TGI 38JC212301A01.pdf

FOUO

FOUO: Public availability to be determined under 5 USC 552

TASK GROUP INSTRUCTION

AIM REV 20.11.4.0 (OCTOBER 2020)

TGI COMPONENT NAME: TYPE: PHASE: REPEAT: CHANGE:

NO.: CMPT 3-370-0-E AY A 0 0

SHIP/HULL NO.: SHIP/HULL NAME: SYSTEM: PROJ/WO NO: CASREP CAT:

DDG-83 USS HOWARD JC2

CU PHASE TITLE:

F/O - INSPECT, REPAIR, AND PRESERVE GENERATOR ROOM (3-370-0-E)

PREPARING ACTIVITY:

PREPARED BY: CODE PHONE DATE

MASAMICHI HAGA 231B. 315-243-2513 25-APR-2024

APPROVED BY: CODE PHONE DATE

RYOUTA TAKAGI 231B. 315-243-4502 25-APR-2024

CONCURRED BY: CODE PHONE DATE

CONCURRED BY: CODE PHONE DATE

CONCURRED BY: CODE PHONE DATE

CONCURRED BY: CODE PHONE DATE

REASON FOR WORK/NEED FOR CHANGE:

CHANGE INSTRUCTIONS:

SPECIAL REQUIREMENTS:

SURFMEPP

This work affects a fire zone boundary. Fabrication and/or staging of a non-flammable closure is required.

CLEANLINESS FOR PIPING SYSTEM/EQUIPMENT LEVEL III

WORK CERTIFICATION SIGNATURES

COMPLETION OF WORK REVIEW: BADGE NO.: SHOP/CODE: PHONE: DATE:

ACCEPTANCE OF COMPLETED WORK

PHYSICAL INSPECTION PHYSICAL INSPECTION COMPLETED: BADGE NO.: SHOP/CODE: PHONE: DATE:

REQUIRED:☐YES ☒NO

RECORDS REVIEW: BADGE NO.: SHOP/CODE: PHONE: DATE:

TGI NO.: CMPT 3-370-0-E AY A 0

FOUO

SHIP: DDG-83 CHG/VER: 0/0

LIST OF EFFECTIVE PAGES

SHT NO. CHG NO. SHT NO. CHG NO. SHT NO. CHG NO. SHT NO. CHG NO. SHT NO. CHG NO.

1-8 J 1-2 M 1-3 Sketch (1)

1. SCOPE/PURPOSE

1.1 Title: Generator Room (3-370-0-E); inspect, repair, and preserve

1.2 Location of Work:

1.2.1 Generator Room (3-370-0-E)

1.2.2 Cross Flooding Duct Frame 368

1.2.3 Gas Turbine Waste Drain Collecting Tank (4-370-2-F)

1.2.4 Fuel Tank Group-5 (5-354-0-F)

1.2.5 Fuel Tank Group-6 (5-370-0-F)

1.2.6 Crew Living Space No. 6 (3-338-3-L)

1.2.7 Crew Living Space No. 7 (3-350-2-L)

1.2.8 Fan Room (3-362-0-Q)

1.3 Identification:

1.3.1 Quantity (One EA), Cross Flooding Duct Frame 368

1.3.2 Quantity (One Lot), Floor Plate of Bilge Area in 3-370-0-E, Frames between 370 and 386, Port and Starboard (Stbd)

Remarks: See 2.3 for material and detail

1.3.3 Quantity (One AY), Box Strainer Plate Assembly on Bilge Drain Well in 3-370-0-E Material: CRES 316L Remarks: See 2.5 and 2.6 for detail

1.3.4 Quantity (One AY), Strainer Plate Assembly on Bilge Drain Well in 3-370-0-E Material: CRES 316L Remarks: See 2.4 for detail

1.3.5 Quantity (One EA), Oily Waste Transfer System Valve

Mfr: Various Size: 2.50-Inch IPS Type: Foot Valve No: OWT-V-79 (MDI/V0078)

1.3.6 Quantity (One AY), Flanged Piping Section: Main Drainage, Valve to Drain Well Tail Piece Size: 4 Inch IPS (4.500 Inch OD x 0.109 Inch WT) Material: Cu-Ni 90-10 Remarks: See 2.8 for details.

