SURPLUS.pdf
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Text version
SURPLUS MATERIEL WORKSHEET
DATE
15 FEB 2022
I. REQUEST FOR EVALUATION
NSN
2995015203563NZ
PART NUMBER
4089285D02
CAGE
77445
APPLICATION
F100-PW-229
IMS
Billingsley, Sarah B
OFFICE SYMBOL
AFLCMC / LPSE
PHONE
405-734-2665
SURPLUS MATERIEL MAY BE AVAILABLE TO FULFILL THE GOVERNMENT'S NEEDS FOR THIS ITEM. AS A RESULT, AN EVALUATION MUST BE PERFORMED
IAW AFMC FAR SUPPLEMENT PART 5352.
THE EVALUATION ON THIS ITEM INDICATES SURPLUS MATERIEL WILL BE CONSIDERED IN THE FOLLOWING TYPES / CATEGORIES
II. EVALUATION CRITERIA (For types/categories deemed acceptable)
ACCEPT-
ABLE (Y/N)
P/N AND
MFG
VERIFI-
CATION
PRIOR
GOV'T
OWNER-
SHIP
100% END
ITEM
INSPECT
TEST AND
VERIFI-
CATION
VERIFI-
ABLE
DIMEN-
SIONS
LOCATION
INSPEC-
TION
TESTING
INITIAL
ACCEPT-
ABILITY
ITEMS
OVERHAUL
AND
CERTIFI-
CATION
OTHER
(Explain in Remarks)
Y X X
N
N
N
N
N
N
N
G O V T
S U R P L U S
NEW/UNUSED
NEW/RECONDITIONED
NEW/MODIFIED
USED/OVERHAULED
C O M M L
S U R P L U S
NEW/UNUSED
NEW/RECONDITIONED
NEW/MODIFIED
USED/OVERHAULED
SURPLUS EVALUATION CRITERIA (If Section 11a. indicates surplus materiel may be considered). (Fill in blanks as appropriate)
PART NUMBER VERIFICATION 77445(AFMCFARS 5352.211-9011) MFG 4089285D02P/N
PRIOR GOVERNMENT OWNERSHIP (AFMCFARS 5352.211-9015)
100% END ITEM INSPECTION (AFMCFARS 5352.211-9017)
TEST AND VERIFICATION (AFMCFARS 5352.211-9013) TECH ORDER NUMBER 2J-F100-54
VERIFIABLE DIMENSION (AFMCFARS 5352.211-9012) DESIGN ACTIVITY 77445
DRAWING NUMBER 4089285D02
LOCATION OF INSPECTION TESTING (AFMCFARS 5352.211-9015)
INITIAL ACCEPTABILITY ITEMS (AFMCFARS 5352.211-9014) A QUANTITY OF ITEMS WILL BE TESTED FOR INITIAL ACCEPTANCE
TEST WILL BE CONDUCTED USING THE FOLLOWING CRITERIA (and location of testing)
OVERHAUL AND CERTIFICATION (AFMCFARS 5352.211-9010)
OTHER SPECIAL REQUIREMENTS (Explain)
Sanor, Dacota RNAME: 09 MAR 2022DATE:
Surplus buy is authorized. Material must be new/unused, in original packaging. Material pass all applicable inspection
REMARKS
JUSTIFICATION FOR UNACCEPTABLE SURPLUS MATERIEL
EVALUATOR
Sanor, Dacota R
OFFICE SYMBOL
AFLCMC / LPSEA
PHONE
405-734-4526 / 884-4526
COMPLETE DATE
09 MAR 2022
SIGNATURE
//SIGNED// Sanor, Dacota R
USER TYPE
Engineer
SIGNATURE DATE
09 MAR 2022
Page 1 of 1AFMC FORM 813, 20000323 (IMT-V1) Version 7Generated by PRPS using Jasper Reports on 06 Oct 2022
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