TGI_3819P25501A01_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.: DFT SIGHTGLASS DRAIN 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:

*(RE) F/O - S/A 80992K, ACCOMPLISH MOD OF DFT SIGHTGLASS DRAIN PP IN 8-76-0-E

PREPARING ACTIVITY:

PREPARED BY: CODE PHONE DATE

SHINTARO IWAI 234. 315-243-0099 25 MAY 2024

APPROVED BY: CODE PHONE DATE

HIDEKUNI SHINMEI 234. 315-243-2371 25 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

CLASS P-2 PIPING

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.: DFT SIGHTGLASS DRAIN 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 QA28

(1)

J-1 M1-2

QA28

(1)

1. SCOPE/PURPOSE

1.1 Title: S/A 80992K, Modification of Deaerating Feed Tank Sightglass Indicator Drain Piping; accomplish

1.2 Location of Work:

1.2.1 Fire Room (8-76-0-E)

1.3 Identification:

1.3.1 Quantity (One Lot), Deaerating Feed Tank (DFT) Sightglass Indicator Drain Piping Remarks: See 2.3 for detail.

1.3.1.1 Quantity (2 EA), DFT Drain Valve

Size: 1.00 Inch IPS Type: Globe, Inline Stop Valve No: V1 Remarks: upper and lower level

APL: 88A080188

1.3.1.2 Quantity (2 EA), DFT Drain Valve

Size: 0.50 Inch IPS Type: Globe, Inline Stop Valve No: V2 Remarks: upper and lower level

APL: 88A050932

1.4 Security Classification: None.

1.5 Initial Condition:

1.5.1 Potential Asbestos Hazard.

1.5.2 Potential Lead Hazard.

1.6 Contractor work start date: 7/21/2026

1.7 Contractor work completion date: 11/21/2027

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

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

1 NSI FY25 Standard Items - ORG N 2 LI FY-25 Local Standard Items - ORG N

3 DWG 208-

8516915

DEAERATING FEED TANK SIGHT

GLASS INDICATORS DRAIN

MODS

A Y AL

L

4 DWG 803-

2177525

1/4"-2" BW & SW 900 LB ASME

Valve

Y Y AL

L

5 TM S9086-

CM-STM-

020/CH-

078V2

Gaskets and Packing - N

6 TM S9086-

RK-STM-

010/CH-505

Piping Systems 6 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 existing, fabricate and install each new DFT sightglass drain piping listed in 1.3.1 in accordance with 2.3.

5.1.1 Remove corrosion preventive compound of each valve listed in 1.3.1.1 and 1.3.1.2.

5.1.1.1 Disassemble each valve as required for cleaning, using 2.4 for guidance.

5.1.1.2 Accomplish a visual inspection of the groove pin of each valve in accordance with Paragraph 4 of NABESEALOGCENDENT PORTSMOUTH BULLENTIN 4855-Ser-6231/B11-2-22nov2011 of 2.4.

5.1.1.3 Assemble each valve with bonnet gasket and gland packing.

5.1.1.4 Bonnet gasket must conform to MIL-G-24716.

5.1.1.5 Gland packing must conform to MIL-P-24503 and MIL-P-24583 combination in accordance with Table 078-9- 1 of 2.5.

5.1.1.6 Thread lubrication must be in accordance with General Note 4.C of 2.4.

5.1.1.7 Accomplish a Hydrostatic test of each valve, using 2.3 and 2.4 for guidance.

5.1.1.8 Tolerance of hydrostatic test pressure and rounded off to graduation of test pressure gauge/gage must be in accordance with Paragraph 505-11.1.3.18 of 2.6.

5.1.1.9 Hydrostatic test equipment must conform to the requirements in Paragraph 505-11.1.3 of 2.6.

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

5.1.1.10 Accomplish the requirements of 009-71 of 2.1 for strength test, using clean fresh water at 50 PSIG for each valve.

5.1.1.11 Accomplish a seat tightness test of each valve for seat tightness in the direction tending to open each valve, using clean fresh water at 50 PSIG for a minimum of 3 minutes. Maximum allowable leakage: 10 cubic centimeters

(cc) per hour.

(V)(G) “SEAT TIGHTNESS TEST”

5.1.1.12 Do not exceed the handwheel closing force specification in Table 505-11-2 of 2.6.

5.1.1.13 Document each shop test results on QA Form 28, Enclosure-01-1.

5.1.1.14 After satisfactory completion of each shop test, drain water from each valve and blow with clean dry air to remove moisture.

