8330-3015_CDRLS.pdf

CONTRACT DATA REQUIREMENTS LIST Form Approved

(1 Data Item) 0MB No. 0704-01 BB Public reporting burden for this COllectlon of lnfonnatlon Is estimated to average 110 hours per response, lnclud,ng the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of infonnatlon. Send comments regarding this burden estimate or any other aspec:t of this c:ollectlon of Information, Including suggestions for reducing the burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Artinglon VA 22202-4302.

Please 00 NOT RETURN your form to either of these address. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No Listed In Block E.

A. CONTRACT LINE ITEM NO. a.EXHIBIT C.CATEGORY

A OTHER X (NDTI) TDF TM

0. SYSTEM/ITEM

I

E. CONTRACT/PR NO. F. CONTRACTOR

MTRA DISPOSAL CONTAINER

1. DATA ITEM N O. 2. TITLE OF DATA ITEM 3. SUBTITLE

A001 TEST/INSPECTION REPORT MILL TEST REPORTS

4. AUTHORITY (Dara Acqu/sh/on Document No.)

I

5. CONTRACT REFERENCE &. REQUIRING OFACE

DI-NDTl-80809B DRAWING 2370-1923 Rev. C PSNS & IMF C/980.1

7, DD250 REQ 9, DIST STATEMENT 10, FREQUENCY 12, DATE OF FIRST 14. DISTRIBUTION

REQUIRED SUBMISSION 117 PRICE GROl

N/A ASGEN SEE BLK 16 b, COPIES

8. APPCODE N/A 11, AS OF DATE 13, DATE OF SUBSEQUENT A. ADDRESSEE Final SUBMISSION 18. ESTIMATED A SEE BLK 16 N/A DraN Reg Repr TOTAL PRIC

16.

BLOCK 3:

I A) THE CONTRACTOR SHALL PROVIDE COPIES OF MATERIAL TEST REPORTS WHICH PSNS C/2370 1 1 0

INCLUDES CERTIFIED COPIES OF MILL REPORTS FOR STEEL PLATE AND PIPE AS

REQUIRED BY DWG 2370-1923 GENERAL NOTE 10.B.

BLOCK 8: TEST REPORTS SHALL BE SUBMITTED FOR GOVERNMENT APPROVAL APPROVAL

WILL BE BASED ON TECHNICAL CONTENT ANO COMPLIANCE WrTH REQUIREMENTS. THE

GOVERNMENT WILL HAVE 7 CALENDAR DAYS FOR REVIEW THE CONTRACTOR SHALL HAVE

7 CALENDAR DAYS TO REVISE !IF REQUIRED) AND RESUBMIT FOR A NEW REVIEW.

BLOCK 11 & 12: THE MANUFACTURER SHALL PROVIDE TEST REPORTS 20 DAYS PRIOR TO

SHIPMENT OF THE MTRA DISPOSAL CONTAINERS

BLOCK 14: THE CERTIFICATIONS SHALL BE PROVIDED ELECTRONICALLY IN UNPROTECTED,

SEARCHABLE PDF FORMAT AS AN EMAIL ATTACHMENT TO All ADDRESSEES.

Mr. James Byrnes C/2370 Puget Sound Naval Shipyard & Intermediate Maintenance Facility 1400 Farragut Ave.

Bremerton, WA. 98314-5001 James.byrnes@navy.mil

TOTAL 1 1 0

G. PREPARED BV H. DATE H. APPROVED BV J. DATE

Mike Baker 19 Nov 2018

P MEYERS

8330-3015

DD Form 1423-1, FEB 2001 previous ediUon may be used. Page _1_of_4_Pages

0002AA

(1 Data Item) 0MB No. 0704-0188

Public reponlng burden for this co�ectlon of Information Is es1Imated to average 110 hours per response, lnciudlng the lime for revlewin11I11s1ructlons, sean:hln11 existing da1a sources, gathering and malntain•ng the data needed, and completing and revl'ewing the coltection of Information. Send comments regarding this burden estimate or any o1her aspect of this collection of information, inciudln11 suggesUons for reducing the burden, 10 Depanmen1 of Defense, Washington Headquaners Services. o:rectorate for lnformaUon Operations and Repons (0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Arllng1on VA 22202-4302.

