TGI_3819P31003A03_c0v0_redact.pdf

FOUO

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 SSDG PP 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 MODIFICATION OF VARIOUS PIPING FOR SSDG

PREPARING ACTIVITY:

PREPARED BY: CODE PHONE DATE

TAKAHIRO SHIBANO 234. 315-243-3583 15-FEB-2025

APPROVED BY: CODE PHONE DATE

HIDEO HARADA 234. 315-243-5176 15-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:

CLEANLINESS FOR PIPING SYSTEM/EQUIPMENT LEVEL II AND III.

CLASS P-1 PIPING

CLASS P-2 PIPING

CLASS P-3b PIPING This work affects a fire zone boundary. Fabrication and/or staging of a non-flammable closure is required.

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 SSDG PP AY A 0

FOUO

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

LIST OF EFFECTIVE PAGES

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

1-13 Sketch (1-3)

QA20-

02 (1- 24)

QA28-

05 (1-2)

QA28-

10 (1-2)

J1-2 Map-01 (1-4)

QA28-

01 (1-3)

QA28-

06 (1)

QA34A

(1)

M1-6 Map-02 (1)

QA28-

02 (1-2)

QA28-

07 (1)

Engrg Inst-01 (1)

Map-03 (1-3)

QA28-

03 (1)

QA28-

08 (1-3)

Engrg Inst-02 (1)

QA20-

01 (1- 172)

QA28-

04 (1-3)

QA28-

09 (1)

1. SCOPE/PURPOSE

1.1 Title: S/A 79243K, Modification of Various Piping for Ship Service Diesel Generator (SSDG); accomplish

1.2 Location of work:

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

1.2.2 DK Department Cleaning Gear Storeroom (6-118-1-A)

1.2.3 400 HZ Equipment Room (6-118-1-Q)

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

1.2.5 Ships Service Diesel Generator Vestibule (4-133-3-L)

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

1.2.7 JP5 (9-109-1-J)

1.2.8 "E" Division Storeroom (9-118-1-A)

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

1.2.10 Distillate Fuel or Ballast (9-127-1-F)

1.2.11 Used Lube Oil Sump Tank (6-122-1-F)

1.2.12 Jacket Water Tank (6-123-1-W)

1.2.13 Oily Waste Tank (6-124-1-F)

1.2.14 Grey Water Drain Tank (6-125-1-W)

1.2.15 Fuel Oil Drain Tank (6-126-1-F)

1.2.16 Distillate Fuel Overflow or Ballast (9-121-1-F)

1.2.17 Fuel Oil Service Tank No. 1A (5-122-1-F)

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

1.2.18 Fuel Oil Service Tank No. 1B (5-123-1-F)

1.2.19 Lube Oil Service Tank (5-124-1-F)

1.2.20 Trunk (6-117-0-T)

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

1.3 Identification:

1.3.1 Quantity (One Lot), Start Air System Piping

Remarks: See 2.3 and 2.4 for material and location details.

1.3.1.1 Quantity (2 EA), Globe Valve

Remarks: See Item Number V4 of 2.3

1.3.1.2 Quantity (4 EA), Globe Valve

Remarks: See Item Number V5 of 2.3

1.3.1.3 Quantity (One EA), Globe Valve

Remarks: See Item Number V6 of 2.3

1.3.1.4 Quantity (3 EA), Globe Valve

Remarks: See Item Number V7 of 2.3

1.3.1.5 Quantity (One EA), Needle Valve

Remarks: See Item Number V8 of 2.3

1.3.1.6 Quantity (4 EA), Globe Valve

Remarks: See Item Number V9 of 2.3

1.3.1.7 Quantity (3 EA), Globe Valve

Remarks: See Item Number V11 of 2.3

1.3.1.8 Quantity (7 EA), Globe Valve

Remarks: See Item Number V12 of 2.3

1.3.1.9 Quantity (One EA), Ball Valve

Remarks: See Item Number V13 of 2.3

1.3.2 Quantity (One Lot), Halon System Piping

Remarks: See 2.8 through 2.10 for material and location details.

1.3.2.1 Quantity (One Lot), Halon System Piping and Hose Assembly for Onboard Shop Hydrostatic Test, Dehydration and Vacuum of Halon System Piping Listed in 1.3.2

Remarks: See 2.8 and Sheet 3, 5 and 6 of 2.11 for details.

1.3.2.2 Quantity (One EA), Time Delay Bypass Valve for Main Remote Actuation Station Remarks: See item Number V2 of 2.11

1.3.3 Quantity (One Lot), Aqueous Film Forming Foam (AFFF) System Piping Remarks: See 2.12 through 2.14 for material and location details.