FOUO

SHIP: DDG-83 CHG/VER: 0/0

1.3.7 Quantity (One EA), Bilge Drain Well in 3-370-0-E, between Frames 370 and 373, and Longitudinal No. 1P and Ship’s Center Line, Port

Reading Point: 6 Inches x 6 Inches Grid Pattern in Bilge Drain Well, including beneath the bottom of suction piping(s)

Remarks: See 2.14 and 2.15 for base material and Sketch Enclosure-01 for detail

1.3.8 Quantity (2 EA), Zinc Anode, including studs on Bilge Drain Well in 3-370-0-E Type: ZHC-23 Size: 6 Inches x 12 Inches x 1-1/4 Inches Thickness Remarks: See 2.9 for material and detail

REF.

NO.

DOCUMENT

/DRAWING

NUMBER

DOCUMENT/DRAWING TITLE REV CHG

NO.

COPY

REQ’D

(Y/N)

SOURCE

DOC

(Y/N)

PARA SEC PG CHP

1 NSI FY-25 NAVSEA Standard Items - ORG N 2 LI FY-25 Local Standard Items - ORG N

3 DWG 622-

6219167

FLOOR PLATES, GRATINGS &

HANDRAILS -AFT GEN RM ARR-

FAB & INSTL

R Y SE

E N

OT

E

4 PDD 611-

ELM-240155

MOD OF DRAIN WELL STRAINER

PL IN GEN RM (3-370-0-E)

- Y AL

L

5 DWG 611-

6221132

FABRICATION OF MISC DECK

FITTING - ZONE 3

AN Y 15

9A ,15 9B

6 DWG 600-

7026471

HULL OUTFIT INSTL DZ 3330 2ND

PLATF FR 370-410

G Y 3C ,4 D, 6A

7 DWG 534-

6567443

WASTE & OILY WASTE WATER

PIPING SYS DIAGRAM

K Y 4A

1.3.9 Quantity (21 SF), Deck Plating around the Bilge Drain Well in 3-370-0-E Remarks: The area is between Frames 370 and 374, and Longitudinal No. 1S and No. 2P except around vertical surfaces

1.3.10 Quantity (520 SF), Bilge Area in 3-370-0-E, Frames between 370 and 386, Port and Stbd Remarks: The area is up to 2 inches above grating level including all structure members, grating frames and support, deck fittings, drain wells, bulkhead fittings, foundation, piping, piping hangers, top side of manhole covers, and boundary bulkheads

1.4 Security Classification: None.

1.5 Initial Condition:

1.5.1 Critical Coated Area: CCNY-DDG83-014-25 for the area listed in 1.3.10

1.5.2 Potential Asbestos Hazard

1.5.3 Dry Dock Work

1.6 Contractor work start date: 4/7/2025

1.7 Contractor work completion date: 7/29/2025

2. REFERENCES:

FOUO

SHIP: DDG-83 CHG/VER: 0/0

REF.

NO.

DOCUMENT

/DRAWING

NUMBER

DOCUMENT/DRAWING TITLE REV CHG

NO.

COPY

REQ’D

(Y/N)

SOURCE

DOC

(Y/N)

PARA SEC PG CHP

8 DWG 529-

6567414

DDG-51 CLASS MAIN &

SECONDARY DRAINAGE SYS

DIAG

F Y 4A

9 DWG 113-

8570500

BILGE WELL REDESIGN MODS &

ML

A Y 1,6 ,7

10 LAR

83111/DDG5

1/1209108

THIS ALT MODIFIED FROM A

SHIPALT TO A (AER)

ALTERATION EQUIVELENT TO A

REPAIR

- Y AL

L

11 LAR

83111/DDG6

9/1144629

CLARIFICATION OF DRAIN

WELLS AND BILGE POCKETS

- Y AL

L

12 LAR

83111/DDG6

3/1129844

REVISE MATL THICKNESS TO

1/2"

