TGI_3819P31003A02_c0v0_redact.pdf

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FOUO: Public availability to be determined under 5 USC 552

TASK GROUP INSTRUCTION

AIM REV 20.11.4.0 (OCTOBER 2020)

TGI COMPONENT NAME: TYPE: PHASE: REPEAT: CHANGE:

NO.: SA 79243K ELEC SSDG AY A 0 0

SHIP/HULL NO.: SHIP/HULL NAME: SYSTEM: PROJ/WO NO: CASREP CAT:

LCC-19 USS BLUE RIDGE 19P

CU PHASE TITLE:

*(RE) F/O – S/A 79243K, ACCOMPLISH ELEC WORK FOR SSDG, ESLP SS/EDG GENSET UPGRD

PREPARING ACTIVITY:

PREPARED BY: CODE PHONE DATE

KAZUKI UCHIMURA 233 080-9350-1432 14-FEB-2025

APPROVED BY: CODE PHONE DATE

MASAHIRO HOSONO 233 080-9350-1455 14-FEB-2025

CONCURRED BY: CODE PHONE DATE

CONCURRED BY: CODE PHONE DATE

CONCURRED BY: CODE PHONE DATE

CONCURRED BY: CODE PHONE DATE

REASON FOR WORK/NEED FOR CHANGE:

CHANGE INSTRUCTIONS:

SPECIAL REQUIREMENTS:

WORK CERTIFICATION SIGNATURES

COMPLETION OF WORK REVIEW: BADGE NO.: SHOP/CODE: PHONE: DATE:

ACCEPTANCE OF COMPLETED WORK

PHYSICAL INSPECTION PHYSICAL INSPECTION COMPLETED: BADGE NO.: SHOP/CODE: PHONE: DATE:

REQUIRED:☐YES ☒NO

RECORDS REVIEW: BADGE NO.: SHOP/CODE: PHONE: DATE:

TGI NO.: SA 79243K ELEC SSDG AY A 0

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LIST OF EFFECTIVE PAGES

SHT NO. CHG NO. SHT NO. CHG NO. SHT NO. CHG NO. SHT NO. CHG NO. SHT NO. CHG NO.

1-6 J1-2 M1-3

1. SCOPE/PURPOSE

1.1 Title: S/A 79243K, Electrical Work for Ship Service Diesel Generator, Extended Service Life Program Ship Service/Emergency Diesel Generator Generator-set Upgrade; accomplish

1.2 Location of Work:

1.2.1 Ship Service Diesel Generator (SSDG) No. One (5-121-1-E)

1.2.2 SSDG Enclosed Operating Station (5-133-1-E)

1.2.3 Escape Trunk (5-131-1-T)

1.2.4 Physical Fitness Room (5-121-2-L)

1.2.5 Passage (3-109-5-L)

1.2.6 Passage (3-121-0-L)

1.2.7 Fan Room (3-121-1-Q)

1.2.8 Damage Control Central (4-81-1-Q)

1.2.9 Passage (4-109-01-L)

1.2.10 Passage (4-121-4-L)

1.2.11 Aqueous Film Forming Form (AFFF) Station No. 2 (4-132-2-Q)

1.2.12 SSDG Vestibule (4-133-3-L)

1.2.13 Enclosed Operating Station (6-86-0-E)

1.2.14 Emergency Switchgear Room No. 2 (7-109-1-E)

1.2.15 Crew Living Space (5-109-0-L)

1.2.16 Steering Gear Room (5-137-0-E)

1.2.17 Void (9-133-0-V)

1.2.18 Medical Storeroom No. 2 (3-119-3-A)

1.2.19 Emergency Generator Room No. 2 (7-109-1-E)

1.2.20 Shaft Alley (9-98-0-Q)

1.2.21 Cross Flooding Duct, Ninth Deck Frame 111

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1.2.22 JP-5 (9-109-1-J)

1.2.23 JP-5 (9-109-4-J)

1.2.24 Pump Room No. 2 and Air Conditioning Machinery Room No. 2 (7-109-2-E)

1.2.25 “E” Division Storeroom (9-118-1-A)

1.2.26 Trunk (7-118-2-T)

1.3 Identification:

1.3.1 Quantity (One EA), Power System

Remarks: See 2.3, 2.4, 2.5, 2.6, 2.7, 2.8, 2.9, 2.14 through 2.17 for details.

