDIATE ACTION REQUIRED

NHHC Approval ! J<L16f e_ {Printed Name) \J, [{] Yes 0No I Remarks Immediate action recommending in repairing left main landing gear and external fuel lank on station #7

I A../ js· jJ I D t 1 a e 04 SEP 18

M Yes�o !Remarks /l A ./l �-l�i(� Trl j signaturef ,.{/[tt /p./f��{f/ I Date I \OOC r2u18-

I I i

Item 3 pg 2

Potomac River Enterprise Solutions, LLC Aircraft Inspections for Display

Aircraft Reclamation and Demilitarization Procedures Under no circumstances shall safety be compromised. Additionally, local discretion is advised in adapting these guidelines to the particular Type, Model, and Series {TMS} of aircraft involved, to the condition of the airframe, and to other peculiar characteristics.

BuNo: 152647 Type: A-7A Aircraft Name: Corsair II

Check list Items Certified By: (Print Name, Rank & Sign) 1--��������������������-, All Class "A", "B" and "C" explosives will be removed, disarmed, or deactivated.

(1} Ejection seat rocket motors and related Cartridge

Actuated Devices (CADS) removed.

(2) Internal/external canopy jettison systems, window or canopy fracture system made safe for display.

(3) Shielded Mild Detonation Cords and Flexible Mild

Detonating Cords (SMDC and FMDC).

(4) All explosive devices fitted to parachute assemblies.

(5) All seat survival unit explosive devices or charges.

(6) CADS must be removed from all external store jettison devises from racks, missile launchers, bomb racks, and ktllS\lM\ J\ACNitLC'f rescue hoists.

(7) Gun rounds, Guns, pyrotechnics, chaff, and flares are

-:p2--�' rendered inert or removed. ��Sfl/1.Jn i\l\C.NflLl Y

Inert Certification: "I certify that the items listed hereon have been inspected by me and, to the best of my �\Di\f\JI\ MtNA-u;y knowledge and belief, contain no items of an explosive nature, to include ejection seat activation devices" ( 2

Signatures Required).

Satisfactory completion of procedures {1} through (7) shall be certified by PRES AE Quality Assurance personnel in accordance with OPNAVINST 8020.13 and PRES AE

QUAL/CERT Program (Designated Quality Assurance)

NOTES: No Armament, Ammunition, or Explosives

08-Aug-18

08-Aug-18

08-Aug-18

08-Aug-18

08-Aug-18

08-Aug-18

08-Aug-18

08-Aug-18

08-Aug-18

Revised: 02.10.17

Item 4

Potomac River Enterprise Solutions, llC Aircraft Inspections for Display

Aircraft Safe For Public Display Checklist And Certification Under no circumstances shall safety be compromised. Additionally, local discretion is advised in adapting these guidelines to the particular Type, Model, and Series (TMS} of aircraft involved, to the condition of the airframe, and to other eculiar characteristics.

BuNo: 152647 Type: A-7A Aircraft Name: Corsair II

Completed and Certified By Contractor:

Check list Items (Print Name & Sign) DATE

Perform Condition Inspection

All Batteries Removed

Radiation Survey of entire vehicle completed. All radioactive materials which are readily removable have been removed (i.e.

gauges, switches, instruments, breakers, etc ... ). I certify this has been completed. Attachment of the radiation survey sheet to this document is required.

Aircraft shall be de-fueled and all internal/external fuel tanks, cells, pods, bladders shall be low-point drained at a minimum.

De-puddled if accessible and GAS FREE as required IAW NAVAIR

01-lA-35.

Aircraft Structure and Auxiliary components Purged of Fluids

Compressed Gas Cylinders Sated IAW OLAR 4145.25, Section 8, Para E

All pressure gaseous or liquid oxygen system cylinders and converters shall be disconnected, drained, and rendered

Inert/or removed.

Landing gear systems, all high/low pressure accumulators and blow down bottles shall be depleted (as applicable).

Hydraulic systems reservoirs, accumulators, high/low pressure vessels shall be drained. Cylinders and emergency brake systems shall be drained and depleted as feasible.

Tailhook nitrogen precharge depleted and tailhook should be secure and landing gear locked before transporting.

Remove all fire extinguishing systems/fire bottles.