Please DO NOT RETURN your form to either of these address. Send completed form to the Government lssulng Contracting Officer for the Contract/PR No. Listed In Block E.

A. CONTRACT LINE ITEM NO. B.EXHIBIT C.CATEGORY

OTliER MISC TllF TM

D. SYSTEM/ITEM

I

E. CONTRACT/PR NO. F. CONTRACTOR

MTRA DISPOSAL CONTAINERS

2. TITLE OF DATA ITEM J. SUBTITLE 1. DATA ITEM NO.

CERTIFICATION/DATA REPORT WELD PROCEDURE

4. AUTHORITY (Dal• Acquisition Document No.} I

5. CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-MISC-80678 Drawina 2370-1923 Rev. C PSNS C/980.1

7. 0D250REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST 14. DISTRIBUTION

REQUIRED SUBMISSION l17 PRICE GRO!

N/A OTIME SEE BLK 16 b. COPIES

8. APP CODE N/A 11. AS OF DATE 13. DATE OF SUBSEQUENT A. ADDRESSEE Anal SUBMISSION 18. ESTIMATED A SEE BLK 16 N/A Draft Reg Repr TOTALPRIC

16, Remarks

BLOCK3;

PSNS C/2370 1 1 0

a) THE CONTRACTOR SHAll PROVIDE WELD PROCEDURE SPECIFICATIONS {WPS}

AND CORRESPONDING, (PQRS), AND CONTINUITY RECORDS REQUIRED BY DWG

237Q.1923 GENERAL NOTE10 C.

BLOCK B· CERTIFICATIONS SHALL BE SUBMITTED FOR GOVERNMENT REVIEW. APPROVAL

WILL BE BASED ON TECHNICAL CONTENT AND COMPLIANCE WITH REQUIREMENTS.THE

GOVERNMENT WILL HAVE 7 CALENDAR DAYS FOR REVIEW. THE CONTRACTOR SHALL HAVE

7 CALENDAR DAYS TO REVISE (IF REQUIRED) AND RESUBMIT FOR A NEW REVIEW

BLOCK 11 & 12: THE MANUFACTURER SHALL PROVIDE CERTIFICATIONS 20 DAYS PRIOR TO

THE START OF CONSTRUCTION.

BLOCK 14: THE CERTIFICATIONS SHALL BE PRESENTED IN UNPROTECTED PDF FORMAT AS

AN EMAIL ATTACHMENT TO ALL ADDRESSEES.

Mr. James Byrnes C/2370 Puget Sound Naval Shipyard & Intermediate Maintenance Facility 1400 Farragut Ave.

Bremerton, WA. 98314-5001 James.byrnes@navy.mil

TOTAL 1 1 0

G. PREPARED BY H. DATE H. APPROVED BY J. DATE

Mike Baker 19 Nov 2018

P MEYERS

8330-3015

DD Form 1423-1, FEB 2001 Previous edition may be used. Page _1_of_2_Pages

0002AB B

B001

Public: reporting burden for this collec:tlon of Information Is estimated to average 110 hours per response Including the time for reviewing lnstrucllons, searching existing data sources, gathering and maintaining the dala needed, and completing and reviewing the collection ol lnlormallon. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing \he burden. lo Department cl Defense, Washington Headquarters Services, Directorate for Information Operations and Reports {0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Please 00 NOT RETURN vour form lo either ol 1hese address. Send comcleted form to the Government lssulna Ccntractlna Officer for the Contrac\l?R No. Listed in Block E.