1.3.1.1 Quantity (One EA), Controller for SSDG Seawater Pump Motor

Remarks: See 2.8 for details.

1.3.2 Quantity (One EA), Lighting System

Remarks: See 2.10, 2.14 and 2.15 for details.

1.3.3 Quantity (One EA), Halon Release Alarm System (2FR) for SSDG Remarks: See 2.12 and 2.15 for details.

1.3.4 Quantity (One EA), Alarm Safety and Warning System (5EK) for SSDG

Remarks: See 2.12 and 2.15 for details.

1.3.5 Quantity (One EA), Fog Foam Circuit System (X50J) for SSDG Remarks: See 2.13 and 2.15 for details.

1.3.6 Quantity (One EA), General Announcing System (1MC) for SSDG Remarks: See 2.13 and 2.15 for details.

1.3.7 Quantity (One EA), Sound Powered Telephone Call Bell System (E) for SSDG

Remarks: See 2.13 and 2.15 for details.

1.3.8 Quantity (One EA), Sound Powered Telephone System (JAZ) for SSDG

Remarks: See 2.13 and 2.15 for details.

1.4 Security Classification: None.

1.5 Initial Condition:

1.5.1 Dry Dock Work

1.5.2 Potential Asbestos Hazard

1.5.3 Potential Lead Hazard

1.5.4 Potential PCB Hazard

1.6 Contractor work start date: 1/12/2026

1.7 Contractor work completion date: 8/5/2027

2. REFERENCES:

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REF.

NO.

DOCUMENT

/DRAWING

NUMBER

DOCUMENT/DRAWING TITLE REV CHG

NO.

COPY

REQ’D

(Y/N)

SOURCE

DOC

(Y/N)

PARA SEC PG CHP

1 NSI FY25 Standard Items - ORG N 2 LI FY25 Local Standard Items - ORG N

3 DWG 301-

8621264

POWER SYSTEM 2000KW SHIP

SERVICE DIESEL GENERATOR

UPGRADE REMOVAL

B Y AL

L

4 DWG 301-

8621265

POWER SYSTEM 2000KW SHIP

SERVICE DIESEL GENERATOR

UPGRADE INSTALLATION

B Y AL

L

5 DWG 301-

8621266

SSDG PMP FUSE PANEL POWER

MODIFICATION

A Y AL

L

6 DWG 302-

8622233

POWER SYSTEM REMOVAL

SHIPS SERVICE DIESEL

GENERATOR UPGRADE

A Y AL

L

7 DWG 302-

8622234

POWER SYSTEM INSTALLATION

SHIPS SERVICE DIESEL

GENERATOR UPGRADE

A Y AL

L

8 DWG 302-

8621269

POWER SYSTEM

MODIFICATIONS INCIDENTAL TO

SSDG UPGRADE

B Y AL

L

9 DWG 302-

8974223

CABLEWAY MODIFICATIONS

INCIDENTAL TO SSDG

INSTALLATION

- Y AL

L

10 DWG 303-

8622311

LIGHTING SYSTEM

MODIFICATIONS INCIDENTAL

SHIP SERVICE DIESEL

GENERATOR

A Y AL

L

11 DWG 345-

8574540

GENSET UPGRADE EQUIPMENT

ARRANGEMENT SSDG MACHY

RM & SSDG EOS

B Y AL

L

12 DWG 401-

8623071

SCD 9243 MISC Damper Alarm Mods Incid to SCD 9243

A Y AL

L

13 DWG 401-

8621382

MISC IC MODS INCDT TO SHIP

SERVICE EDG 2 REPLACMENT

A Y AL

L

14 LAR SRFY-

0019-25

DISCREPANCY IN VACUUM

PRESSURE SW FOR

COMBUSTION AIR AND

EDITORIAL ERROR IN SSDG

- Y AL

L

15 PDD

302/303-

ELM-250185

SUPPL INFO FOR SCD 9243

GENSET UPGRADE, SSDG

- Y AL

L

16 PDD 103-

ELM-250166

Patch for Removed Hull Penetration Incid to SCD 9243

- Y AL

L

17 DWG 345-

8574538

GENSET UPGRADE EQUIPMENT

ARRANGEMENT EDG RM 2 &

EMER SWITCHGEAR RM 2

B Y AL

L

18 DWG 114-

2491160

TRANSV BHD 133 & 137 & MISC

STRUCT BHD BEL 5TH DK AFT

FR 121

J Y AL

L

19 DWG 604-

2491435

NON STRUCT BHD 3RD DK FR

98-AFT

G Y 3, 20 MIL MIL-

STD-2003

Electric Plant Installation Standard Methods for Surface Ships and Submarines

B N

21 TM S9AA0-

AB-GOS-

010/GSO

General Specifications for Overhaul of Surface Ships (GSO)