- Y AL

L

13 DWG 633-

6567062

Installation of Cathodic Protection & Zinc Anode

AB Y 4A

,4 B

14 DWG 100-

7026700

UNIT STRUCTURAL ARR DWG

ASSY UNIT 3220

F Y 3,5 A, 6,6 C

15 DWG 100-

7026703

UNIT STRL ARR DWG ASSY UNIT

H Y 3,4 ,6, 16 TM T9074-

AS-GIB-

010/271

Requirements for Nondestructive Testing Methods

1 N

17 TM S9086-

DA-STM-

010/CH-100

Hull Structures 4 N

3. APPENDICES:

3.1. Appendix “J” TGI Job Summary Information Sheet

3.2. Appendix "M" TGI Material List

3.3. Appendix “D” Deficiency Form

4. GENERAL REQUIREMENTS:

4.1 Not Applicable.

5. PROCEDURE:

5.1 Accomplish the requirements of 099-902YO of 2.2 for each space listed in 1.3.1.

5.2 Remove each existing floor plate listed in 1.3.2 in way of bilge preservation, using 2.3 for guidance.

5.2.1 Matchmark, identify and retain each deck plate and grating.

5.3 Pump out, clean and dry the bilge area located in 1.2.1 free from oil, debris, and other foreign matter.

5.4 Remove each existing box strainer plate assembly listed in 1.3.3 in accordance with 2.4, using 2.5 and 2.6 for guidance.

5.5 Fabricate and install each new strainer plate assembly listed in 1.3.4 in accordance with 2.4.

5.5.1 Template detail from existing shipboard conditions for new fabrication and installation.

C1209.3 Shimizu, 11120180, SS, 5/22/2024

Shinya.Shimizu.ja Line

FOUO

SHIP: DDG-83 CHG/VER: 0/0

5.5.2 New strainer material must be CRES Grade 316L.

5.5.3 Dimensions of openings in perforated metal must be of same size as existing.

5.5.4 Accomplish the requirements of 009-12 of 2.1, including Table 2, Column(s) D, Lines One through 7.

5.6 Remove each valve listed in 1.3.5, using 2.7 for guidance.

5.6.1 Restore each mating surface exposed by removal. Repair by removing each high spot, burr, abrasion, and foreign matter, where removal can be accomplished by hand tools.

5.6.2 Accomplish an inspection of each valve for evidence of damage or deterioration and each valve seating mechanism for freedom of movement.

5.6.2.1 Submit one legible copy, in hard copy or approved transferrable media, of a report listing results of the requirements of 5.6.2 to the SUPERVISOR.

5.6.3 Retain each removed valve and associated component for installation.

5.7 Remove each flanged piping section listed in 1.3.6 from each bilge drain well listed in 1.3.7 and, located in 1.2.1 to the first flange upstream of the bell mouth, using 2.8 for guidance.

5.7.1 Matchmark, identify, and retain each flanged pipe section.

5.8 Restore each piping flange mating surface exposed by removal of the piping system in 5.7, listed in 1.3.6 from each bilge drain well listed in 1.3.7, and located in 1.2.1 in accordance with 2.8.

5.8.1 Restore each piping flange mating surface exposed by disassembly of piping system. Repair by removing each high spot, burr, abrasion, and foreign matter, where removal can be accomplished by a hand tool. Maintain phonographic finish on each flange that has it.

5.9 Remove existing and install new each zinc anode listed in 1.3.8 in accordance with 2.9 through 2.12, using 2.13 through 2.15 for guidance.

5.9.1 Accomplish the requirements of 009-12 of 2.1, including Table 2, Column(s) A, Lines One through 7.

5.9.2 Install new washers and new nuts conforming to material list of 2.9.

5.10 Accomplish the requirements of 009-32 of 2.1, including Table 3, Line(s) 13, Column(s) A, for surfaces preparation for each bilge drain well and deck plating listed in 1.3.7 and 1.3.9.

5.11 Accomplish ultrasonic thickness measurement (UTM) on each bilge drain well listed in 1.3.7 in accordance with Paragraph 6.7 of 2.16 and 2.17, using 2.14 and 2.15 for guidance.

5.11.1 Accomplish a visual inspection of each bilge drain well and deck plating listed in 1.3.7 and 1.3.9 for structural integrity, deterioration, pitting, each crack, and area of damage or distortion, using 2.14 and 2.15 for guidance.

5.11.2 Submit one legible copy, in hard copy or approved transferrable media, of a report listing results of the requirements of 5.11 and 5.11.1 to the SUPERVISOR.