A. CONTRACT LINE ITEM NO. B.EXHIBIT C.CATEGORY

OTHER MISC lDF TM

0. SYSTEM/ITEM

I

E. CONTRACT/PR NO. F. CONTRACTOR

MTRA DISPOSAL CONTAINERS

1, DATA ITEM NO, 2. TITLE OF DATA ITEM 3. SUBTITLE

CERTIFICATION/DATA REPORT NOT QUALIFICATIONS

4. AUTHORITY (Dall Acqu/slllon Document No.)

I

5. CONTRACT REFERENCE &, REQUIRING OFFICE

DI-MISC-80678 Drawina 2370-1923 Rev. C PSNS C/980.1

7. DD 250REQ 9. 01ST STATEMENT 10. FREQUENCY 12. DATE OF FIRST 14. OISTRIBUTION

REQUIRED SUBMISSION

NIA OTIME SEE BLK 16 b. COPIES

8. APPCODE N/A 11. AS OF DATE 13. DATE OF SUBSEQUENT A. ADDRESSEE Final SUBMISSION A SEE BLK 16 N/A Draft Reg Repr

16, Remerl<s

BLOCK 3: PSNS C/2370 1 1 0

a) THE CONTRACTOR SHALL PROVIOE AWS CERTIFICATIONS FOR PERSONNEL PERFORMING NONDESTRUCTIVE TESTING (Non SHALL BE CURRENTLY L

CERTIFIED BY THE AMERICAN WELDING SOCIETY ANO OR THE AMERICAN

SOCIETY FOR NONDESTRUCTIVE TESTING AS A WELD INSPECTOR AND FOR THE

TYPES OF NOrs PERFORMED AS REQUIRED BY DWG 2370-1923 GENERAL NOTE B.A.

BLOCK 8 CERTIFICATIONS SHALL BE SUBMITTED FOR GOVERNMENT REVIEW APPROVAL

WILL BE BASED ON TECHNICAL CONTENT AND COMPLIANCE WITH REQUIREMENTS.THE

GOVERNMENT WILL HAVE 14 CALENDAR DAYS FOR REVIEW THE CONTRACTOR SHALL

HAVE 7 CALENDAR DAYS TO REVISE (IF REQUIRED) ANO RESUBMIT FOR A NEW REVIEW

BLOCK 11 & 12: THE MANUFACTURER SHALL PROVIDE CERTIFICATIONS 20 DAYS PRIOR TO

THE START OF CONSTRUCTION.

BLOCK 14. THE CERTIFICATIONS SHALL BE PRESENTED IN UNPROTECTED PDF FORMAT AS

AN EMAIL ATTACHMENT TO ALL ADDRESSEES.

Mr. James Byrnes C/2370 Puget Sound Naval Shipyard & Intermediate Maintenance Facility 1400 Farragut Ave.

Bremerton, WA 98314-5001 James. byrnes@navy.mil

TOTAL 1 1 0

G. PREPARED BY H. DATE H. APPROVED BY J. DATE

Mike Baker 19 Nov 2018

P MEYERS

8330-3015

DD Form 1423-1, FEB 2001 Previous edition may be used. Page _1_of_2_Pages

0002AC C

C001

Public reporting burden for this cOllectlon of Information ls estimated to average 110 haurs per response lnaudlng the time for reviewing Instructions, searching existing data sources, gathering and ma'ntalnfng the data needed, and completing and revlew'ng the col ection of Information. Send comments regarding this burden estimate or any other aspect of th.s collectlan of information. lndudlng suggestions for redutfllg the burden to Department of Defense, Washington Headquarters Services, Directorate for Informal on Operatrons and Reports (0704-0lee>. 1215 Jellerson Davis Highway, Suite 1204, Arlington VA 22202-4302. Please 00 NOT RETURN vour form to either of these address. Send como"eted form to the Government lssulna Contractlna Officer for the Contract/PR No. Listed In Block E.

A. CONTRACT LINE lTEM NO. B.EXHIBIT C.CATEGORY

OTHER X (NDTI) lDF TM

D. SYSTEM/ITEM

I

E. CONTRACT/PR NO. F. CONTRACTOR

MTRA DISPOSAL CONTAINERS

1. DATA ITEM NO. Z. TITLE OF DATA ITEM J. susmLE

TEST/INSPECTI ON REPORT MT TEST REPORTS

4. AUTHORITY (Data Acquisition Document No.) I 5. CONTRACT REFERENCE &. REQUIRING OFACE DI-NDTl-808098 DRAWING 2370-1923 Rev. C PSNS & IMF C/980.1

