TGI_3819P51405A01_c0v0.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.: #5 AC PLANT COND AY A 0 0

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

LCC-19 USS BLUE RIDGE 19P

CU PHASE TITLE:

F/O - ACCOMPLISH MECHANICAL CLEANING OF NO. 5 A/C PLANT CONDENSER

PREPARING ACTIVITY:

PREPARED BY: CODE PHONE DATE

REIYA KIMURA 234. 315-243-5507 20-MAY-2024

APPROVED BY: CODE PHONE DATE

HIDEO HARADA 234. 315-243-5176 20-MAY-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:

CLEANLINESS FOR PIPING SYSTEM/EQUIPMENT LEVEL II (REFRIGERANT SIDE) AND III (SEAWATER SIDE).

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.: #5 AC PLANT COND AY A 0

FOUO

SHIP: LCC-19 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.

1-5 J1 M1-3

QA28(1)

1. SCOPE/PURPOSE

1.1 Title: No. 5 Air Conditioning (A/C) Plant Condenser Mechanical Cleaning; accomplish

1.2 Location of Work:

1.2.1 Pump Room No. 2 and Air Conditioning Machinery Room No. 2 (7-109-2-E)

1.3 Identification:

1.3.1 Quantity (One EA), No. 5 Air Conditioning (A/C) Plant

Mfr: York International Corporation Mfr Id: 476-97532-000 Plant Capacity: 250-Ton System Refrigerant Charge: HFC-236fa (600 LB) Oil Charge: 37 Quarter of POE 46 Oil

APL: 32A030076

1.3.1.1 Quantity (One EA), Condenser

Mfr: York International Corporation Mfr ID: 376-67967 Number of Tube: 332 Tube Size: 3/4 Inch OD x 0.049 THK X 126 Inch LG Tube Material: 70-30 CNA Weight of Water head Inlet Outlet Head: 338 LBS Weight of Water head Return Head: 266 LBS

CAGE: 66935

APL: 043020362

1.4 Security Classification: None.

1.5 Initial Condition:

1.5.1 Potential Asbestos Hazard

1.6 Contractor work start date:

1.7 Contractor work completion date:

2. REFERENCES:

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

1/12/2026

5/15/2027

FOUO

SHIP: LCC-19 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

3 TM S9514-

EL-MMA-010

AIR CONDITIONING PLANT, HFC-

236fa, 250-TON CAPACITY, LCC-

19 CLASS

5 N

4 TM S9086-

HY-STM-

010/CH-254

Condensers Heat Exchangers And Air Ejectors

7 N

5 TM S9AA0-

AB-GOS-

010/GSO

General Specifications for Overhaul of Surface Ships (GSO)

11 N

6 TM S9086-

RK-STM-

010/CH-505

Piping Systems 6 N

7 TM S9086-

RJ-STM-

010/CH-504

PRESS., TEMP. and Other Mechanical and Electromechanical Measuring Instruments

7 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 Remove refrigerant HFC-236fa from the refrigerant system of A/C plant listed in 1.3.1 in accordance with Paragraph 6-4.2 of 2.3.

5.1.1 Remove and dispose lubrication oil from the lubricating system in accordance with Paragraph 6-4.3 of 2.3.

5.1.2 Evacuate the refrigerant system in accordance with Paragraph 6-5.1 of 2.3.

5.1.3 Ensure that the density of refrigerant is below 500 ppm at leak detector. If not, vacuum the refrigerant system until the leak detector reads 500 ppm or below.

5.2 Remove each condenser water head from the condenser listed in 1.3.1.1 in accordance with 2.3.

5.2.1 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. Take precautions to maintain phonographic finish on each flange that has it.

5.2.2 Restore each mating surface exposed by condenser water head removal. Repair by removing each high spot, burr, abrasion, and foreign matter, where removal can be accomplished by hand tool.

5.2.3 Accomplish a visual inspection of each piping flange connection, condenser water head, and tube insert in accordance with 2.3. Allowable warpage, cracking, elongated/distorted bolt hole, missing thread, leakage path, and excessive corrosion: None.