Inert Certification: "I certify that the items listed hereon have been inspected by me and, to the best of my knowledge and belief, contain no items of an explosive nature, to include e·ection seat activation devices" 2 Si natures Re uired .

Reviewed By (Designated Quality Assurance):

Radiation Survey Record: -08-18-05

NOTES: No Battery, POL's, Oxygen, Nitrogen, Pressurized Components, or Fire Extinguishers/Bottles

08-Aug-18

08-Aug-18

06-Aug-18

08-Aug-18

08-Aug-18

08-Aug-18

08-Aug-18

08-Aug-18

08-Aug-18

08-Aug-18

08-Aug-18

08-Aug-18

08-Aug-18

Revised: 02.10.17

Item 5

Statement of Work Completed Form:

HAZMAT, HAZWASTE, Parts, Artifacts, Munitions

TYPE QUANTITY DATE LOCATION

-Fuel filter

JP 1 Gallon 08AUG18 - low point drain lines

-Constant Speed Drive (CSD)

Oil 1 Gallon 08 AUG 18 drain

-PC System #1 and #2

Hydraulic 1 Gallons, 08AUG18 reservoirs, filters, and low

Fluid 3 Pints point drain lines

-Arresting gear accumulator

Nitrogen 800 PSI 08 AUG 18 -Right main landing gear strut

Examples of Entries: Petroleum, Oil, Lubricants (POL), and Fluids Removed

Type: JP/AVGAS/Oils/Hydraulics, etc.

Quantity: Gals/Other

Date: Completion Date of Removal

Remarks: Disposal Method, Company, etc.

REMARKS

-Fuel has been properly disposed/recycled in compliance with all applicable federal, state, and local environmental and hazardous material regulations

-Oil has been properly disposed/recycled in compliance with all applicable federal, state, and local environmental and hazardous material regulations

-Hydraulic fluid has been properly disposed/recycled in compliance with all applicable federal, state, and local environmental and hazardous material regulations

-Nitrogen has been depleted

MATERIAL REMOVAL

TYPE QUANTITY RESOLUTION DATE

Radiation Survey 1 Completed 06 AUG 18

Hazardous Material Found None N/A

Parts Removed None N/A

Examples of Entries:

Type: Radioactive Component/Hazardous Material Found/Part Removal

Quantity: Number

Resolution: Disposal/ Abatement/Removal

Date: Completion Date of Action

Remarks: Disposal Method, Company, etc.

TYPE QUANTITY

None N/A

Examples of Entries:

Type: CAD/PAD/SMDC/Ordnance/Pyrotechnics Inspection

Quantity: Number

Resolution: Disposal/ Abatement/Removal

Date: Completion Date of Action

Remarks: Disposal Method, Company, etc.

ORDNANCE

RESOLUTION

N/A

N/A

N/A

REMARKS

Radiation Survey Record: -08 8- 05 -1

N/A

N/A

DATE REMARKS

N/A N/A

Item 6

Aircraft Radiation Survey Potomac River Enterprise Solutions, LLC Aircraft: A-7 A BUNO 152647 Date: 08/06/2018 Borrower: School Board of Alachua Countv I POC/Title: POC INFORMATION Manager Conducted bv:

Address: 3700 Northeast 53ra Avenue, Gainesville, FL 32609

Instrument Verification Checks Complete: Ii!! Yes 0 No Suspected Radionuclide Survey Instrument Model

¥ I DU 238 I 1 LND Inspector USB EXP

€ I None I 2 LND Inspector USB EXP

Ii!! Displa

No Tl p RN 1 # 2 # 3 # 4 # 5 # 6 # 7 # 8 # 9 #

10 # 11 # 12 # ¥ 13 # 14 # ¥ 15 # ¥ 16 * ¥ 17 * ¥ - Le!!end OC = On Contact

Aircraft 0 Restoration 0 Stora!!e

I

Survev Readings Result I Location OmR/h OmR/h OmR/h OmR/h Left Win OmR/h Tail OmR/h Right Wing ine

OmR/h Ri!!ht Side Engine OmR/h External Stores OmR/h OmR/h OmR/h

0.601 mR/h OmR/h

0.025 mR/h

52.4 mR/h Note 1

OCPM Smear l OCPM Smear 2

T = Tvoe P =Particle #=Frisk RN = Radionuclide

Dist.