11 N

3. APPENDICES:

3.1. Appendix “J” TGI Job Summary Information Sheet

3.2. Appendix "M" TGI Material List

3.3. Appendix “D” Deficiency Form

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4. GENERAL REQUIREMENTS:

4.1 Not Applicable.

5. PROCEDURE:

5.1 Accomplish electrical removals, modifications and installations of the system listed in 1.3.1 through 1.3.8 in accordance with 2.3 through 2.17, using 2.18 and 2.19 for guidance.

5.1.1 Electrical installations must be in accordance with 2.20.

5.1.2 Accomplish the requirements of 009-12 of 2.1, including Table 2, Column(s) A, Lines One through 7.

5.1.3 Inspect each protective device of the equipment listed in 1.3.1.1.

5.1.3.1 Verify that size and setting of each overload heater are correctly used under full load running current of the motor in accordance with Section 302g of 2.21 and 2.8.

(V) "SIZE/SETTING"

5.1.3.2 Verify that each fuse is correctly sized in accordance with Section 302g of 2.21 and 2.8.

(V) "SIZE"

5.2 Accomplish the requirements of 009-32 of 2.1 for each new and disturbed surface.

5.3 Notes:

5.3.1 Planner: Code 233.1 K. Uchimura, 080-9350-1432

Planner: Code 231B Y. Yoshihara, 243-9984 Planner: Code 231B N. Kurokawa, 243-0108

5.3.2 Opening, initial cleaning, and closing of each space listed in 1.2.17 will be covered by TGI No(s)

3819P12363A01 (KTR TGI).

5.3.3 Opening, initial cleaning, closing, and installation/removal of FMEs of each space listed in 1.2.21 through

1.2.23 will be covered by the following TGI No(s).

Cross Flooding Duct, Ninth Deck Frame 111: 3819P12320A01 (KTR TGI)

JP-5 (9-109-1-J): 3819P12320A01 (KTR TGI)

JP-5 (9-109-4-J): 3819P12321A01 (KTR TGI)

5.3.4 Preservation work for new and disturbed surfaces of each space listed in 1.2.17 will be covered by TGI No.

3819P12363A01 (KTR TGI).

5.3.5 Work Integration Manager (WIM): Code 333 T. Yaginuma, 080-5419-0598

5.3.6 JCN EE01-L107 is related to this TGI.

5.4 Government Furnished Material (GFM):

5.4.1 All GFM listed in each S/A drawing will be provided as kitted material.

5.5 SRF-JRMC will provide the following service work: (TGI No. 3819P31003S02)

5.5.1 [C740] Crane and crane rigging service.

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5.5.2 [X99E] Utilities service, electrical.

5.5.3 [X99M] Utilities service, including low pressure air supply, water supply, and steam supply.

5.5.4 [C106.1] Safety inspection for SRF-JRMC employees.

5.5.5 [C106.2] Gas free inspection for SRF-JRMC employees.

5.5.6 [C133] QA Inspection for (G) symbol(s).

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APPENDIX "J"

TGI JOB SUMMARY INFORMATION SHEET

SYSTEM: PLANT NO.: COMPONENT NAME: TYPE: PHASE: REPEAT: CU PH

VERSION:

CASREP

CAT:

SA 79243K ELEC SSDG AY A 0 0

CU PHASE TITLE:

*(RE) F/O – S/A 79243K, ACCOMPLISH ELEC WORK FOR SSDG, ESLP SS/EDG GENSET UPGRD

PRIMARY COMPONENT:

COMPONENT UNIT LIST (FOR ASSEMBLIES):