5.1.2 Accomplish the requirements of 009-12 of 2.1, including Table One, Column(s) A, Lines One through 10.

5.1.2.1 Accomplish nondestructive testing in accordance with Line 13 for liquid penetrant testing accomplished to satisfy operational pressure test option.

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

5.1.4 Accomplish the requirements of 009-71 of 2.1 for hydrostatic test, using clean, fresh water at 50 PSIG, for each new and disturbed DFT drain piping systems listed in 1.3.1.

5.1.4.1 Document shop hydrostatic test results on QA Form 28 Enclosure-02-1.

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

5.3 Notes:

5.3.1 Planner: Code 234 S. Iwai, 243-0099

Planner: Code 232 Y. Abematsu, 243-2492

5.3.2 All material listed in 2.3 will be provided as kitted material by Puget Sound Naval Shipyard (PSNS).

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

5.3.4 JCN EXSA-ZBV5 is related to this TGI.

5.4 Government Furnished Material (GFM):

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

5.5 SRF-JRMC will provide the following service work: (TGI No. 3819P25501S02)

5.5.1 [C740] Crane and crane rigging service.

5.5.2 [X99E] Utility service, electrical.

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

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

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

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

5.5.6 [C133] QA inspection for (G) symbol(s).

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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:

DFT SIGHTGLASS DRAIN AY A 0 0

CU PHASE TITLE:

*(RE) F/O - S/A 80992K, ACCOMPLISH MOD OF DFT SIGHTGLASS DRAIN PP IN 8-76-0-E

PRIMARY COMPONENT:

COMPONENT UNIT LIST (FOR ASSEMBLIES):

DFT SIGHTGLASS DRN PP DFT SS DRN COV V1 LO V- DFT SS DRN COV V1 UP V- DFT SS DRN COV V2

LO V- DFT SS DRN COV V2 UP V-

ATTACHMENT LIST:

1. ENCLOSURE-01 (3819P25501A01-QA28-01.docx) saved on 20-MAY-2024 0000.

2. ENCLOSURE-02 (3819P25501A01-QA28-02.docx) saved on 20-MAY-2024 0000.

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

YAGINUMA ,TAKEHIDE

JO: KO: TOTAL MAN HRS: PLANNING ACCEPTANCE:

3819P25501 A01

CU PHASE DESCRIPTION:

The purpose of this TGI to accomplish modification of DFT sightglass drain piping.

Location of Work: Fire room (8-76-0-E)

TASK NAME

SHOP TSD/WC TS CREW# MHRS

HIGH RAD

HOURS

RC

GRID#

5.1 PFTR HRs, WELD HRs, IMCH HRs, INSL HRs, ELEC

HRs, QA HRs, PNTR HRs, RGRS HRs

22 KE PC

5.2 PNTR: HRs, QA: HRs 22 KE PC

Piping Work CFM for marine chemist, firewatch cost, NDT cost, lead sampling/analysis cost, asbestos sampling/analysis cost, painting material, and MISC such as welding rod, gas, saw blades, fastener, gasket, lagging pad material, plastic bag/sheet, and etc.

22 MQ CS

Process Funding Document 10 CT OM

TGI NO.: DFT SIGHTGLASS

DRAIN

AY A 0

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:

DFT SIGHTGLASS DRAIN AY A 0 0

CU PHASE TITLE:

*(RE) F/O - S/A 80992K, ACCOMPLISH MOD OF DFT SIGHTGLASS DRAIN PP IN 8-76-0-E

MATERIAL REFERENCES

REF

NO.

DOCUMENT/DRAWING

NUMBER

DOCUMENT/DRAWING TITLE REV

JOB ORDER: KEY OP:

3819P25501 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 PIPE,METALLIC, 1"IPS, C-

STEEL, SCH40

ORIG:C-234 S.IWAI 243-0099

ORDERED FOR KTR

9B 4710 009619174 NA 4 N 41215119 5/FT

002 M PIPE,METALLIC, 1/2" IPS, C-

STEEL, SCH40

ORIG:C-234 S.IWAI 243-0099

ORDERED FOR KTR

9B 4710 009935036 NA 4 N 41215122 10/FT

003 M PIPE HANGER, 1/2"IPS, PIPE

HANGER, 1/2"IPS, MATERIAL:

STEEL, TYPE-4, LEG: 15",

LINER THK: 1/4"THK, LINER:

NEOPRENE, FASTENER: CRES

316, MODIFY FASTENER FROM

STEEL TO CRES 316

ORIG:C-234 S.IWAI 243-0099

ORDERED FOR KTR

9B 4730 LL9602132 NA 4 N 41217487 2/EA

200 M GASKET,S, ORIG: C232 Y.

ABEMATSU, 243-2492

ORDERED FOR KTR

FOR VALVE V2

9B 5330 015386718 NA 4 N 41165015 2/EA

NOTES:

TGI NO.: DFT SIGHTGLASS

DRAIN

AY A 0

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

201 M GASKET,SPIRAL WOUND,

ORIG: C232 Y. ABEMATSU,

243-2492

ORDERED FOR KTR

FOR VALVE V1

9B 5330 013551459 NA 4 N 41165002 2/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:

LCC-19 DFT SIGHTGLASS DRAIN AY A 0

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

3819P25501 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 DFT SIGHTGLASS DRAIN AY A 0

COMUSFLTFORCOMINST 4790.3 REV D CHG 3

07 Nov 2023

SHOP TEST RECORD Page 1 of 4

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 LCC-19 EXSA-ZBV5 KTR N/A DFT DRAIN VALVE V1 (L-1) UPPER LEVEL

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. DWG 208-8516915 Rev “A”

B. DWG 803-2177525 Rev. “Y”

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

USED

PRESSURE

ACTUAL

MINIMUM

DURATION

ALLOWED

LEAKAGE

ACTUAL

LEAKAGE SAT/UNSAT SIGNATURE, BADGE NO. & DATE

H 5.1.1.10 A, B Clean Fresh Water

50 PSIG 30 minutes None

ST 5.1.1.11 A, B

Clean Fresh Water

50 PSIG 3 minutes 10 cc per hour

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

3819P25501A01 ENCLOSURE-01-1 Total 1

SHOP TEST RECORD Page 2 of 4

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 LCC-19 EXSA-ZBV5 KTR N/A DFT DRAIN VALVE V1 (L-2) LOWER LEVEL

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. DWG 208-8516915 Rev “A”

B. DWG 803-2177525 Rev. “Y”

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

K

EY

) PARAGRAPH

DESCRIBING

VALVE POSITION

GAGE

USED

(LTR

ACTUAL

LEAKAGE SAT/UNSAT SIGNATURE, BADGE NO. & DATE

H 5.1.1.10 A, B Clean Fresh Water

50 PSIG 30 minutes None

ST 5.1.1.11 A, B

Clean Fresh Water

50 PSIG 3 minutes 10 cc per hour

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)

SHOP TEST RECORD Page 3 of 4

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 LCC-19 EXSA-ZBV5 KTR N/A DFT DRAIN VALVE V2 (L-3) UPPER LEVEL

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. DWG 208-8516915 Rev “A”

B. DWG 803-2177525 Rev. “Y”

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

K

EY

) PARAGRAPH

DESCRIBING

VALVE POSITION

GAGE

USED

(LTR

ACTUAL

LEAKAGE SAT/UNSAT SIGNATURE, BADGE NO. & DATE

H 5.1.1.10 A, B Clean Fresh Water

50 PSIG 30 minutes None

ST 5.1.1.11 A, B

Clean Fresh Water

50 PSIG 3 minutes 10 cc per hour

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)

SHOP TEST RECORD Page 4 of 4

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 LCC-19 EXSA-ZBV5 KTR N/A DFT DRAIN VALVE V2 (L-4) LOWER LEVEL

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. DWG 208-8516915 Rev “A”

B. DWG 803-2177525 Rev. “Y”

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

K

EY

) PARAGRAPH

DESCRIBING

VALVE POSITION

GAGE

USED

(LTR

ACTUAL

LEAKAGE SAT/UNSAT SIGNATURE, BADGE NO. & DATE

H 5.1.1.10 A, B Clean Fresh Water

50 PSIG 30 minutes None

ST 5.1.1.11 A, B

Clean Fresh Water

50 PSIG 3 minutes 10 cc per hour

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)

3819P25501A01 ENCLOSURE-02-1 TOTAL 1

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 EXSA-ZBV5 KTR N/A DFT SIGHTGLASS DRAIN PIPING

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. S9086-RK-STM-010/CH-505 Rev. 6

B. DWG 208-8516915 Rev. A

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

K

EY

) PARAGRAPH

DESCRIBING

VALVE POSITION

GAGE

USED

(LTR

ACTUAL

LEAKAGE SAT/UNSAT SIGNATURE, BADGE NO. & DATE

H 5.1.4 A,B Clean Fresh Water

50 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)