7. DD250REQ 9. DIST STATEMENT 1 D. FREQUENCY 12, DATE OF FIRST 14. DISTRIBUTION

REQUIRED SUBMISSION

N/A ASGEN SEE BLK 16 b. COPIES

8. APP CODE N/A 11. AS OF DATE 13. DATE OF SUBSEQUENT A. ADDRESSEE Final SUBMISSION A N/A NIA Draft Reg Repr

16, BLOCK 3·

PSNS C/2370 1 1 0

A) THE CONTRACTOR SHALL PROVIDE RECORD OF PERFORMANCE OF MT

{MAGNETIC PARTICLE TESTING) OF EACH PADEYE'S (PC-06, PC-O7, AND

PC-08) WELDS AND BASE MATERIAL IN ACCORDANCE WITH AWS 01.1/1

IM. ACCEPTANCE CRITERIA FOR MT SHALL BE IN ACCORDANCE WITH

AWS D1.1/1.1M)

B) THE CONTRACTOR SHALL PROVIDE WRITTEN DOCUMENTATION THAT

THE Mrs WERE SATISFACTORILY PERFORMED. DOCUMENTATION

SHALL CLEARLY SPECIFY MT RESULTS, METHOD USED. ACCEPTANCE

CRITERIA USED. ITEMS (PIECES ANO WELDS) THAT WERE INSPECTED.

DATES OF TESTS, AND PERSONNEL (INCLUDING QUALIFICATIONS)

THAT PERFORMED THE TESTS

BLOCK 8: WRITTEN LOAD TEST REPORTS SHALL BE SUBMITTED FOR GOVERNMENT

APPROVAL APPROVAL WILL BE BASED ON TECHNICAL CONTENT AND COMPLIANCE WITH

REQUIREMENTS. THE GOVERNMENT WILL HAVE 7 CALENDAR DAYS FOR REVIEW. THE

CONTRACTOR SHALL HAVE 7 CALENDAR DAYS TO REVISE (IF REQUIRED) AND RESUBMIT

FOR A NEW REVIEW.

BLOCKS 11 AND 12 WRITTEN LOAD TEST/ NOT REPORTS SHALL BE PROVIDED SHOWING

LOAD TESTING WAS SATISFACTORILY PERFORMED FOR EACH LIFT POINT 20 DAYS PRIOR

TO THE DELIVERY OF THE EQUIPMENT TO PSNS BREMERTON WA.

BLOCK 14· THE TEST REPORT SHALL BE PROVIDED IN ELECTRONIC UNPROTECTED

SEARCHABLE PDF FORMAT WITH EMAIL NOTIFICATION TO ALL ADDRESSEES.

Mr. James Byrnes C/237O Puget Sound Naval Shipyard & Intermediate Maintenance Facility 1400 Farragut Ave.

Bremerton, WA. 98314-5001 James.bymes@navy.mil

TOTAL 1 1 0

G. PREPARED BY H. DATE H. APPROVED BY J. DATE

Mike Baker 19 Nov 2018

PMEYERS

8330-3015

DD Form 1423-1, FEB 2001 Previous edition may be used. Page _1 _ of j_ Pages

•1e E�

TC

L

0002AD D

D001

(1 Data Item) OMS No. 0704-0188 Public reporting burden for this collectlon 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 the burden, lo Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302 Please DO NOT RETURN vour fonn 10 either or these address. Send completed form to the Government Issuing Contractlna Officer for the Contract/PR No. Listed In Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C.CATEGORY

OTHER X (NDTI) lDF TM

D. SYSTEM/ITEM I E. CONTRACT/PR NO. F. CONTRACTOR

MTRA DISPOSAL CONTAINERS

2. TITLE OF DATA ITEM 3. SUBTITLE 1. DATA ITEM NO.

TEST/INSPECTION REPORT MEASURED WEIGHT REPORT

4. AUTHORITY (Data Acquisition Documenl No,) I 5. CONTRACT REFERENCE 6, REQUIRING OFFICE

Dl-NDTl-80809B DRAWING 2370-1923 Rev. C PSNS & IMF C/980.1

7, DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. OATE OF FIRST 14. DISTRIBUTION

REQUIRED SUBMISSION

N/A ASGEN SEE BLK 16 b, COPIES

8, APP CODE N/A 11. AS OF DATE 13. DATE OF SUBSEQUENT A. ADDRESSEE

Fln1I SUBMISSION

A SEE BLK 16 N/A Dr■ft Reg Repr 16, BLOCK 3: THE CONTRACTOR SHALL PROVIDE TEST REPORT OF MEASEURED WEIGHT OF

EACH COMPLETED MTRA DISPOSAL CONTAINER AS REQUIRED BY DRAWING 2370-1923, PSNS C/2370 1 1 0

GENERAL NOTE 10.G.