1.3.4 Quantity (One Lot), Fuel Oil (FO) Service System Piping Remarks: See 2.14 through 2.16 for material and location details.

FOUO

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

1.3.5 Quantity (One Lot), FO Transfer System Piping

Remarks: See 2.17 for material and location details.

1.3.6 Quantity (One Lot), Jacket Water Drain System Piping

Remarks: See 2.18 for material and location details.

1.3.7 Quantity (One Lot), Low pressure (LP) Air System Piping Remarks: See 2.19 and Engrg Inst Enclosure-01 for material and location details.

1.3.7.1 Quantity (One EA), Globe Valve

Remarks: See Item Number V2 of 2.19

1.3.7.2 Quantity (3 EA), Globe Valve

Remarks: See Item Number V3 of 2.19

1.3.7.3 Quantity (One EA), Globe Valve

Remarks: See Item Number V5 of 2.19

1.3.8 Quantity (One Lot), Miscellaneous (MISC) System Piping

Remarks: See 2.20 and 2.21 for material and location details.

1.3.9 Quantity (One Lot), Seawater System Piping for Modification of Exhaust Remarks: See 2.24 for material and location details.

1.3.10 Quantity (One Lot), Seawater System Piping for Upgrade SSDG Remarks: See 2.25 through 2.29 and Engrg Inst Enclosure-02 for material and location details.

1.3.10.1 Quantity (One EA), SSDG Auxiliary Sea Water Cooling Pump Unit Remarks: See Item Number R16 of 2.25 and F43 of 2.26

1.3.10.2 Quantity (One EA), Gate Valve

Remarks: See Item Number V1 of 2.26

1.3.10.3 Quantity (3 EA), Gate Valve

Remarks: See Item Number V2 of 2.26

1.3.10.4 Quantity (One EA), Butterfly Valve

Remarks: See Item Number V3 of 2.26

1.3.10.5 Quantity (2 EA), Globe Valve

Remarks: See Item Number V5 of 2.26

1.3.10.6 Quantity (2 EA), Gate Valve

Remarks: See Item Number V6 of 2.26

1.3.10.7 Quantity (2 EA), Globe Valve

Remarks: See Item Number V7 of 2.26

1.3.10.8 Quantity (One EA), Ball Valve

Remarks: See Item Number V8 of 2.26

1.3.10.9 Quantity (12 EA), Globe Valve

Remarks: See Item Number V1 of 2.27

1.3.10.10 Quantity (6 EA), Gate Valve

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

Remarks: See Item Number V2 of 2.27

1.4 Security Classification: None.

1.5 Initial Condition:

1.5.1 Potential Asbestos Hazard.

1.5.2 Potential Lead Hazard.

1.5.3 Dry Dock Work.

1.6 Contractor work start date: 1/12/2026

1.7 Contractor work completion date:8/5/2027

2. REFERENCES:

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 FY-25 NAVSEA Standard Items - ORG N 2 LI FY-25 Local Standard Items - ORG N

3 DWG 513-

8974783

STARTING AIR INSTALLATION

SSDG MACHY RM (5-121-1-E)

A Y AL

L

4 LAR SRFY-

0011-25

CL 400 FTG IN 3000 PSI DESIGN

PRESS STG AIR PP

- Y AL

L

5 MIL MIL-

STD-1627

BENDING OF PIPE OR TUBE FOR

SHIP PIPING SYSTEMS

C N

6 TM S6430-

AE-TED-010

Piping Devices, Flexible Hose Assemblies

7 N

7 TM S9086-

RK-STM-

010/CH-505

Piping System 6 N

8 DWG 507-

8620699

HALON MODIFICATIONS INCID

SSDG UPGRADE 5TH DK, FR 121-

134 (S)