JP5 STOR 9-109-4-J TK CMPT 7-109-1-E MS #1 SSDG FD #1 SSDG GE #1

SSDG DE CMPT 5-133-1-E MS CMPT 3-121-1-Q MS JP5 STOR 9-109-1-J TK

TRUNK 5-131-1-T MS CMPT 3-109-5-L MS CMPT 3-119-3-A MS CMPT 5-121-1-

E MS VOID 9-133-0-V VD CMPT 3-121-0-L MS VOID XFLD DUCT FR111 VD INTFC PNL 5-

121-1-E PA (5-130-3)-4P-C C- (5-134-1)-1L-E C- (5-134-1)-1L-F C- 3SG-4P-3S C- DC-

24P-CHARGER C- K-3SG101 C- K-3SG102 C- K-3SG103 C- K-3SG11 C-

K-3SG123 C- K-3SG124 C- K-3SG27 C- KEC-10 C- KEC-11

C- KEC-12 C- KEC-13 C- KEC-14 C- KEC-15 C- KEC-16

C- KEC-17 C- KEC-18 C- KEC-20 C- KEC-21 C- KEC-22

C- KEC-23 C- KEC-3SSDG PMP(3) C- KEC-3SSDG PMP(4) C- KEC-3SSDG PMP(5)

C- SSDG-4P-3S C- SSDD BTRY#1 BA SSDG BTRY#2 BA SSDG BATCHG5-121-

1-E BC 4/0 CABLE C- SSDG BATCHG5-121-1-E RE 3S-1P-INTERFACE PNL C- 3SSDG-

1EPUPSRUNRELAY C- KEC-28P-3SSDG PMP(1) C- KEC-28P-3SSDG PMP(2) C- KEC-28P-BTRY

CHARGER C- KEC-30 C- KEC-31 C- KEC-32 C- KEC-33 C- KEC-

36 C- KEC-3SSDG PMP(1) C- KEC-3SSDG PMP(2) C- NTWK 4A-28P-DC(ALT) C- NTWK

4B-28P-DC(ALT) C- (5-134-1)-1L-E C- K-3SG111 C- K-3SG112 C- K-3SG113 C-

K-3SG115 C- K-3SG116 C- K-3SG117 C- K-3SG118 C- K-3SG119

C- K-3SG120 C- K-3SG121 C- K-3SG122 C- K-3SG125 C- K-3SG126

C- K-3SG127 C- K-3SG128 C- KEC-19 C- KEC-34 C- KEC-35

C- DG SENSING ENCLOSURE EE DUAL VR RG K-3SG129 C- K-3SG130 C-

K-3SG131 C- K-3SG132 C- K-3SG133 C- K-3SG134 C- (5-130-3)-2P-B

C- (5-130-3)-4P-B C- (3-120-1)-1P-K7 C- (3-120-1)-1P-K8 C- (3-120-1)-1P-K9 C- (3-120-1)-4P- K1 C- (5-137-1)-28P-A C- (5-137-1)-28P-B C- (5-137-1)-28P-C C- (5-137-1)-28P-D C- 3S-

28P-PMP C- K-3SG16 C- K-3SG17 C- K-3SG18 C- K-3SG20 C-

K-3SG21 C- K-3SG23 C- K-3SG24 C- PMP-28P-NTWK 4A C- PMP-

28P-NTWK 4B C- RECT 6A-28P-3S DIST C- RECT 6A-28P-PMP C- RECT 6B-28P-3S DIST C-

RECT 6B-28P-PMP C- PDB 3-119-1 PA PDB 3-121-3 PA PDP 5-137-1 PA PMP

FUSE 5-133-1-E PA TF BANK 5-120-1 XF (5-134-1)-1L-B1 LF (5-134-1)-1L-C LF (3-120-1)-1P- K10 C- (3-120-1)-1P-K10(LS) C- (3-120-1)-1P-K10(PB) C- (3-120-1)-1P-K10(VS) C- (3-120- 1)-1P-K11 C- (3-120-1)1PK10(SOL-A C- (3-120-1)1PK10(SOL-B C- (4-128-2)4P-C(INTLK) C- (5-130- 3)-1P-D(PB) C- (5-134-1)-1L-J C- (5-137-1)-28P-E C- (5-137-1)-28P-F C- (6-118-1)-4P-H C-