BLOCK B: TEST REPORTS SHALL BE SUBMITTED FOR GOVERNMENT APPROVAL. APPROVAL

WILL BE BASED ON TECHNICAL CONTENT AND COMPLIANCE WITH REQUIREMENTS.

BLOCK 11 & 12: THE MANUFACTURER SHALL PROVIDE TEST REPORTS NO LESS THAN 10

WORKING DAYS PRIOR TO SHIPMENT OF THE MTRA DISPOSAL CONTAINERS.

BLOCK 14: THE TEST REPORTS SHALL BE PROVIDED ELECTRONICALLY IN UNPROTECTED,

SEARCHABLE PDF FORMAT AS AN EMAIL ATTACHMENT TO ALL ADDRESSEES.

Addressees:

Mr. James Byrnes C/2370 Puget Sound Naval Shipyard & Intermediate Maintenance Facility 1400 Farragut Ave.

Bremerton, WA. 98314-5001 James.bymes@navy.mil TOTAL 1 1 0

G. PREPARED BY H. DATE H. APPROVED IIY J, DATE

Mike Baker 19 Nov 2018

P MEYERS

8330-3015

DD Form 1423�1, FEB 2001 previous edition may be used. Page _1_of_4_Pages

L

0002AE E

E001

Public reponlng burden for th s colledJon of Information Is estimated to average 110 hours p er response. Including the time for reviewing lnstrudions, searching existing dat a sources, gathering and maintaining the dat a needed, and complet ng and reviewing the coiled on of Information Send comments regarding this burden estimate or any other asped of this colledlon of Information. lnctuding suggestions f or reducing the burden to Oep anment of Defense, Washington Headquarters Servlc:es, Olreciorate for Information Operatons and Repons (0704-0188), 1215 Jefferson Davis H!ghway, Suit e 1204, Arilngton VA 22202-4302. Please DO NOT RETURN vour form to either of these address. Send comcleled form to the Government lssuina Conlrac f

M Officer for the ContracVPR No. Listed In Block E.

A. CONTRACT LINE ITEM NO. B, EXHIBIT C.CATEGORY

OTHER MISC IDF TM

D. SYSTEMnTEM I E. CONTRACT/PR NO. F. CONTRACTOR

MTRA DISPOSAL CONTAINERS

2. TITLE OF DATA ITEM 3. SUBTITLE 1. DATA ITEM NO.

CERTIFICATION/DAT A REPORT CALIBRATION CERTIFICATION

4. AUTHORITY (Data Acquisition Document No.) I 5. CONTRACT REFERENCE &. REQUIRING OFFICE

DI-MISC-80678 DRAWING 2370-1923 Rev. C PSNS C/980.1

7. DD25DREQ 9. DIST STATEMENT 10. FREQUENCY 12, DATE OF FIRST 14. DISTRIBUTION

REQUIRED SUBMISSION

N/A OTIME SEE BLK 16 b, COPIES

8. APP COOE NIA 11. AS OF DATE 13. DATE OF SUBSEQUENT A. ADDRESSEE

Final SUBMISSION

A SEE BLK 16 N/A Draft Rog Ropr

BLOCK3·

THE CONTRACTOR SHALL PROVIDE CALIBRATION CERTIFICATION RECORDS FOR HANGING

PSNS C/2370 1 1 0 LOAD CELL AS REQUIRED BY DRAWING 2370• 1923 GENERAL NOTE 1 O,H

BLOCK B: CERTIFICATION SHALL BE SUBMITTED FOR GOVERNMENT REVIEW AND

APPROVAL TO VERIFY CONTRACT REQUIREMENTS ARE MET. APPROVAL WILL BE BASED

ON TECHNICAL CONTENT AND COMPLIANCE WITH REQUIREMENTS. THE GOVERNMENT

WILL HAVE 7 CALENDAR DAYS FOR REVIEW. THE CONTRACTOR SHALL HAVE 7 CALENDAR

DAYS TO REVISE (IF REQUIRED) AND RESUBMIT FOR A NEW REVIEW.