oc oc oc oc oc oc oc oc oc oc

*=Smear a = Radiation Tvoe

Radiation Survev Record: 08-18-05

Serial Number Calibration Date 28726-08657 3/13/18

28726-08657 3/13/18

Location

Date: 08/06/2018

Instrument Efficiency ± 10%

± 10%

Time: 0900

Background Survey Reading

0.009 mR/h

33.8 CPM

Tvue 0 Indoors Ii!! Outdoors 0 Covered D Han!!in D Ground Ii!! Mounted 0 Pedestal t /�'

_ _,_.-���·;¥; ,.� . ..__-JL�.· ··.:.�

�l .. - ' (;;-1 ...

\l

. -"':"G- i . ,i'.' -� ��I :'.•<

... .. ... .. -�-•. . '>-"1'·--�-o'-·...I w . "\.."\.. ' �';,,r�";:r.,.-•.c.;:�'.�� �' ��\ �

.,-=._�,f-;.. •• ��:'.2--'-�f'-··� ' 1 ' . '. �·-i'i"·'" •. • ' �1 L •

. . . 0 counterweight. tests. Reading 17.

NOTES:

All readings taken on contact. Radiation detected on right side fuselage and inside cockpit. CO was able to isolate the source of the radiation to the areas identified above as Note 1 -

Depleted Uranium (DU) counterweight. The DU counterweight is located on the forward right side of the cockpit. Reading number 12 shows the radiation level on the right side of the fuselage below the windscreen and reading number 14 shows the radiation level at the center of the cockpit. An exterior panel was removed and reading number 15 shows the radiation level at the DU counterweight. As part of this survey, two field smear tests were performed. Smear 1 and Smear 2 were taken directly on the DU The two smear numbers 16 and did not indicate anv leakage.

NHHC RSO Review: Print: NAME Title: RSM, NHHC Sign/ Date:

Item 5

Item 7

Item 6 print and sign form

Aircraft Radioactive Material Disposal Form

Aircraft: T-39D BUNO Borrower: Southern Museum ofFli ht POC/Title:

Address 4343 73' Street North, Birmin ham, AL 35206

Instrument Verification Checks Com lete: Ii!! Yes DNo

Suspected Radionuclide Survey Instrument Model

¥ Radium 226 1 LND Inspector USB EXP

€ 2 LND Ins ector USB EXP

Aircraft

151338

NAMES GO HERE

Serial Number Calibration Date 28726-08657 3/13/18

28726-08657 3/13/18

Location

Potomac River Enterprise Solutions, LLC

Date: 11/05/18 Conducted b :

Radiation Surve Record:

Date: I 1/0518

Instrument Efficiency ± 10%

± 10%

PRINT AND SIGN NAME

-T0-12-D

Time: 1000

Background Survey Reading

0.01 I mR/h

42CPM

T e

Ii!! Dis la DRestoration DStora e D Indoors li!!Outdoors DCovered D Han in Ii!! Ground D Mounted DPedestal

Survey Readings

No T P RN Activity/ Disposal Instrument Dist.

Survey

1 # y ¥ 0.36uCi

2 # ¥ 0.25mR/hr

3 # y ¥ 0.036mR/hr

OC = On Contact # = Frisk *=Smear

Cockpit Toggle Switch

Note 2 oc

Bag 2-oc

4"x4"x3" 1.0 lbs

RN = Radionuclide

Location of Disposal Bag 2

NOTES: Activity measurements were ascertained using RAD PRO Calculator Program (Version 3.26). Estimated activity of disposal item is noted in row I. Radioactive material was double bagged with J-seal and labeled as bag #2. Bag number 2 contains a toggle switch/panel from the cockpit measuring 4"x4"x3", 1.0 lbs. Note 1 shows the storage location of disposal item (bag 2). It is a combined storage area inside the F-86F (bureau #1L390) left fuselage panel labeled "RADIO ACCESS", accessible with a flathead screwdriver. Note 2 shows the combined storage area items located inside the panel. A radiation survey of the external panel cover showed 0.25mR/h on contact with the panel cover. The physical address/location of the stored radioactive material destined for disposal is the same as listed above.

NHHC RSO Review: Print: NAME Title: RSM,NH HC Sign/ Date:

CERTIFICATE OF CALIBRATION

S.E. INTERNATIONAL, INC.