5.12 Accomplish the following repairs of each bilge drain well listed in 1.3.7, located in 1.2.1, based on each report in 5.11.2, using 2.14 and 2.15 for guidance, as designated by the SUPERVISOR. See 5.18.4 and 5.18.5.

FOUO

SHIP: DDG-83 CHG/VER: 0/0

5.12.1 Remove existing, fabricate and install new a total of 5 square feet of deteriorated bilge drain well bottom plate(s), using 0.5 inch thickness plate conforming to MIL-S-22698 DH-36 for bottom plate, using 2.14 and 2.15 for guidance.

5.12.2 Chip and grind each surface flush in way of each repair.

5.12.3 Base metal weld build-up a total of 29 square inches of each plate defect.

5.12.3.1 For bidding purposes, the weld build-up must be one quarter inch thick.

5.12.3.2 Surface must be ground to sound metal prior to base metal weld build-up.

5.12.3.3 Fill each local pit and groove with weld metal prior to the application of each principal build-up layer.

5.12.3.4 Grind each surface of completed base metal weld build-up smooth if greater than 1/8 inch above plate surface.

5.12.4 Accomplish the requirements of 009-12 of 2.1, including Table 2, Column(s) A, Lines One through 7.

5.13 Accomplish the requirements of 009-32 of 2.1, including Table 3, Line(s) 13, for each area listed in 1.3.10.

5.13.1 Submit one legible copy, in hard copy or approved transferrable media, of a report identifying inaccessible area(s) with mapping plan and recommended preservation plan for the area to the SUPERVISOR within 3 working days ship check becomes possible after contracting.

5.13.2 Accomplish visual inspection of each area, including floor plate and support, foundation, piping, piping hanger and liner, and structural member for structural integrity, deterioration, pitting, crack, and area of damage or distortion.

5.13.2.1 Submit one legible copy, in hard copy or approved transferrable media, of a report listing results of the requirements of 5.13.2 to the SUPERVISOR.

5.14 Install each floor plate removed in 5.2 in accordance with 2.3.

5.14.1 Accomplish repair to floor plate using visual inspection in 5.13.2 when directed by SUPERVISOR. See 5.18.4 and 5.18.5.

5.14.2 Weld fill, drill and tap a total of 40 holes in floor plate support structure.

5.14.3 Chip and grind each surface flush in way of each repair.

5.14.4 Accomplish the requirements of 009-12 of 2.1, including Table 2, Column(s) A and D, Lines One through 7.

5.14.5 Chase and tap each exposed threaded area.

5.15 Install each valve listed in 1.3.5, using 2.7 for guidance.

5.15.1 Remove existing and install new each piping joint gasket. Each gasket must conform to UNAFLEX Type 87, 96, or MIL-PRF-1149.

5.15.2 Remove existing and install new each piping joint fastener. Each screw must conform to MIL-DTL-1222, Grade 400 or 405, nickel-copper alloy. Each self-locking nut must conform to NASM17828.

5.16 Install each flanged piping section retained in 5.7.1 in accordance with 2.8, using 2.15 for guidance.

5.17 Accomplish the requirements of 009-32 of 2.1 for each new and disturbed surface.

FOUO

SHIP: DDG-83 CHG/VER: 0/0

5.18 Notes:

5.18.1 Planner: Code 231B M. Haga, 243-2513

Planner: Code 231B Y. Koyama, 070-7787-2059 Planner: Code 232 K. Ikeda, 243-0958 Planner: Code 233 M. Yamaguchi, 080-9350-1450 Planner: Code 234 D. Ogawa, 243-5968 Engineer: Code 250 I. Hayasaka, 243-4334 Engineer: Code 260 T. Fukai, 243-4340

5.18.2 Work Integration Manager (WIM): Code 333 T. Yaginuma, 080-5419-0598

5.18.3 This TGI meets the intent of DDG CSWT File Nos. 113-002 and 631-047.

5.18.4 Removal and installation of interferences, and gas free operation, preservation of boundary spaces relating to front loading structure repair are not included in this TGI. They will be covered by a DL in the future based on Contractor submitted condition report.

5.18.5 Materials for structure members relating to front loading repair will be provided in the future as a DL based on Contractor submitted condition report.