BLOCK 11 & 12: CERTIFICATION SHALL BE PROVIDED NO LESS 114) DAYS PRIOR TO THE

SHIPMENT OF MTRA DISPOSAL CONTAINERS TO PSNS BREMERTON WA

BLOCK 14 MEDIA REQUIREMENTS. CERTIFICATION SHALL BE DELIVERED IN UNPROTECTED

PDF FORMAT WITH EMAIL NOTIFICATION TO ALL ADDRESSEES

Mr. James Byrnes C/2370 Puget Sound Naval Shipyard & Intermediate Maintenance Facility 1400 Farragut Ave.

Bremerton, WA. 98314-5001 James.byrnes@navy.mil

TOTAL 1 1 0

G. PREPARED BY H. DATE H. APPROVED BY J, DATE

Mike Baker 19 Nov 2018

P MEYERS

8330-3015

DD Form 1423-1, FEB 2001 Previous edition may be used. Page _1_of_2_Pages

0002AF F

F001

Public reporting burden for this co"ectlon of lnfonnat[on It estimated to average 110 hOurs per respons♦, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and comptetlng and reviewing the co:lectlon of Information. Send comments regarding this burden estimate or any other aspect of th,s co lectlon of Information. includi�g suggestlons for redueln11 the burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and ReJ)llrlS (0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302 Please DO NOT RETURN vour form to either of these address. Send comoreted form ta the Government lssulno Contractlna Officer for the Contract/PR No. Listed In Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C.CATEGORY

OTHER MISC TDF TM

D. SYSTEMnTEM I E. CONTRACT/PR NO. F. CONTRACTOR

MTRA DISPOSAL CONTAINERS

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE

CERTIFICATION/DATA REPORT COMPLIANCE STATEMENT

4. AUTHORITY (D•la Acquisition Document Ho.)

I

s. COITTRACT REFERENCE &, REQUIRING OFFICE DI-MISC-80678 DRAWING 2370-1923 Rev. C PSNS C/980.1

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST 14. DISTRIBUTION

REQUIRED SUBMISSION

N/A ASGEN SEE BLK 16 b. COPIES

8, APP CODE N/A 11. AS OF DATE 13. DATE OF SUBSEQUENT A. ADDRESSEE

Final SUBMISSION

N/A SEE BLK 16 N/A Draft Reg Repr

16.

BLOCK 3:

A) THE CONTRACTOR SHALL PROVIDE CERTIFICATE OF COMPLIANCE AS PSNSC/2370 0 1 0

REQUIRED BY DRAWING 2370-1923 GENERAL NOTE 10.1. THE

CERTIFICATE OF COMPLIANCE SHALL BE ON COMPANY LETTER-HEAD

AND SHALL INCLUDE:

• CONTRACTOR'S COMPANY INFORMATION (E.G. COMPANY NAME.

CONTACT INFOMRMATION, ETC.).

• CONTRACT NUMBER AND AWARD AMOUNT.

• DATE THAT CONTRACT WAS AWARDED, DATE FIRST ARTICLE

INSPECTION WAS PERFOMRMED, AND DATE THE INSPECTED

CONTAINERS WERE ACCEPTED BY PSNS.

• APPLICABLE PSNS & IMF DRAWING NUMBER (INCLUDING REVISION).

• QUANTITY OF ITEMS INCLUDING SERIAL NUMBERS.

• A STATEMENT INDICATING, ''THIS CERTIFICATE OF COMPLIANCE

CERTIFIES THAT THE MTRA DISPOSAL CONTAINERS HAVE BEEN

MANUFACTURED IN ACCORDANCE WITH REQUIREMENTS SPECIFIED IN

PSNS DRAWING 2370- 1923 REVISION C AND CONTRACT (ENTER

CONTRACT NUMBER)"

• SIGNATURE AND DATE OF COMPANY PRES IDENT OR PROJECT

MANAGER.