436 Farm Road P.O. Box 39 Summertown, TN. 38483

Ph: 931.964.3561 Fax: 931.964.3564 www.seintl.com I radiationinfo@seintl.com

Certificate Number:

18-598

CAL DATE: 3/13/2018

CAL DUE DATE:3/13/2019

Customer Information:

COMPANY

INFORMATION

ADDRESS

PHONE #

Instrument Information:

Instrument: Radiation Alert Type: GM Survey Meter Model: Inspector USB EXP Serial: KL;LJK654L;K65KL;

Make: LND Tube Model: 7317 Detector: External Input Sens: 2.4VDC

Inst Voltage set: 509VDC

Calibration Data:

INSTRUMENT MODEL & SERIAL NUMBER

Contamination Check: L Alarm Check: !2 Audio Check: EZ Received: Out of Spec:

Mechanical Check: f:2 Battery Check: � 9.68VDC

Tolerance: � ± 10% '.:J ± 20% = Out of Spec

S.E. International, Inc. Certifies the above described instrument was calibrated in a known radiation field using a Cs137 (662keV) beam calibrator. Transfer instrument MOH Industries, Model 2025 X-Ray lvbnitor, S.N. 4351, with 180cc Probe, S.N. 7773. Calibration is traceable to NIST DG8640/87. GM detectors are positioned perpendicular to source. This calibration conforms to ANSVNCSL 2540-1, ANSI N323-1978, ISO 17025. The results are tabulated below. Measurement of uncertainty is ± 5%. This certificate may not be reproduced, unless in full, without written approval from S.E. International, Inc.TENNESSEE LICENSE# R-51002-C27

Precision/Constancy Check performed with Cs137 Source s/n 0108181 Precision: ::Z ± 10% L; ± 20%

Constancy Check: 1 uCi of Cs 137 indicates 0.387 mR/hr

0.386 Temperature: 21.4 °C Notes:

--- ·- ·- -- -- --- -- -- -- ·-1 Reading 1:

mR/hr

0.382 Reading 2:

mR/hr

Reading 3:

0.392 mR/hr

0.387 Mean:

mR/hr

Decade Range

10 mR/hr - 100 mR/hr

1 mR/hr - 10 mR/hr

0.1 mR/hr - 1 mR/hr

Relative Humidity: 46.1% mmHg: 7375.

Dead Time is set at 1.919E-05 Gamma Sensitivity is set ! at 3666 For more on the Dead Time and Gamma

! Sensitivity, see owners manual. Unit: Received with the I Dead Time set at 1.140E-04 Received with a Gamma I Sensitivity of 3340

Instrument Meter

Reference Point Reading after Calibration • Correction Factors for>+/. 10%

50mR/hr 53.51mR/hr None

5mR/hr 4.560mR/hr None

0.5mR/hr 0.455mR/hr None

••=Range calibrated to electronic standard I •indicates 1 minute average

Cs137 Gamma 6810 Capsule S/N A-855 and Model 28-5A Calibrator S/N 10291 calibrated monthly for decay

Multimeter S/N 86820561 Cal Date:21 Nov. 2017 Cal Due:21 Arb Gen. S/N US34004570 Cal Date: 1-23-2018 Cal

Nov. 2018 Due:1-23-2019

Calibrated by: Robert Russell J<W- fr�

Item 9

Shipper: BORROWER NAME WITH EPA ID NUMBER Address: BORROWER

ADDRESS

PHONE

24-Hour Emer.:ency Telephone Number: (619) 545·6520

Transporter: Noreas Environmental Services, UC Naval Air Station North Island Building 1606 San Diego, CA 92135

Telephone: (619) 54S-6520

Ship to address: NAVFAC SW Environmental Services Naval Air Station North Island Building788 San Diego, CA 92135

Telephone: (619) 545-6520 sl Noreas Environmental Services L..L..C

STRAIGHT Bill OF LADING

HM ID# Proper Shipping Name

Contaminated Petroleum Product

1) RPlS

Bol: 20180830-01 Page: 1 of 1

PACKAGING

HC PG QTY TYPE

lO CM

WT UNIT

2'/'f ) p

This Is to certify that the above-named materials are properly classified, described, packared, marked, and labeled and are In proper condition for transportation accordinr to the applicable regulations of the Department of Transportation.