5.18.6 Work per this instruction involves cutting an access (or removal of a door) through a fire zone bulkhead, through the hull of the ship above the turn of the bilge, through ventilation components (ducting, plenums, etc.), or through any air-tight, fume-tight or watertight bulkheads normally used to control air flow in the event of a shipboard fire. A nonflammable closure is required in accordance with COMNAVSEASYSCOM MSG R 261400Z JUL 12. The closure, if not continuously in use, shall be staged near the access, readily visible and accessible, so that any emergency responder can install the closure to affect proper air flow onboard the ship.

5.18.7 Provision of oily/chemical water barge will be coordinated by Project Team.

5.18.8 WPC will copy the following pages in reference.

REF. 2.3: Pages, 3A, 5A16, 5B16, 5C16, 5D14, 5J16, 5R, 5T16, and 5U

5.18.9 Opening, initial cleaning, and closing of each space listed in 1.2.3 through 1.2.5 will be covered by the following TGI No(s).

Gas Turbine Waste Drain Collecting Tank (4-370-2-F): 38JC212325A01 (KTR TGI) Fuel Tank Group-5 (5-354-0-F): 38JC212353A01 (KTR TGI) Fuel Tank Group-6 (5-370-0-F): 38JC212311A01 (KTR TGI)

5.18.10 JCNs EM04-ZAD0 and EM04-ZAD2 are related to this TGI.

5.19 Government Furnished Material (GFM):

5.19.1 SRF-JRMC will provide GFM listed in Appendix "M".

5.20 SRF-JRMC will provide the following service work: (TGI No. 38JS212301S02)

5.20.1 [C740] Crane and crane rigging service.

5.20.2 [X99E] Utility service, electrical.

5.20.3 [X99M] Utility service, including low pressure air supply, water supply, and steam supply.

5.20.4 [C106.1] Safety inspection for SRF-JRMC employees.

FOUO

SHIP: DDG-83 CHG/VER: 0/0

5.20.5 [C106.2] Gas free inspection for SRF-JRMC employees.

5.20.6 [C133] QA inspection for (G) symbol(s) and review of coating application data.

5.20.7 [C250] Technical support for frontload repair work.

FOUO

M-1

SHIP: DDG-83 CHG/VER: 0/0

APPENDIX “M”

TGI MATERIAL LIST

SYSTEM: PLANT NO.: COMPONENT NAME: TYPE: PHASE: REPEAT: CU PH

VERSION:

CASREP

CAT:

CMPT 3-370-0-E AY A 0 0

CU PHASE TITLE:

F/O - INSPECT, REPAIR, AND PRESERVE GENERATOR ROOM (3-370-0-E)

MATERIAL REFERENCES

REF

NO.

DOCUMENT/DRAWING

NUMBER

DOCUMENT/DRAWING TITLE REV

JOB ORDER: KEY OP:

38JC212301 A01

MATERIAL LIST

ITEM

NO.

PC

NO.

REF

NO.

M

C DESCRIPTION

STOCK

NUMBER

GENERIC

MATL

TYPE LVL QA

HAZ

MAT

DOC

NO.

QTY

REQD/

UNIT

QTY

USED/

UNIT

001 M INSULATION, FIRE, MATERIAL

ORDER FOR KTR

INSULATION, FIRE, SIZE: 24"W

X 36"L X 1-1/4"THK,

LIGHTWEIGHT MARINE

BLANKET, BIW CATALOG NO.

47215-030, 3SHEETS/BOX

ORIG: C231B M.HAGA 243-2513

LL4823204 NA 4 N 4/BX

002 M CAP, STUD, 3/16"DIA,

MATERIAL ORDER FOR KTR

CAP, STUD, MATL: CRES 304,

HD DIA: 1-1/16",

USE FOR 3/16"DIA STUD,

USE FOR NAVY ANNULAR

RING STUDS, 3/16"DIA,

USE FOR HULL THERMAL

INSULATION

ORIG: C231B M.HAGA 243-2513

9Z 5340 LL4945008 NA 4 N 50/EA

003 M ADHESIVE, MATERIAL ORDER

FOR KTR

ORIG: C231B M.HAGA 243-2513

9B 8040 002738708 NA 4 Y 41155232 1/GL

004 M TAPE,TEX, MATERIAL ORDER

FOR KTR

ORIG: C231B M.HAGA 243-2513

9B 8315 002671632 NA 4 N 41155233 1/RO

NOTES:

FOUO

M-2

SHIP: DDG-83 CHG/VER: 0/0

MATERIAL LIST

ITEM

NO.

