OES SIR J Att J6.pdf

693KA8-23-R-00004

J6-i

PART III – LIST OF DOCUMENTS, EXHIBITS, AND OTHER ATTACHMENTS

SECTION J – LIST OF ATTACHMENTS

ATTACHMENT J6 – MATERIAL MANAGEMENT FORMS

FOR

SCREENING INFORMATION REQUEST

Solicitation Number: 693KA8-23-R-00004

Ontario Engineering Services (OES)

DEPARTMENT OF TRANSPORTATION

FEDERAL AVIATION ADMINISTRATION

ATTACHMENT J6 – MATERIAL MANAGEMENT FORMS

J6-ii

1.0 MATERIAL REQUISITION FORM 4650-12

2.0 REPORT OF SURVEY FORM 4630-8

3.0 INVENTORY DISPOSAL SCHEDULE FORM SF 1428

4.0 INSPECTION REPORT OF MATERIAL AND/OR SERVICES

ATTACHMENT J6 – MATERIAL MANAGEMENT FORMS

J6-1

1.0 MATERIAL REQUISITION FORM 4650-12

ATTACHMENT J6 – MATERIAL MANAGEMENT FORMS

J6-2

Instructions for Filling Out an FAA Form 4650-12:

Block # Contents

1 Receiving Location Name, Facility Type, Location Identifier & State Example Glasgow RCAG (GGW), MT

2 Signature and Typed Manager Name & Routing Symbol (for Rack Facility) Example Elan Martinez, AJM-313

3 5 Digit Incoming Number; first two digits for Fiscal Year, 3rd digit for

Receiving Region code, last two digits sequential number Example 18201 (18 for Fiscal Year 2018, 2 for Southwest Region Code & 01 for the first shipment of the year)

4 Estimated Ship Date Example 01/31/2018

5 Shipping Carrier Name Example Roadway Express

6 Point of Contact Name, Routing Symbol & Phone Number at Receiving Site Example John Doe, ASW-122

(123) 456-7890

7 Date FAA Form 4650-12 Prepared Example 12/31/2018 (should be prior to block 4 date)

8 GBL Number (Government Bill of Lading) Example 830-595622-0

9 Number of Packages Example 3

10 Ship To Address Example Federal Aviation Admin.

Mark For: GGW RCAG 1050 Meacham Blvd Hometown, TX 21198

11 Ship From Address Example Rack Fabrication Facility

1130 North Plymouth Avenue Battle Creek, MI 12345 Attn: Joe Rubia

(123) 456-9999

12 Item Number Example 1.

13 NIIN

ATTACHMENT J6 – MATERIAL MANAGEMENT FORMS

J6-3

Instructions for Filling Out an FAA Form 4650-12:

Block # Contents Example 000024346

14 Item Description Example U/V 10W RCAG Rack

15 Quantity Example 2

16 UI - Unit of Issue Example Ea for each or Kt for kit

17 Unit Price Example Estimated Unit Cost TBD including materiel, labor, packaging, handling and shipping costs

18 Total Cost Example Quantity multiplied times the unit price

19 Comments Block Example Statement where to send a copy of the signed FAA Form 4650-12 indicating receipt & to the attention of a specific point of contact

20 Project ID Example Field TBD during development of the Industrial Financial System (IFS)

21 Total Example Total of all line items listed under block 18

ATTACHMENT J6 – MATERIAL MANAGEMENT FORMS

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2.0 REPORT OF SURVEY FORM 4630-8

ATTACHMENT J6 – MATERIAL MANAGEMENT FORMS

J6-5

REPORT OF SURVEY FORM 4630-8 Continued

ATTACHMENT J6 – MATERIAL MANAGEMENT FORMS

J6-6

3.0 INVENTORY DISPOSAL SCHEDULE FORM SF 1428

ATTACHMENT J6 – MATERIAL MANAGEMENT FORMS

J6-7

INSTRUCTIONS FORM SF 1428

ATTACHMENT J6 – MATERIAL MANAGEMENT FORMS

J6-8

4.0 INSPECTION REPORT OF MATERIAL AND/OR SERVICES FAA Form 256 (3-61)

End of Attachment J6

1 6 .

A C C E P T E D

1 7 .

S U B M I T T E D

1 8 .

R E J E C T E D

1 9 .

A C C E P T E D

D A T E

F o r m F A A - 2 5 6 ( 3 - 6 1 ) R e v . B ( 3 / 0 3 / 9 5 )

I N S P E C T I O N

D A T E D A T E

D E P A R T M E N T O F T R A N S P O R T A T I O N

1 5 .

3 . O R D E R N O .

INSPECTION REPORT OF MATERIAL AND/OR SERVICES

9 . P L A C E O F I N S P E C T I O N

1 3 .

Q U A N T I T Y

7 . C O N T R A C T O R

1 . R E P O R T N O .

5 . I T E M N O .

F E D E R A L A V I A T I O N A D M I N I S T R A T I O N

4 . C O N T R A C T N O .2 . D A T E

S T A R T E D

6 . M A T E R I A L A N D / O R S E R V I C E S I N S P E C T E D

D A T E

1 4 .

1 0 .

R E J E C T E

8 . M A N U F A C T U R E R

( I f

A p p l i c a b l e )

R E C ' D

S E R I A L N O / S #

R E A D Y

N O T I C E

1 2 .1 1 . D A T E

C O M P L E T E

P R E V I O U T O T A L

R E P O R T / T O D A T E

T H I S

R E P O R T

2 0 .

Q U A N T I T Y O N

O R D E R

2 2 .

2 1 .

B A L A N C E R E M A I N I N G

0 A C C E P T E D T O D A T E0 0

P A G E 1 O F 1

23. REMARKS

T I T L E2 5 .

TH E M A TER IA LS A N D /O R SER VIC ES LISTED H ER EIN H A VE B EE N IN SP EC TED ,O R C ER TIFIE D TEST D A TA H A S B EEN EXA M IN ED ,B Y M E O R UN D ER M Y SUP ER VISIO N . TH E M A TE R IA LS A N D /O R SER VIC ES LISTED A B O V E A S A C C EP TED C O N FO R M T O C O N TR A C T R EQ UIR EM EN T S. TH O SE LIS TED A S R EJEC TED D O N O T C O N FO R M A N D M A Y N O T B E

D ELIVER ED , EXC EP T A S A UTH O R IZED UN D ER "R E M A R KS."

2 4 . I N S P E C T E D B Y T I T L E