PC01_CDRL_Pressure_Testing_04-09-2018.doc

DD FORM 1423-1, JUN 09 PREVIOUS EDITIONS ARE OBSOLETE PAGE (1) OF (1) 10 June 2009

Public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments, regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate for information Operations and Reports, 1215 Jefferson Davis HWY, Suite 1204, Arlington VA, 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-01880, Washington, DC 20503. Please Do Not Return your form to either of these addresses. send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in block E.

A. Contract Line Item No.

TBD

B. Exhibit

PC

C. Category: TDP ( ) TM( ) Other ( XX )

D. System/Item

MQ-8C Hydraulic Pressure Gage Adapter and Hydraulic Power Supply Adapter E. Contract/PR No.

TBD

F. Contractor

TBD

1. Data Item No.

PC01

2. Title of Data Item

Test/Inspection Report

3. Subtitle

Hydrostatic Pressure Testing

4. Authority (Data ID No.)

DI-NDTI-80809B See Block 16

5. Contract Reference

SOW Para. 3.4

6. Requiring Office

NAVAIR LKE Code 13400B

7. DD 250 REQ

LT

9. Dist. Statement Req.

D

10. Frequency

AS REQ

See Block 16

12. Date of first submission

See Block 16

14. Distribution

See Block 16

8. APPCODE

N/A See Block 16

11. As of Date

N/A

13. Date of Subsequent Submission

See Block 16

6761400B

Block 9: Use Distribution Statement D. Distribution authorized to DoD and DoD

Contractors only, (30 January 2007) other U.S. requests shall be referred to Code 13400B

Block 10, 13: A Hydrostatic Pressure Testing Certificate shall be provided for each production unit requiring Hydrostatic Pressure Testing in accordance with applicable drawings and specifications. The frequency will coincide with actual hardware deliveries.

Block 12: A copy of the Hydrostatic Pressure Testing Certificate shall be shipped with each item. The Hydrostatic Pressure Testing Certificate shall be placed in a plastic pouch/bag/ envelope and secured to the item using a zip tie or similar temporary fastening device.

Block 13: An electronic copy of each Hydrostatic Pressure Testing Certificate shall be submitted within 15 days of actual hardware delivery for each production unit requiring testing.

Block 14: Delivery Media: Distribution of data shall conform to Electronic Media

Compatible with MS Word or MS-Excel or PDF. Hydrostatic Pressure Testing

Certificates shall be emailed to the following individuals:

13400B: nancy.mcquillan@navy.mil

486400B: dominic.ziccardi@navy.mil

6761400B: Michael.moncayo@navy.mil

TOTAL

G. Prepared By

Sokang Teng H. Date

9 April 2018 I. Approved By

Dominic Ziccardi J. Date

9 April 2018