6-113-1-4P-H1 C- 6-113-1-4P-H2 C- K-3SG12 C- K-3SG13 C- K-3SG14

C- K-3SG15 C- K-3SG19 C- K-3SG26 C- K-EC20 C- K-EC21

C- K-EC22 C- SSDG-4P-3S C- SSDG-4P-3S(IND) C- SSDG-4P-3S(MTR) C-

SSDG-4P-3S/ES C- AUX FOTP CT SSDG SW PUMP CT EMER COMB AIDR

ENCL EE LGE ENG COT PNL PA K-3SG25 C- K-3SG26 C- K-EC36 C-

K-EC37 C- K-1HF-10 C- K-1HF-7 C- SSDG HLN 5-121-1-E PA K-

2FF26 C-

ATTACHMENT LIST:

ZONE MANAGER: ZONE: COMPARTMENT: LEVEL: FRAME: SIDE:

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J-2

SHIP: LCC-19 CHG/VER: 0/0

YAGINUMA ,TAKEHIDE

JO: KO: TOTAL MAN HRS: PLANNING ACCEPTANCE:

3819P31003 A02

TOTAL MAT’L COST TOTAL DURATION:

CU PHASE DESCRIPTION:

The purpose of this TGI to accomplish electrical work for ship service diesel generator, extended service life program ship service/emergency diesel generator generator-set upgrade.

Location of Work:

Ship Service Diesel Generator (SSDG) No. One (5-121-1-E) SSDG Enclosed Operating Station (5-133-1-E) Escape Trunk (5-131-1-T) Physical Fitness Room (5-121-2-L) Passage (3-109-5-L) Passage (3-121-0-L) Fan Room (3-121-1-Q) Damage Control Central (4-81-1-Q) Passage (4-109-01-L) Passage (4-121-4-L) Aqueous Film Forming Form (AFFF) Station No. 2 (4-132-2-Q) SSDG Vestibule (4-133-3-L) Enclosed Operating Station (6-86-0-E) Emergency Switchgear Room No. 2 (7-109-1-E) Crew Living Space (5-109-0-L) Steering Gear Room (5-137-0-E) Void (9-133-0-V) Medical Storeroom No. 2 (3-119-3-A) Emergency Generator Room No. 2 (7-109-1-E) Shaft Alley (9-98-0-Q) Cross Flooding Duct, Ninth Deck Frame 111

JP-5 (9-109-1-J)

JP-5 (9-109-4-J)

Pump Room No. 2 and Air Conditioning Machinery Room No. 2 (7-109-2-E) “E” Division Storeroom (9-118-1-A) Trunk (7-118-2-T)

TASK NAME

SHOP TSD/WC TS CREW# MHRS

HIGH RAD

HOURS

RC

GRID#

5.1 ELEC , SFTR , WELD , SMTL , INSL , PNTR , LBR , QA 22 KE PC

5.2 PNTR , QA 22 KE PC

Electrical Work CFM: or air compressor rental cost, fuel oil cost, asbestos sample and analysis cost, banding material, fasteners, insulation tape, plastic bags, rope, and other consumable.

22 MQ CS

Structural Work CFM: for all paints, thinner, grits including disposal cost, fire watch cost, confined space watch cost, marine chemist cost, lead sampling and analysis cost, asbestos sampling/analysis cost for compartment insulation, adhesive, anchor pin, and misc such as electrode, gases, ---continue to below---

22 MQ CS

---continued from above--- temporary covering material, tyvex suit, plastic bag, masking tape, and other consumable.

22 MQ CS

Process Funding Document. 10 CT OM

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APPENDIX “M”

TGI MATERIAL LIST

SYSTEM: PLANT NO.: COMPONENT NAME: TYPE: PHASE: REPEAT: CU PH

VERSION:

CASREP

CAT:

SA 79243K ELEC SSDG AY A 0 0

CU PHASE TITLE:

*(RE) F/O – S/A 79243K, ACCOMPLISH ELEC WORK FOR SSDG, ESLP SS/EDG GENSET UPGRD

MATERIAL REFERENCES

REF

NO.

DOCUMENT/DRAWING

NUMBER

DOCUMENT/DRAWING TITLE REV

1 ELM-250185

2 8622234 A

JOB ORDER: KEY OP:

3819P31003 A02

MATERIAL LIST

ITEM

NO.

PC

NO.

REF

NO.