BLOCK 11 & 12 THE MANUFACTURER SHALL PROVIDE CERTIFICATE OF COMPLIANCE

STATEMENT 10 DAYS PRIOR TO SHIPMENT OF MTRA DISPOSAL CONTAINERS

BLOCK 14; THE CERTIFICATIONS SHALL BE PROVIDED ELECTRONICALLY IN UNPROTECTED.

SEARCHABLE PDF FORMAT AS AN EMAIL ATTACHMENT TO ALL ADDRESSEES.

Mr. James Byrnes C/2370 Puget Sound Naval Shipyard & Intermediate Maintenance Facility 1400 Farragut Ave.

Bremerton, WA. 98314-5001 James.bymes@navy.mil

TOTAL 0 1 0

G. PREPARED BY H. DATE I H. APPROVED BY

I

J. DATE

Mike Baker 19 Nov 2018 P MEYERS

DD Form 1423-1, FEB 2001 Previous edition may be used. Page _1 _ of L Pages

L

0002AG G

G001

Public reporting burden lor this collection of Information Is estimated to average 110 hours per responsa, lncl\idlng the time for reviewing Instructions searching existing data sources, gathering and maintaini ng the data needed and ccmpletlng and reviewing the collection ol lnlormatlon. Send comments regarding this burden estimate or any other aspect Df this collection of Information Including suggestions lor reducing the burden, to Department of Defense Washington Headquarters Services, Directorate 10l' Information Operations and Reports (0704-0188), 1215 Jefferson Dav·s H;ghway. Suite 1204, Arlington VA 22202-4302 Please 00 NOT RETURN your form to either al these address. Send completed form to the Government Issuing Contracting Officer lor the Contract/PR No. Listed In Block E.

A. CONTRACT LINE ITEM NO. B.EXHIBIT C.CATEGORY

OTHER X (NDTI) TDF TM

D. SYSTEMnTEM I

E. CONTRACT/PR NO. F. CONTRACTOR

MTRA DISPOSAL CONTAINERS

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE

TEST/INSPECTION REPORT FIRST ARTICLE TEST REPORT

4. AUTHORITY (Dara Acqu/5/1/on Oocumanl No.)

I

5. CONTRACT REFERENCE 6, REQUIRING OFFICE

DI-NDTl-80809B DRAWING 2370-1923 Rev. C PSNS & IMF C/980.1

7, DD250REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST 14. DISTRIBUTION

REQUIRED SUBMISSION

N/A ASGEN SEE BLK 16 b. COPIES

II, APP CODE N/A 11. AS OF DATE 13, DATE OF SUBSEQUENT A. ADDRESSEE Final SUBMISSION A N/A N/A Draft Reg Repr

16.

BLOCK 3·

PSNS C/2370 1 1 0

A) THE FIRST ARTICLE INSPECTION SHALL DOCUMENT ITEMS LISTED BELOW:

• MILL CERTIFICATIONS FOR ALL STEEL PLATE AND PIPE.

• WELD PROCEDURE SPECIFICATIONS (WPS) AND CORRESPONDING

PROCEDURE QUALIFICATIONS RECORDS (PQRS).

• COPY OF WRITTEN NDT PROCEDURE AND ACCEPTANCE CRITERIA QUALIFIED

TO MEET THE REQUIREMENTS OF AWS 01 .1/ 1.1M.

• IN-PROCESS RECORDS FOR INSPECTIONS AND TEST (E.G., MEASURED

WEIGHT OF ITEMS, NDT RESULTS, ETC.).

• ANY IN-PROCESS PHOTOGRAPHS AVAILABLE.

• OBSERVE USE OF CORRECT MATERIALS (E.G., PLATE, PIPE, FASTENERS.

PAINT, ETC ).

• VERIFY ITEMS FOR DIMENSIONAL ACCURACY.

• VERIFY PADEYE HOLES MEET OR EXCEED THE SURFACE ROUGHNESS

REQUIREMENTS OF PARAGRAPH 4.E OF DWG 2370- 1923.

• OBSERVE CLAMP ASSEMBLY FOR FORM, FIT FUNCTION, AND FINISH. VERIFY

FIT IN THE CONTAINER.