5.2.3.1 Submit one legible copy, in hard copy or approved transferrable media, of a report listing results of the requirements of 5.2.3 to the SUPERVISOR.

FOUO

SHIP: LCC-19 CHG/VER: 0/0

5.3 Accomplish the mechanical cleaning of the seawater side of the condenser listed in 1.3.1.1 in accordance with paragraph 254-6.2 of 2.4, using 2.3 for guidance.

5.3.1 Remove each existing tube insert from the inlet end of the tubes.

5.3.2 Ensure General Cleaning must be Level III for seawater side in accordance with Section 505j2 of 2.5.

5.4 Accomplish a borescope inspection of each internal surface on a total of 332 tubes (100 percent) for the condenser listed in 1.3.1.1 in accordance with Paragraph 254-2.6.4.3 of 2.4. Allowable marine growth, scale, and mineral deposit: None.

(V) "BORESCOPE INSPECTION"

5.5 Accomplish a leak check of the refrigerant system of A/C plant listed in 1.3.1 in accordance with Paragraph 6-5.1 of 2.3.

5.6 Install each condenser water head to the condenser listed in 1.3.1.1 in accordance with 2.3.

5.6.1 Remove existing, fit and install each new zinc anode to each water head.

5.6.2 Remove existing and install each new gasket and O-ring. Material must conform to each specification in Figure 7-14 of 2.3.

5.6.3 Install each new tube insert to the inlet end of the tubes.

5.6.3.1 Apply adhesive conforming to MMM-A-189, Class 2, on each tube insert.

5.6.4 Torque each fastener in accordance with 2.3.

5.6.4.1 Submit one legible copy, in hard copy or approved transferrable media, of a report listing results of the requirements of 5.6.4 to the SUPERVISOR.

5.7 Accomplish testing of the condenser listed in 1.3.1.1 in accordance with 2.6.

5.7.1 Each master and backup test gage must conform to gage range and graduation shown on Table 504-6-1 of

2.7. The backup gage must be cross-checked to the master hydrostatic test gage up to the maximum test pressure just prior to start of testing. Master and backup gages must track within 2 percent of each other.

5.7.2 Accomplish a shop hydrostatic test for tube side of the condenser for evidence of external leakage and/or deformation. Allowable external leakage and/or deformation: None.

(V)(G) “VISUAL INSPECTION - SHOP HYDROSTATIC TEST”

5.7.3 Install each vent/drain piping to water heads prior to beginning hydrostatic test.

5.7.4 The tube side test pressure is 270 PSIG.

5.7.5 The test medium is clean fresh water.

5.7.6 Document shop hydrostatic test results on QA Form 28, Enclosure-01-1.

5.7.7 Ensure General Cleaning must be Level III for seawater side in accordance with Section 505j2 of 2.5.

5.7.8 Install new label plate on the condenser engraving the hydrostatic test pressure and date tested.

5.8 Restore the refrigerant system of each A/C plant listed in 1.3.1 to the operating condition, using 2.3 for guidance.

FOUO

SHIP: LCC-19 CHG/VER: 0/0

5.8.1 Evacuate and dehydrate the refrigerant system in accordance with Paragraph 6-5.1 of 2.3.

5.8.2 Accomplish a vacuum hold check of the refrigerant system in accordance with Paragraph 6-5.1 of 2.3.

(V)(G) "VACUUM HOLD CHECK"

5.8.3 Charge the lubricant system with new lubricating oil (POE 46) in accordance with Paragraph 6-5.4 of 2.3.

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

5.10 Notes:

5.10.1 Planner: Code 234 R. Kimura, 243-5507

Planner: Code 232 T. Funaki, 243-2494 Planner: Code 233 S. Ogawa, 090-6170-8579

5.10.2 Work Integration Manager (WIM): C333 T. Yaginuma, 080-5419-0598

5.10.3 This TGI meets the intent of LCC CSWT File No. 514-002.

5.10.4 JCN EA05-ZAG2 is related to this TGI.

5.11 Government Furnished Material (GFM):

5.11.1 SRF-JRMC will provide GFM listed in Appendix “M”.

5.12 SRF-JRMC will provide following Service Work (TGI).

5.12.1 [C740] Crane and rigging service.