PC

NO.

REF

NO.

M

C DESCRIPTION

STOCK

NUMBER

GENERIC

MATL

TYPE LVL QA

HAZ

MAT

DOC

NO.

QTY

REQD/

UNIT

QTY

USED/

UNIT

005 M TAPE,TEX, MATERIAL ORDER

FOR KTR

ORIG: C231B M.HAGA 243-2513

9B 8315 002671633 NA 4 N 41155235 1/RO

006 M SCREW, PAN HEAD, MATERIAL

ORDER FOR KTR

SCREW, PAN HEAD, 5/16"-

18UNC-2A X 3/4"LG, CRES,

PAN HEAD, CROSS

RECESSED, WITH NYLON

LOCKING STRIP

ORIG: C231B M.HAGA 243-2513

LL4599435 NA 4 N

200/EA

101 M ANODE,CORROSION PRE,

ORIG: C231B, Y. KOYAMA 070-

7787-2059

ORDERED FOR KTR

9B 5342 008136058 NA 4 N 41025106 2/EA

102 M STUD,WEL, ORIG: C231B, Y.

KOYAMA 070-7787-2059

ORDERED FOR KTR

9B 5307 012813886 NA 4 N 41025108 4/EA

103 M NUT,SELF, ORIG: C231B, Y.

KOYAMA 070-7787-2059

ORDERED FOR KTR

9B 5310 005957421 NA 4 N 41025109 4/EA

104 M WASHER,L, ORIG: C231B, Y.

KOYAMA 070-7787-2059

ORDERED FOR KTR

9B 5310 015492705 NA 4 N 41025110 4/EA

105 M SHEET, PERFORATED, 4,

SHEET, PERFORATED,

SIZE: 4FT X 4FT X 9/16" THK,

MATL: ASTM A240 CLASS 316L,

HOLE: 3/4" DIA DRILL, HOLE

PITCH: 1-1/2" STAGGERED.

ORIG: C231B, Y. KOYAMA 070-

7787-2059

ORDERED FOR KTR

9B 9515 LL9305688 NA 4 N 41117469 1/SH

106 M PLATE, METAL, 4FT X , PLATE,

METAL, 4FT X 8FT X 3/4" THK,

CRES 316L, ASTM A240.

ORIG: C231B, Y. KOYAMA 070-

7787-2059

ORDERED FOR KTR

9B 9515 LL9305687 NA 4 N 41117468 1/PM

107 M STUD, 5/8"-11UNC-2A ,

CONTINUOUS-THREAD STUD,

MIL-DTL-1222, TYPE IV, 5/8"

DIA, COARSE

THREAD UNC, CLASS 2A, 1-

3/4" LONG (NOMINAL),

CRES COLD WORKED GRADE

316, NO LOCKING ELEMENT,

NO COATING

ORIG: C231B, Y. KOYAMA 070-

7787-2059

ORDERED FOR KTR

9B 5307 LL7029557 NA 4 N 41107435 7/EA

108 M NUT,SELF-LOCKING,HE, ORIG:

C231B, Y. KOYAMA 070-7787-

ORDERED FOR KTR

9B 5310 015549323 NA 4 N 41025111 7/EA

109 M WASHER,FLAT, ORIG: C231B,

Y. KOYAMA 070-7787-2059

ORDERED FOR KTR

9B 5310 015574109 NA 4 N 41025112 7/EA

FOUO

M-3

SHIP: DDG-83 CHG/VER: 0/0

MATERIAL LIST

ITEM

NO.

PC

NO.

REF

NO.

M

C DESCRIPTION

STOCK

NUMBER

GENERIC

MATL

TYPE LVL QA

HAZ

MAT

DOC

NO.

