Technical Exhibit Q - EAP Form 1105 - Statement of Render Safe.pdf
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- Solicitation number
- W91ZLK-25-R-0002
About this file
This is EAP Form 1105, a Statement of Render Safe Procedure form used as both an inspection checklist and documentation of safety measures taken under APGR 755-3. The form contains sections for processing different types of military equipment prior to disposal or turn-in.
The form includes detailed checklists for weapons/components (including chamber/bore clearing, ammunition removal, and release of pressurized systems), vehicles/components (covering fuel tank draining, pressurized systems, and special purpose tanks), aircraft components (addressing fuel tanks, de-icing equipment, and armament removal), test residue material (checking for explosive residue and projectiles), electronic equipment (removal of radioactive components), and fire hazard inspections. Each section requires organizational information, dates, signatures, and letter order numbers for verification. The form serves as a comprehensive safety documentation tool ensuring proper decommissioning and handling of military equipment.
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Text version
VECHICLE AND/OR COOMPONENTS
STATEMENT OF RENDER SAFE PROCEDURE
(APGR 755-3)
INSTRUCTIONS
ITEM DESCRIPTION & NUMBER
WEAPONS AND/OR COOMPONENTS
1.
Page 1 of 2EAP Form 1105, 1 Apr 76
1. This form is to be used, both as an inspection check list and a statement of "RENDER SAFE" measures taken under the provisions of APGR 755-3.
2. Personnel accomplishing inspections, will note same by check mark in appropriate box, and attest to completion of inspection, by inserting organization, date, & full name in applicable spaces.
3. Supply Division will specify type and scope of required Render Safe Operations and/or inspection(s) prior to initial turn-in of material.
4. Identification and numbering of item(s) being turned in for disposal will be in accordance with APGR 755-3, para 5i(1).
2.
Chamber & Bore (Clear) Ammunition Stow Space (Empty) Recoil Mechanism(s) Elevating Mechanism(s) Nitrogen Pressure (Released) Nitrogen Pressure (Released)
Spring Tension (Released) Spring Tension (Released) Recoil Fluids (Emptied) Fluids (Emptied)
Organization _______________________ Date __________ Signed
Letter Order No. ________________________ Year __________
3.
Fuel Tanks (Drained) Flushed Special Purpose Tanks (Acid, etc.)
Pressurized Systems (CO2) Fire Fighting Apparatus, etc.)
Bladder Fuel Tanks (Remove) Special Components (Describe)
Note: If Tacticle Vehicle Complete Section 2.
Organization _______________________ Date __________ Signed
Letter Order No. ____________________ Year __________
Page 2 of 2Reverse of EAP Form 1105, 1 Apr 76
AIRCRAFT OR COMPONENTS THERE OF
TEST RESIDUE MATERIAL (ARMOR PLATE, VEHICLES, ETC.)5.
ELECTRONIC EQUIPMENT6.
INSPECTION FOR FIRE HAZARDS7.
ITEMS OF EQUIPMENT OR MATERIAL NOT LISTED ABOVE8.
Identify Object: _____________________________________________________________________
Cite Hazard, if any: ___________________________________________________________________
Remedial Action Taken: _______________________________________________________________
Organization _______________________ Date __________ Signed
Letter Order No. _________________________ Year __________
Free of Flammable Liquids and/or Materials
Organization _______________________ Date __________ Signed
Letter Order No. ________________________ Year __________
Radioactive Components Removed Power Sources Disconnected Other (Describe)
Organization Date Signed
Letter Order No. Year
Free of Embedded Projectiles & Explosive Residue Inert or Solid Projectiles Cut Flush with Plate Surface Accessible Areas are Free of Explosives or Related Items, per para 3d, APGR 755-3 Projectiles are Inert or Free of Explosives and/or Flammable Materials
Note: Sections 2 & 3 may apply also.
Organization _______________________ Date __________ Signed
Letter Order No. _________________________ Year __________
4. Fuel Tanks (Drained) Not Drained per Request from Proper Disp Br De-Icing Equipment (Alcohol Drained)
De-Activiation and/or release of pressurized components, such as CO2 Firefighting equipment, etc.
Armament Removed
Other (Describe) __________________________________________________________________
Organization _______________________ Date __________ Signed
Letter Order No. ________________________ Year __________ christopher.scott32 Highlight christopher.scott32 Highlight christopher.scott32 Highlight christopher.scott32 Highlight
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| 5_2: |
| Chamber Bore Clear: |
| undefined: |
| Nitrogen Pressure Released: |
| Spring Tension Released: Off |
| Spring Tension Released_2: |
| Recoil Fluids Emptied: |
| undefined_2: |
| Organization: |
| Date: |
| Letter Order No: |
| Year: |
| Fuel Tanks Drained: Off |
| Flushed: Off |
| Special Purpose Tanks Acid etc: Off |
| Pressurized Systems CO2 Fire Fighting Apparatus etc: Off |
| Bladder Fuel Tanks Remove: Off |
| Special Components Describe 1: |
| Special Components Describe 2: |
| Organization_2: |
| Date_2: |
| Letter Order No_2: |
| Year_2: |
| Fuel Tanks Drained_2: Off |
| Not Drained per Request from Proper Disp Br: Off |
| DeIcing Equipment Alcohol Drained: Off |
| DeActiviation andor release of pressurized components such as CO2 Firefighting equipment etc: Off |
| Armament Removed: Off |
| Other Describe: |
| Organization_3: |
| Date_3: |
| Letter Order No_3: |
| Year_3: |
| Free of Embedded Projectiles Explosive Residue: Off |
| Inert or Solid Projectiles Cut Flush with Plate Surface: Off |
| Accessible Areas are Free of Explosives or Related Items per para 3d APGR 7553: Off |
| Projectiles are Inert or Free of Explosives andor Flammable Materials: Off |
| Organization_4: |
| Date_4: |
| Letter Order No_4: |
| Year_4: |
| Radioactive Components Removed: Off |
| Power Sources Disconnected: Off |
| undefined_3: |
| Organization_5: |
| Date_5: |
| Letter Order No_5: |
| Year_5: |
| Free of Flammable Liquids andor Materials: Off |
| Organization_6: |
| Date_6: |
| Letter Order No_6: |
| Year_6: |
| Identify Object: |
| Cite Hazard if any: |
| Remedial Action Taken: |
| Organization_7: |
| Date_7: |
| Letter Order No_7: |
| Year_7: |
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