TEST_REPORT1.pdf

· CONTRACT DATA REQUIREMENTS LIST Form Approved (1 Data Item) OMB No. 0704-0188

The public reporting burden for !his.C9I1ection of information is estimat~d to average 1.10 hours ff.er ~espo~se , inclyding the time for reviewing i,nstruc;::tions. searching existing data sources gathering and maintaining the data needed, and completing and reviewing the co lechon of Information. Send comments regarding this burden estimate or a7a other as~ct of this collection of informations includinJ, suggestions for reducing the burden, to Deeartment of Defens~ Washington Headquarters Services, Directorate for In ormation perations and Reports (0701-018 ), 1215 efferson DavIs HI~hway, SUite 1204, Arilnp, on, VA 22202-430 . Respondents should be aware thai notwithstanding any other ~rovision of law'RnoTljerson shall be subject to any penalty for fal ing to comply with a col ection of information ~ it does not diSfolat¥, a curren~ valid OMB control number. lease DO NOT E RN your form to Ihe above address. Send completed form to the Governmenllssulng Contracting Officer or e Conlra PR No. listed in Block E.

A. CONTRACT LINE ITEM NO.

D. SYSTEM/ITEM

B. EXHIBIT C. CATEGORY:

TOP D

JE. CONTRACT/PR NO.

TM 0 OTHER X

F. CONTRACTOR

AN/APQ-170 FD2060-12-0020 1 DRS

17. PRICE GROUP 2. TITLE OF DATA ITEM 1. DATA ITEM NO. 3. SUBTITLE

Test/Inspection Reports

18. ESTIMATED4. AUTHORITY(Data Acquisilion Document No.) \ 6. CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-NDTI-80809B

9. DIST STATEMENT 7. DO 260 REQ 10. FREQUENCY

REQUIRED

BLK 16 ASREQC

8. APP CODE 11. AS OF DATE

N/A Block 16

16. REMARKS

DO FORM 1423-1, FEB 2001" PREVIOUS EDITION MAY BE USED. Page I of I Pages APD PE vl .00

TOTAL PRICE PWS WR-ALC/GRU

12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

b. COPIESASREQ

13. DATE OF SUBSEQUENT a. ADDRESSEE Final

SUBMISSION Draft Reg .Repro Block 16

411 SMSC/GULA I

Block 7: Conlractor shall submil a final 00250 via WAWF 10 DODAAC FA8509, alieni ion

OaI.Le@robins .ar.mil 10 colleclively accounl for data previously submilled by Leiters of Tran smillal.

Block 10-\3: Test Report shall be submilled within 30 calendar days following tesling. ) Eleclronic version lAW DoD policy .

Block 14 :

E-mail for WR-ALCIGRUEB 10 DaI.Le@robins.af.mil

E-mail for 411 SMSCIGULA valeriea .womack@robins.afmil

WR-ALC/GRUEB

4) I SMSC/GULB I

E-mail for 411 SMSCIGULB 10 coslella .edwards@robins .afmil

315. TOTAL ...

G_ PREPARED BY J. DATEH.DATE I. APPROVE:;;

28 Mar 2012 .A~. J ~b.~ I~' 1~.A

~fo?A:IIL mailto:coslella.edwards@robins.afmil mailto:valeriea.womack@robins.afmil mailto:DaI.Le@robins.af.mil mailto:OaI.Le@robins.ar.mil Vernita.Salter Typewritten Text A006

Vernita.Salter Typewritten Text