5.12.2 [X99E] Utility service, electrical.

5.12.3 [X99M] Utility service, except electrical.

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

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

5.12.6 [C133] QA inspection for (G) symbols.

FOUO

J-1

SHIP: LCC-19 CHG/VER: 0/0

APPENDIX "J"

TGI JOB SUMMARY INFORMATION SHEET

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

VERSION:

CASREP

CAT:

#5 AC PLANT COND AY A 0 0

CU PHASE TITLE:

F/O - ACCOMPLISH MECHANICAL CLEANING OF NO. 5 A/C PLANT CONDENSER

PRIMARY COMPONENT:

COMPONENT UNIT LIST (FOR ASSEMBLIES):

#5 AC PLANT AE #5 AC COND/CHILLER CN

ATTACHMENT LIST:

1. ENCLOUSRE-01 (3819P51405A01-QA28.docx) saved on 18-MAY-2024 0000.

ZONE MANAGER: ZONE: COMPARTMENT: LEVEL: FRAME: SIDE:

YAGINUMA ,TAKEHIDE

JO: KO: TOTAL MAN HRS: PLANNING ACCEPTANCE:

3819P51405 A01

TOTAL MAT’L COST TOTAL DURATION:

CU PHASE DESCRIPTION:

The purpose of this TGI is to accomplish mechanical cleaning of No. 5 Air Conditioning (A/C) Plant Condenser.

Location of Work:

Pump Room No. 2 and Air Conditioning Machinery Room No. 2 (7-109-2-E)

TASK NAME

SHOP TSD/WC TS CREW# MHRS

HIGH RAD

HOURS

RC

GRID#

5.1 OMCH HRs 22 KE PC

5.2 BLRM HRs, INSL HRs, ELEC HRs, PFTR HRs 22 KE PC

5.3 BLRM HRs 22 KE PC

5.4 BLRM HRs 22 KE PC

5.5 OMCH HRs 22 KE PC

5.6 BLRM HRs 22 KE PC

5.7 BLRM HRs, INSL HRs, ELEC HRs, PFTR HRs 22 KE PC

5.8 OMCH HRs 22 KE PC

5.9 PNTR HRs, QA HRs 22 KE PC

Boiler Work CFM for marine chemist cost, asbestos sampler and analysis cost, covering material, paint, label plate material and other consumable material (MISC).

22 MQ CS

Machinery Work CFM for rag wiping, tape duct, flux bag plastic and misc.

22 MQ CS

Process Funding Document 10 CT OM

FOUO

M-1

SHIP: LCC-19 CHG/VER: 0/0

APPENDIX “M”

TGI MATERIAL LIST

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

VERSION:

CASREP

CAT:

#5 AC PLANT COND AY A 0 0

CU PHASE TITLE:

F/O - ACCOMPLISH MECHANICAL CLEANING OF NO. 5 A/C PLANT CONDENSER

MATERIAL REFERENCES

REF

NO.

DOCUMENT/DRAWING

NUMBER

DOCUMENT/DRAWING TITLE REV

1 S9514-EL-MMA-010

JOB ORDER: KEY OP:

3819P51405 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

200 M NITROGEN, FOR KTR

FOR LEAK CHECK FOR A/C

PLANT

POC: C232 T.FUNAKI

243-2494

9B 6830 007586475 NA 4 Y 41325012 12/CY

201 M LEAK DET, FOR KTR

FOR LEAK CHECK FOR A/C

PLANT

POC: C232 T.FUNAKI

243-2494

9B 6850 001862963 NA 4 Y 41325026 10/BT

202 M LUBRICAT, FOR KTR

FOR COMPRESSOR

LUBRICATING OIL POE-46

POC: C232 T.FUNAKI

243-2494

9B 9150 014439390 NA 4 Y 41325006 10/GL

300 M SEALER,CHEMICAL, ORDERED

FOR CONTRACTOR

ORIG: CODE 233, S. OGAWA

090-6170-8579

9B 6850 011329623 NA 4 Y 41135160 1/CN

NOTES:

FOUO

M-2

SHIP: LCC-19 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

301 M LUBRICANT,THREAD,

ORDERED FOR CONTRACTOR

ORIG: CODE 233, S. OGAWA

090-6170-8579

9B 9150 015976309 NA 4 Y 41135163 1/CN

400 1 M O-RING, C234 R.KIMURA, 243-

ORDER FOR KTR

SEAL, O-RING,

S9514-EL-MMA-010, FIG 7-14-2

9B 5331 002518839 NA 4 N 41295268 10/EA

401 1 M INSERT,TUBE FITTING, C234

R.KIMURA, 243-5507

ORDER FOR KTR

MATERIAL: INSERT, TUBE

FITTING

S9514-EL-MMA-010,FIG 7-1-77

9B 4730 011819598 NA 4 N 41295220

350/EA

402 1 M O-RING, ORG: C234 R.KIMURA,

243-5507

ORDER FOR KTR

O-RING

S9514-EL-MMA-010, FIG 7-14-4

9B 5331 006413763 NA 4 N 41295269 10/EA

403 M ANODE,CORROSION PRE,

C234 R.KIMURA, 243-5507

ORDER FOR KTR

MATERIAL:

ANODE,CORROSION,

PREVENTIVE

SIZE: 0.840" OD X 72" LG

9B 5342 008136055 NA 4 N 41295270 1/EA

404 M GASKET, RUBBER GASKET,

SIZE: 3FT X 4FT X 1/8"THK,

SPEC: ASTM 2000D, M2-AA603-

A13-B13-EA14,

DWG: 804-5284201-S12,

CERTIFICATION SHEET

REQUIRED,

DO NOT CROSS TO NSN: 5330-

01-490-5044 (QDR SUBMITTED)

ORDERED FOR KTR

ORG: C234 R.KIMURA, 243-

9B 5330 LL4598269 NA 4 N 41347437 2/SH

405 1 M GASKET, ORG: C234

R.KIMURA, 243-5507

ORDER FOR KTR

MATERIAL: GASKET RUBBER,

NOMEN: S9514-EL-MMA-010,

FIG 7-14-15

9B 5330 010425984 NA 4 N 41295271 1/EA

406 1 M SEAL,NONMETALLIC ST, ORG:

C234 R.KIMURA, 243-5507

ORDER FOR KTR

MATERIAL: GASKET RUBBER,

NOMEN: S9514-EL-MMA-010,

FIG 7-14-14

9B 5330 010422696 NA 4 N 41295196 1/SP

407 M ADHESIVE, ADHESIVE FOR

RUBBER

ORIG: C234 R.KIMURA, 243-

ORDERED FOR KTR

9B 8040 008419773 NA 4 Y 41295203 2/PT

408 M ADHESIVE, ADHESIVE FOR

CLOTH,

ORDERED FOR KTR

ORIG: C234 R.KIMURA, 243-

9B 8040 002738708 NA 4 Y 41295272 1/GL

FOUO

M-3

SHIP: LCC-19 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

409 M INSULATI, INSULATION, PIPE,

BRAND: K-FLEX ECO,

SPECIFICATION COMPLIANCE:

EB 4013,

FOR 5" IPS,

SIZE: 5-1/2" ID X 3/4" THK X 6

FT LG,

UI: EA/6 FT(ONE CONTINUOUS

LENGTH REQUIRED),

MATL: NON-HALOGEN,

2EA/BOX. *MUST BE ORDERED

IN MULTIPLES OF 2EA*

ORIG: C234, R.KIMURA, 243-

ORDERED FOR KTR

9B 5640 LL9607849 NA 4 N 41327433 2/EA

410 M INSULATI, INSULATION, PIPE,

BRAND: K-FLEX ECO,

SPECIFICATION COMPLIANCE:

EB 4013,

FOR SIZE: 6" IPS,

SIZE: 6-5/8" ID X 3/4" THK X 6FT

LG,

UI: EA/6 FT(ONE CONTINUOUS

LENGTH REQUIRED),

MATL: NON-HALOGEN,

2EA/BOX. *MUST BE ORDERED

IN MULTIPLES OF 2EA*

ORIG: C234, R.KIMURA, 243-

ORDERED FOR KTR

9B 5970 LL9607850 NA 4 N 41327437 2/EA

411 M INSULATION SHEET,

INSULATION, FLAT SHEET,

BRAND: K-FLEX ECO,

SPECIFICATION COMPLIANCE:

EB 4013, FOR SIZE: 36”W X

48”L X 3/4” THK, MATL: NON-

HALOGEN,

**GSA ADVANTAGE

AVAILABLE**

8SH/BOX.

ORDERED FOR KTR

ORIG: C234 R.KIMURA, 243-

9B 5640 LL9607854 NA 4 N 41327451 2/SH

412 M ADHESIVE, ADHESIVE FOR

TUBE INSERT

ORIG: C-234 R.KIMURA, 243-

ORDERED FOR KTR

9Q 8040 005437170 NA 4 Y 41295273 2/PT

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:

LCC-19 #5 AC PLANT COND AY A 0

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

3819P51405 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:

LCC-19 #5 AC PLANT COND AY A 0

COMUSFLTFORCOMINST 4790.3 REV D CHG 3

07 Nov 2023

SHOP TEST RECORD Page 1 of 1

QA FORM 28 Planning must fill in blocks identified by a prior to issuing

1. SHIP HULL NO. 2. JCN 3. LWC/SHOP 4. CWP/REC SER NO. 5. SYSTEM/COMPONENT/ROTATABLE POOL SER NO.

USS BLUE RIDGE LCC19 EA05-ZAG2 KTR N/A No. 5 Air Conditioning Plant Condenser

6. REFERENCES: TEST REF (E.G., MS, TECH MAN) & OTHER REFS (E.G., VLV DWG) 7. TEST GAGE RANGE /INSTRUMENT USED SERIAL NO. CAL DUE DATE 8. RELIEF VLV SET POINT

A. TM S9514-EL-MMA-010 Rev. 5

B.

C.

D.

9. TEST REQUIREMENTS & RESULTS

TEST TYPE KEY H = STRENGTH AND POROSITY/ELEVATED PRESSURE TEST J = MECHANICAL JOINT TIGHTNESS ST = SEAT TIGHTNESS OP = OPERATIONAL O = OTHER

(SPECIFY): ______________________

TE

ST

T Y

PE

(S

EE

K

EY

) PARAGRAPH

DESCRIBING

VALVE POSITION

AND POINT OF

ENTRY

REF

LTR

GAGE

USED

(LTR

FROM

BLK 7)

REQUIRED

MEDIUM

MEDIUM

USED

REQUIRED

PRESSURE

ACTUAL

PRESSURE

MINIMUM

DURATION

ACTUAL

DURATION

ALLOWED

LEAKAGE

ACTUAL

LEAKAGE SAT/UNSAT SIGNATURE, BADGE NO. & DATE

H 5.7 A Clean Fresh Water

270 PSIG 30 minutes None

10. REMARKS. (CRAFTSMAN/QAI SUBMIT A DF TO RESOLVE UNSAT DATA)

11. QA INSPECTOR/SHOP SUPERVISOR SIGNATURE/BADGE NO. (RECORD

REVIEWED FOR FINAL ACCEPTANCE)

DATE 12. QAS SIGNATURE/BADGE NO. (RECORD HAS BEEN REVIEWED FOR

COMPLETENESS)

DATE

3819P51405A01 ENCLOSURE-01-1 TOTAL 1