J-7 MSC Ship Repair Facility Survey.docx

N3220520R6500

USNS MERCY (T-AH 19)

MSC SHIP REPAIR FACILITY SURVEY

NOTE: If survey form has been previously submitted, then enter changes only.

DATE:

SHIPYARD AND ADDRESS

Commander (Code M-4E3) Military Sealift Command Washington, DC 20390

SHIPYARD DATA

Telephone No:

Telex No:

Date Found:

BUILDING WAYS (M. I. W.)

NO. LAUNCHING DIMENSIONS MAXIMUM SHIP SIZE

OF (check one) (ton 2,240 lbs)

WAY

[ ] END LENGTH: LENGTH:

[ ] SIDE

[ ] BASIN WIDTH: WIDTH:

[ ] SLAB

DEPTH: DEPTH:

DEPTH OF WATER

CRANES SERVING WAY

CERTIFICATION DATE &

CERTIFIED BY WHOM

LIFT CAPACITY

(std. tons)

TYPE

NO.

AT DROP

OFF

OVER

WAY END

[ ] END LENGTH: LENGTH:

[ ] SIDE

[ ] BASIN WIDTH: WIDTH:

[ ] BASIN WIDTH: WIDTH:

[ ] BASIN WIDTH: WIDTH:

[ ] BASIN WIDTH: WIDTH:

[ ] BASIN WIDTH: WIDTH:

LENGTH OF LAUNCHING RUN DEPTH OF RUN AT M.L.W.

TIDAL RANGE (DIFF. OF M.L. M.H)

IS SNUBBING NECESSARY?

YES NO

IS FIRE PROTECTION AVAILABLE

ON BUILDING WAY?

YES NO

SHEET 1 OF 5

DOCK

MAXIMUM SHIP SIZE

ACCOMMODATED

LENGTH OA-BEAM

LENGTH

at coping (GD), at keel blocks OVERALL on cradle (MR), on PONTOON

(FD)

CLEAR WIDTH

at top cradle (MR), at keel at top inboard block wing wall (FD, GD) height

DEPTH/DRAFT

OVER OVER OVER

SILL FLOOR KEEL

(GD) BLOCKS

LIFTING CAPACITY

(ton 2,240)

DATE CERTIFIED, CERTIFIED BY WHOM, &

DATE CERTIFICATION EXPIRES

DRY DOCKS (continued)

MATERIAL TYPE

Floating--(FD) Graving--(GD) Marine Railway (MR)

DOCK

SERVICES AVAILABLE

(use abbreviation of service below)

USE

REPAIR/

OUTFIT-

ING

HEIGHT

OF

DOCK

(M.L.W.)

OUT-

BOARD

IN-

BOARD

TYPE

LENGTH

(actual & usable)

ACT:

USE:

ACT:

USE:

ACT:

USE:

ACT:

USE:

ACT:

USE:

ACT:

USE:

WATER DEPTH

(M. L. W.)

LEGEND (abbreviation of services) Fresh Water --- F.W. - G.P.M. - P.S.I. Steam --- S - P/HR - P.S.I. Electric Power --- E - V - AC - AMP Fire Protection --- FP - G.P.M. - P.S.I.

Salt Water ----- S.W. - G.P.M. - P.S.I Air ------ A - C.F.M. - P.S.I. Electric Power --- E - V- DC - AMP Sanitary Sewer --SS - YES - NO

MSC SHIP REPAIR FACILITY SURVEY (continued) SHIPYARD:

BERTHING, SHOP OR YARD CRANES; STATIONARY, RAIL, MOBILE, OR BRIDGE (3 tons or over)

MAX REACH HEIGHT OF HOOK

NO TYPE CAPACITY MAX SPAN CAPACITY BOOM HEIGHT ABOVE BASE HEIGHT OF HOOK AREA SERVICE DATE CERTIFIED, CERTIFIED BY WHOM & (STD TONS) (BRIDGE) AT REACH LENGTH HINGE ABOUT REACH (BRIDGE) DATE CERTIFICATION EXPIRES

DISTANCE TO NEAREST DISTANCE TO NEAREST AIRPORT

RAILROAD CONNECTION (identify)

NAVIGATIONAL RESTRICTIONS (indicate at M.L.W.)

MINIMUM CHANNEL (depth width) MINIMUM HORIZONTAL AND VERTICAL BRIDGE CLEARANCES

LIST ANY OTHER RESTRICTIONS (include projects under construction which will after navigational restrictions)

STORAGE SPACE FOR COMPONENTS AND MATERIALS

(LIST DIMENSIONS FOR EACH AREA, PLUS TYPE MATERIAL STORED)

PRINCIPAL SHOPS AND BUILDINGS

ALL OTHER SHOPS

(LIST NAMES AND DIMENSIONS)

LARGEST EXIT

WIDTH HEIGHT

DIMENSIONS OF

SHOP OR BUILDING

NAME OF SHOP

OR BUILDING

FABRICATING

PLATE

SHEET METAL

SUBASSEMBLY

WOOD WORKING

BOAT ASSEMBLY

OR MOLDING

BOILER

MACHINE

ELECTRICAL

ELECTRONIC

PIPE

FOUNDRY

RIGGER

RAW STEEL STORAGE (SQ. FT.) ___________________________________________________________

WELDING AND ASSEMBLY (SQ. FT.) _______________________________________________________

ACREAGE LEGALLY CONTROLLED

IN USE DEVELOPED TOTAL

LIST TYPES OF WORK NORMALLY SUBCONTRACTED

LIST ANY EQUIPMENT OR CAPABILITY NOT OTHERWISE DESCRIBED IN THIS FORM

REQUIRED SUBMITTALS TO ACCOMPANY THIS FORM:

1. PLOT PLAN OF YARD.

2. CERTIFIED DEPTH OF WATER PLOT

3. FOR EACH SHOP LISTED ON SHEET 4, A LIST OF MACHINE TOOLS AND

EQUIPMENT WHICH INDICATES THE CAPACITIES OF THE SHOP.

4. A GENERAL STATEMENT (INCLUE, NAME OF SHIP, DATES, AND

DOLLAR AMONT OF JOB) OF SHIP REPAPIR WORK WHICH HAS BEEN

ACCOMPLISHED BY THE APPLICANT.

5. LISTING OF OFFICIALS AND THE QUALIFICATIONS OF EACH FOR SHIP

REPAIR (INCLUDE AS A MINIMUM JOBS HELD, YEARS, HELD, ONE LINE

6. IF FACILITIES ARE LOCATED AT MORE THAN ONE LOCATION THEN

LIST EACH FACILITY AND ITS LOCATION.

7. POINT OF CONTACT FOR INFORMATION SUBMITTED IN THIS FORM

(NAME/TITLE/PHONE NUMBER).

NORMAL

SHIFTS

NORMAL

MAXIMUM

POTENTIAL MAXIMUM

CURRENT

CURRENT

EMPLOYMENT

MANAGEMENT, ADMINISTRATION

PROFESSIONAL ENGINEERING

PRODUCTION SKILLED

PRODUCTION UNSKILLED

NONPRODUCTION

TOTAL:

NAME AND TITLE OF SENIOR SURVEYOR SIGNATURE DATE SIGNED

ARE YOU CERTIFIED AS A SMALL BUSINESS ? YES NO

SHEET 5 OF 5

ATTACHMENT J - 7 MSC Form 4330/26