Shipper Name: :;:' eP'F fdtryl} �

Date:

Receiving F1cill : � VV\O' "'-. \o v V-11? Date: f3 I

CSW-044 12/13/17

ERG#

Item 10 pg 1

DoclD: OTH-005 NAVFAC Southwest Environmental Services Industrial Waste/Oily Waste Facility Bilge & Oily Waste Treatment System Facilities

Used In:

Revision# Revision Date:

IWOW-03. 08. 22. 27. 67

7125117

WASTE ACCEPTANCE FORM

NES / 2 0 7 1 MAURICIO HERNAN DEZ JULIAN DATE: 8242 -------

Transporter's Co. I Truck# I Driver Name

Bulk Pumping# (Non-FRC): Activity#:

CUSTOMER USE ONLY:

SA N DIEGO A R

L

ESPIE

ACTIVITY NAME:

JOB ORDER NUMBER QI available): __ B_0_1 O _____ _

BASE waste is coming from:_N_ l_A ____ _

PHONE NUMBER: (888-888-8888

Base waste is aoing to: NBC BLDG. 0788

Jp_5 (Requires manifest if different than base waste is coming from)

WASTE DESCRIPTION: _· ______ 1_0_X_5_5_G_A_L_D_M _________________ _

NBC·NI IWOW HAS THE APPROPRIATE PERMIT(S) FOR, AND WILL ACCEPT. THE WASTE THE GENERATOR IS SHIPPING.140 CFR 264.12 (b}I

Transporter certifies that they currejitly are registered as a Hazardous Waste Transporter __f! yes _Ono VOLUME (GALLONS): �GAL :JL/ 4 Q f

FRC USE ONLY �

MWSER ID: _______ _ TANK NO:. ________ _ SHOP NO: ________ _

PROCESS GENERATING WASTE: FRC WASTE PROFILE NUMBER:

NES PERSONNEL USE ONLY: BULK PROFILE l __ �_\/'J_·_q_\ __ _ TRUCK DOI: NOT REQUIREO$f COMPLETED 0 FACILITY: IWTP __ NI ORP __ NBSD BOWfS __ NBPL BOWTS __ NAB BOWTS __

NBCNI ONLY: Manifestl:. ________ GENERATOR'S ID NUMBER: __________ NON_HAZ _____ �

TIME ARRIVED :_�J�_l _S ____ PUMP START TIME: _...;.J_4-_2C> _ _____ Pl"'41P END TIME: __ \ 4-_:3_S ____ _

PHYSICAL STATE: \...-\ Q IA.A b SLUDGE IN BOWSER/TANKER TRUCK: YES ___ NO 2'.._ VOLUME (GALLONS): 5 50 FIELD TEST RESULTS (MG/L), if required (see FRC Profile List):

Total Cr ___ _ Cr. {VQ ____ _ CHLOR-D-TECT ____ _

CN ____ _ • HYDROCLOR-0 ____ _

pH: ____ _ OTHER ____________ _

TREATMENT GROUP: 1 - OW/GIW __ .;.,;<. __ _

3-CHROME ____ _ 4 - MIXED METALS, PHENOL. CORROSIVE _

5-CYANIDE ____ _

7-SPECIAL ____ _

TREATMENT TANK: 4-A BATCH NUMBER: ____ N.-f_ A-______ _

MANAGEMENT METHOD CODE H 135

ACTIVITY REPRESENTATIVE:

NES REPRESENTATIVE

NES TRUCK AUTHORIZATION

PRINT NAME

�[};ME/6&vnt4 t2. TO......,,_.--=>

PRINT NAME

TRACKING NUMBER:

rt·- Jt? - It'

DATE

'&.so. J 2 DATE It B/3o f8

I DAT� Time WAF Issued

Total Truck Hours (Pac Trans): ____ _

Total Truck Hours over 4:

Item 10 pg 2

Applicable Instructions, Procedures, and Publications

Aircraft Safe for Display

A-7A Buno 153135

Instructions: 1. Ammunition Explosives Qualifications and Certifications Program

2. Aircraft Radiation Survey Program

Procedures: 1. Aircraft Safe for Display Checklist

2. Aircraft Radiation Survey

Publications: NAVAIR 01-45AAA-2-1

A-7D/E Corsair II Flight Manual

Item 11