M

C DESCRIPTION

STOCK

NUMBER

GENERIC

MATL

TYPE LVL QA

HAZ

MAT

DOC

NO.

QTY

REQD/

UNIT

QTY

USED/

UNIT

001 1 1 M PAD, TAPPED ROUND, PAD,

TAPPED ROUND, 1/4"-20UNC-

2B X 1"LG, STEEL, CARBON,

AISI-1020, CENTERED,

CONCENTRIC INTERNAL

THREAD THRU HOLE 5/8" OD,

FINISH: PLAIN.

BIW CATALOG NO.53204-155

ORDER FOR KTR

ORIG: C226 K.YAMAMI, 080-

9350-1447

9B 5340 LL9003506 NA 4 N 50457597 60/EA

NOTES:

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MATERIAL LIST

ITEM

NO.

PC

NO.

REF

NO.

M

C DESCRIPTION

STOCK

NUMBER

GENERIC

MATL

TYPE LVL QA

HAZ

MAT

DOC

NO.

QTY

REQD/

UNIT

QTY

USED/

UNIT

002 2 1 M PAD, TAPPED ROUND, PAD,

TAPPED ROUND,

CENTERED, CONCENTRIC

INTERNAL THREAD THRU

HOLE 3/4" OD,

SIZE: 3/8-16UNC-2B X 1" LG,

MATL: STEEL, CARBON, AISI-

1020, FINISH: PLAIN,

BIW CATALOG NO. 53204-040,

ORDER FOR KTR

ORIG: C226 K.YAMAMI, 080-

9350-1447

9B 5340 LL9306697 NA 4 N 50457600 60/EA

003 3 1 M PAD, TAPPED ROUND, ORDER

FOR KTR

ORIG: C226 K.YAMAMI, 080-

9350-1447

9B 5315 LL9307892 NA 4 N 50457523 60/EA

004 4 1 M ANGLE,STRUCTURAL, ORDER

FOR KTR

ORIG: C226 K.YAMAMI, 080-

9350-1447

9B 9520 002774913 NA 4 N 50455334 20/FT

005 5 1 M ANGLE,STRUCTURAL, ORDER

FOR KTR

ORIG: C226 K.YAMAMI, 080-

9350-1447

3B 9520 009545666 NA 4 N 50455451 20/FT

006 6 1 M PLATE,METAL, SIZE: 3 FT X 2

FT,

ORDER FOR KTR

ORIG: C226 K.YAMAMI, 080-

9350-1447

9B 9515 002375333 NA 4 N 50455232 6/SF

007 7 1 M PLPLATE,METAL, SIZE: 3 FT X

2 FT,

ORDER FOR KTR

ORIG: C226 K.YAMAMI, 080-

9350-1447

9B 9515 001533184 NA 4 N 50455233 6/SF

008 8 1 M PIPE,METALLIC, ORDER FOR

KTR

ORIG: C226 K.YAMAMI, 080-

9350-1447

9B 4710 002785348 NA 4 N 50455452 20/FT

009 9 1 M BUSHING,ELECTRICAL,

ORDER FOR KTR

ORIG: C226 K.YAMAMI, 080-

9350-1447

9B 5975 005782859 NA 4 N 50455453 3/EA

010 10 1 M CONDUIT OUTLET, ORDER

FOR KTR

ORIG: C226 K.YAMAMI, 080-

9350-1447

9B 5975 011845832 NA 4 N 50455454 2/EA

011 11 1 M CONDUIT OUTLET, ORDER

FOR KTR

ORIG: C226 K.YAMAMI, 080-

9350-1447

9B 5975 008395324 NA 4 N 50455455 1/EA

012 12 1 M GASKET, ORDER FOR KTR

ORIG: C226 K.YAMAMI, 080-

9350-1447

9B 5330 012342617 NA 4 N 50455456 3/EA

013 13 1 M COVER,CONDUIT, COVER,

CONDUIT, 1", STEEL, FOR

CONDUIT BODY, 1", P/N:

LB100M.

ORDER FOR KTR

ORIG: C226 K.YAMAMI, 080-

9350-1447

9B 5975 LL9308962 NA 4 N 50457630 3/EA

014 14 1 M LOCKNUT,ELECTRICAL,

ORDER FOR KTR

ORIG: C226 K.YAMAMI, 080-

9350-1447

9B 5975 007148031 NA 4 N 50455459 13/EA

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MATERIAL LIST

ITEM

NO.