QTY

REQD/

UNIT

QTY

USED/

UNIT

201 M SEAT,VAL, ORIG: C232, K.

IKEDA, 243-0958

ORDERED FOR KTR

9B 4820 000356971 NA 4 N 41065095 2/EA

202 M SEAT,VAL, ORIG: C232, K.

IKEDA, 243-0958

ORDERED FOR KTR

9B 4820 010717388 NA 4 N 41065097 6/EA

203 M GASKET, ORIG: C232, K.

IKEDA, 243-0958

ORDERED FOR KTR

9B 5330 015860604 NA 4 N 41065098 2/EA

400 M COUPLING,TUBE,

ORIGINATOR:C234 D, OGAWA

080-9345-4110

ORDERED FOR KTR

9B 4730 014635878 NA 4 N 41065006 4/EA

401 M COUPLING,TUBE,

ORIGINATOR:C234 D, OGAWA

080-9345-4110

ORDERED FOR KTR

9B 4730 014635857 NA 4 N 41065008 4/EA

402 M SLEEVE,, ORIGINATOR:C234

D, OGAWA 080-9345-4110

ORDERED FOR KTR

9B 4730 LL4903762 NA 4 N 41067416 4/EA

403 M BACKING, ORIGINATOR:C234

D, OGAWA 080-9345-4110

ORDERED FOR KTR

9B 4730 LL4558775 NA 4 N 41067412 4/EA

404 M COUPLING,TUBE,

ORIGINATOR:C234 D, OGAWA

080-9345-4110

ORDERED FOR KTR

9B 4730 005423290 NA 4 N 41065010 4/EA

405 M BACKING, ORIGINATOR:C234

D, OGAWA 080-9345-4110

ORDERED FOR KTR

9B 4730 LL4558779 NA 4 N 41067413 4/EA

406 M COUPLING,TUBE,

ORIGINATOR:C234 D, OGAWA

080-9345-4110

ORDERED FOR KTR

9B 4730 007225471 NA 4 N 41065013 3/PG

407 M BACKING, ORIGINATOR:C234

D, OGAWA 080-9345-4110

ORDERED FOR KTR

9B 4730 LL4558781 NA 4 N 41067414 4/EA

FOUO: Public availability to be determined under 5 USC 552 SHEET_____OF_____

☐ NUCLEAR APPENDIX "D"

DEFICIENCY FORM

☐ NON-NUCLEAR

1. SHIP/HULL NO.: 2a. DL or DR No.

(Circle One)

2b. REVISION: 3a. COMPONENT NAME: 3b. TYPE: 3c. PHASE: 3d. REPEAT:

DDG-83 CMPT 3-370-0-E AY A 0

4a. ICN: 4b. KEY OP: 5. LOC SPACE/LVL: FRAME: P/S/C: 6. CAUSED BY:

38JC212301 A01

7. DESCRIPTION:

8. ORIGINATOR: NAME: BADGE: SHOP/CODE: DATE: PHONE NO.:

9. CORRECTIVE ACTION:

10. EVALUATOR: NAME: BADGE: SHOP/CODE: DATE: PHONE NO.:

FOR NON-NUCLEAR USE ONLY

11. RFD/RFW REQ’D ☐ LAR REQ'D ☐

ILS MOD REQ’D ☐

SRD/PLAN REV REQ'D ☐

DWG NO.: _____________________ S/A NO.: ___________________

12. ISOLATION SIGN: BADGE: SHOP/CODE: DATE: PHONE NO.:

SATISFACTORY:

13. SUBSAFE OQE RECORD? SIGN: BADGE: SHOP/CODE: DATE: PHONE NO.

YES ☐ NO ☐

14. CORRECTIVE ACTION SIGN: BADGE: SHOP/CODE: DATE: PHONE NO.

COMPLETE:

15. INSPECTION REQ’D? INSPECTION COMPLETE/SIGN: BADGE: SHOP/CODE: DATE: PHONE NO.

_________:YES ☐ NO ☐

16. RECORDS REVIEW SIGN: BADGE: SHOP/CODE: DATE: PHONE NO.

COMPLETE (DR ONLY)

DL’s ISSUED

(DR ONLY)

FOUO: Public availability to be determined under 5 USC 552 SHEET_____OF_____

☐ NUCLEAR Deficiency Form Continuation Sheet ☐ NON-NUCLEAR

1. SHIP/HULL NO.: 2a. DL or DR No.

(Circle One) 2b. REVISION: 3a. COMPONENT NAME: 3b. TYPE: 3c. PHASE: 3d. REPEAT:

DDG-83 CMPT 3-370-0-E AY A 0

38JC212301A01 SHEET 1 OF 1

SKETCH

ENCLOSURE-01