• VERIFY FORK POCKETS AND ATTACHING PLATES ARE FULLY SEAL WELDED TO

EACH OTHER AND THE CONTAINER PIPE.

• VERIFY INTERIOR SURFACES OF PIPE ARE SMOOTH IN ACCORDANCE WITH

PARAGRAPH 6.A OF DWG 2370-1923.

• OBSERVE WELD QUALITY (E.G., CHECK PROFILE, NO-UNDER-CUTTING, NO

VISIBLE CRACKS, ETC.).

• VERIFY GAPS BElWEEN LID AND CONTAINER FLANGE ARE IN ACCORDANCE

WITH PARAGRAPH 8 D OF DWG 2370- 1923.

BLOCK 8. WRITTEN TEST REPORTS SHALL BE SUBMITTED FOR GOVERNMENT APPROVAL.

APPROVAL WILL BE BASED ON TECHNICAL CONTENT AND COMPLIANCE WITH

REQUIREMENTS THE GOVERNMENT WILL HAVE 7 CAL EN DAR DA VS FOR REVIEW THE

CONTRACTOR SHALL HAVE 7 CALENDAR DAYS TO REVISE (IF REQUIRED) AND RESUBMIT

FOR A NEW REVIEW

BLOCK 14 THE TEST REPORT SHALL BE PROVIDED IN ELECTRONIC UNPROTECTED

SEARCHABLE PDF FORMAT WITH EMAIL NOTIFICATION TO ALL ADDRESSEES.

Mr. James Byrnes C/2370 Puget Sound Naval Shipyard & Intermediate Maintenance Facility 1400 Farragut Ave.

Bremerton, WA. 98314-5001 James. byrnes@navy.mil TOTAL 1 1 0

G. PREPARED BY H. DATE H. APPROVED BY J. DATE

Mike Baker 19 Nov 2018

P MEYERS

8330-3015

DD Form 1423-1, FEB 2001 Previous edition may be used. Page _1 _of....!.... Pages

C '18 �

TC

L_

0002AH H

H001

DATA ITEM DESCRIPTION

Title: Test/Inspection Report Number: DI-NDTI-80809B Approval date: 970124 AMSC Number: N/A Limitation: N/A DTIC ApplicabJe: N/A GIDEP Applicable: N/A Office of Primary Responsibility: F/AFMC-DOP Applicab]e Forms: NIA

Distribution Statement A: Approved for public release. Distribution is unlimited.

Description/Purpose: The test/inspection report is used to document test/inspection results, findings, and analyses that will enable the Government or Contracting Agency to evaluate compliance with system requirements, performance objectives, specifications, and test/inspection plans.

Application/interrelationship: This Data Item Description (DID) contains the format and content preparation instructions for the data product generated by the specific and discrete task requirement as delineated in the contract.

This DID is applicable to engineering (developmental), preliminary qualification, qualification, and acceptance testing.

Requirements:

1 Format. Contractor format is acceptable. Organize the information required by paragraph 2 and its subparagraphs in a manner that facilitates presentation and understanding.

2 Content. The test/inspection report shall contain the following information, as applicable.

2.1 The following information shall appear on the outside front cover and title page:

a. Report date

b. Report number (contractor or Government)

c. Contractor's name, address, and commercial and Government code

d. Contract number and contract line item number or sequence number (if applicable)

e. Type of test/inspection (for example, first article acceptance test, quality performance inspection, developmental test, qualification test, environmental test)

f. Identification of item tested/inspected

g. Date or period of test/inspection

h. Name and address of requiring Government activity

2.1.1 ltem(s) tested/inspected. Complete identification of the item(s) tested/inspected including the following:

a. Nomenclature

b. National stock number

c. Model number, part number, and serial number

d. Type of item (for example; prototype, production item, laboratory model)

e. Serial or lot number

f. Applicable engineering changes

g. Production item specification, if applicable

h. Date of manufacture

2.1.2 Test/inspection requirements. Complete identification of the test/inspection requirements correlated to contractual requirements including the following:

a. Required test/inspection parameters

b. Performance requirements, acceptance or compliance limits, and environmental criteria

2.2 Summary. Complete test/inspection report summary

3 End of DI-NDTI-80809B