PC

NO.

REF

NO.

M

C DESCRIPTION

STOCK

NUMBER

GENERIC

MATL

TYPE LVL QA

HAZ

MAT

DOC

NO.

QTY

REQD/

UNIT

QTY

USED/

UNIT

015 15 1 M PIPE,METALLIC, ORDER FOR

KTR

ORIG: C226 K.YAMAMI, 080-

9350-1447

9B 4710 002775473 NA 4 N 50455169 10/FT

016 24 2 M WIRE,ELECTRICAL, ORDER

FOR KTR

ORIG: C226 K.YAMAMI, 080-

9350-1447

9B 6145 002841483 NA 4 N 50455460 20/FT

100 M INSULATI, ORIG C231B N.

KUROKAWA 243-0108

ORDER FOR KTR

9Q 5640 008096312 NA 4 N 50455336 10/EA

101 M SOUND CO, ORIG C231B N.

KUROKAWA 243-0108

ORDER FOR KTR

9Q 5640 007565866 NA 4 N 50455337 5/SH

102 M ADHESIVE, ORIG C231B N.

KUROKAWA 243-0108

ORDER FOR KTR

9B 8040 002738708 NA 4 Y 50455085 1/GL

103 M TAPE,TEX, ORIG C231B N.

KUROKAWA 243-0108

ORDER FOR KTR

9B 8315 002671632 NA 4 N 50455338 1/RO

104 M CAP,SNAP, ORIG C231B N.

KUROKAWA 243-0108

ORDER FOR KTR

9B 5325 007377648 NA 4 N 50455171

100/EA

105 M CAP, ORIG C231B N.

KUROKAWA 243-0108

ORDER FOR KTR

9Z 5340 LL4601470 NA 4 N 50457556

100/EA

FOUO: Public availability to be determined under 5 USC 552 SHEET_____OF_____

☐ NUCLEAR APPENDIX "D"

DEFICIENCY FORM

☐ NON-NUCLEAR

1. SHIP/HULL NO.: 2a. DL or DR No.

(Circle One)

2b. REVISION: 3a. COMPONENT NAME: 3b. TYPE: 3c. PHASE: 3d. REPEAT:

LCC-19 SA 79243K ELEC SSDG AY A 0

4a. ICN: 4b. KEY OP: 5. LOC SPACE/LVL: FRAME: P/S/C: 6. CAUSED BY:

3819P31003 A02

7. DESCRIPTION:

8. ORIGINATOR: NAME: BADGE: SHOP/CODE: DATE: PHONE NO.:

9. CORRECTIVE ACTION:

10. EVALUATOR: NAME: BADGE: SHOP/CODE: DATE: PHONE NO.:

FOR NON-NUCLEAR USE ONLY

11. RFD/RFW REQ’D ☐ LAR REQ'D ☐

ILS MOD REQ’D ☐

SRD/PLAN REV REQ'D ☐

DWG NO.: _____________________ S/A NO.: ___________________

12. ISOLATION SIGN: BADGE: SHOP/CODE: DATE: PHONE NO.:

SATISFACTORY:

13. SUBSAFE OQE RECORD? SIGN: BADGE: SHOP/CODE: DATE: PHONE NO.

YES ☐ NO ☐

14. CORRECTIVE ACTION SIGN: BADGE: SHOP/CODE: DATE: PHONE NO.

COMPLETE:

15. INSPECTION REQ’D? INSPECTION COMPLETE/SIGN: BADGE: SHOP/CODE: DATE: PHONE NO.

_________:YES ☐ NO ☐

16. RECORDS REVIEW SIGN: BADGE: SHOP/CODE: DATE: PHONE NO.

COMPLETE (DR ONLY)

DL’s ISSUED

(DR ONLY)

FOUO: Public availability to be determined under 5 USC 552 SHEET_____OF_____

☐ NUCLEAR Deficiency Form Continuation Sheet ☐ NON-NUCLEAR

1. SHIP/HULL NO.: 2a. DL or DR No.

(Circle One) 2b. REVISION: 3a. COMPONENT NAME: 3b. TYPE: 3c. PHASE: 3d. REPEAT:

LCC-19 SA 79243K ELEC SSDG AY A 0