A Y AL

L

9 LAR SRFY-

0275-24

CLEANLINESS LEVEL FOR CO2

ACT PP FOR HALON WORK

- Y AL

L

10 LAR

PSNSIMF-

0003-25

HALON UPDATES TO INCORP

NAVSEA COMMENTS

- Y AL

L

11 DWG 507-

7542662

FIRE EXTINGUISHING SYSTEM

HALON SYS INSTL INCDT SSDG

A Y AL

L

12 DWG 507-

8620737

AFFF PIPING MODS INCIDENTAL

TO SHIP SERVICE DIESEL

GENERATOR NO.1 UPGRADE

A Y AL

L

13 LAR

PSNSIMF-

0921-24

AFFF SPRINKLING UPDATES TO

INCORP NAVSEA COMMENTS

- Y AL

L

14 PDD 103-

ELM-250166

Patch for Removed Hull Penetration Incid to SCD 9243

- Y AL

L

15 DWG 300-

8576349

FUEL OIL SERVICE PIPING

REMOVAL - SSDG #1

GENERATOR UPGRADE

A Y AL

L

16 DWG 300-

8576359

FUEL OIL SERVICE PIPING INSTL

- SSDG #1 GENERATOR

UPGRADE

A Y AL

L

17 DWG 511-

8576361

FUEL OIL TRANS/STRIP

MODIFICATIONS - SSDG

GENERATOR UPGRADE

A Y AL

L

FOUO

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

REF.

NO.

DOCUMENT

/DRAWING

NUMBER

DOCUMENT/DRAWING TITLE REV CHG

NO.

COPY

REQ’D

(Y/N)

SOURCE

DOC

(Y/N)

PARA SEC PG CHP

18 DWG 300-

8576362

JACKET WATER DRAIN TANK

PIPING MODIFICATION - SSDG #1

GENERATOR UPGRADE

A Y AL

L

19 DWG 513-

8620746

LP AIR SYSTEM MODIFICATIONS

INCIDENTAL TO SSDG UPGRADE

5TH DK & BLW FR 109-130 S

A Y AL

L

20 DWG 300-

8576375

MISC PIPING MODIFICATIONS

TANK TOP - SSDG #1

GENERATOR UPGRADE

A Y AL

L

21 LAR SRFY-

0278-24

ADDL MISK PP MOD FOR

LOWERING SSDG PIT

- Y AL

L

22 PDD 505-

ELM-210146

TEST GUIDANCE FOR REQD

ELEVATED NDT OF

INACCESSIBLE WELDING JOINT

ON PIPING SYS

- Y AL

L

23 TM S9AA0-

AB-GOS-

010/GSO

General Specifications for Overhaul of Surface Ships GSO 2016 Edition

11 N

24 DWG 209-

8576363

SEA WATER PIPING MODS IWO

NEW EXHAUST SSDG -

GENERATOR UPGRADE

A Y AL

L

25 DWG 209-

8576335

DIESEL GENERATOR

SALTWATER PIPING REMOVAL -

SSDG #1 GENERATOR UPGRADE

A Y AL

L

26 DWG 209-

8576348

DG SEA WATER PIPING

INSTALLATION - SSDG

GENERATOR UPGRADE

B Y AL

L

27 DWG 209-

8576373

SEAWATER INSTRUMENTATION

SSDG #1 GENERATOR UPGRADE

A Y AL

L

28 LAR

NSWCPD-

0602-24

LCC19 SEA WATER PIPING 3

WAY VALVE MODIFICATION

- Y AL

L

29 LAR SRFY-

0014-25

DWG DISCREPANCY FOR SW

COOLING PIPING SYSTEM

- Y AL

L

30 DWG 101-

2491015

FLOORS FR 123-STERN K Y 7

31 DWG 104-

7542709

STRL MD SSDG MCHY PIT AND

TN

A Y 1,4

32 LAR SRFY-

0044-25

TYPOGRAPHICAL ERROR FOR

LABEL PLATE OF STARTING AIR

SYSTEM

- Y AL

L

3. APPENDICES:

3.1. Appendix “J” TGI Job Summary Information Sheet

3.2. Appendix "M" TGI Material List

3.3. Appendix “D” Deficiency Form

4. GENERAL REQUIREMENTS:

4.1 Not Applicable.

5. PROCEDURE:

5.1 Accomplish modification of start air system piping listed in 1.3.1 with associated work in accordance with 2.3, 2.4 and 2.32.

5.1.1 Bend each new pipe in accordance with 2.5.

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

5.1.2 Accomplish the requirements of 009-12 of 2.1, including Table One, Column(s) A, Lines One through 10.

5.1.2.1 Accomplish the requirements of 009-09 of 2.1.

5.1.2.2 Accomplish nondestructive testing in accordance with Lines 13.

5.1.2.3 Accomplish the requirements of 099-911YO of 2.2, using QA Form 20 Enclosure-07-1 through Enclosure-07-

172. Each joint identification number must be in accordance with Mapping Plan Enclosure-04.

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

5.1.4 Accomplish the requirements of 009-71 of 2.1 for hydrostatic test, using clean, fresh water at 4,050 PSIG, for each new and disturbed 3,000 PSI start air piping systems.

5.1.4.1 Document shop hydrostatic test results on QA Form 28 Enclosure-09-1.

5.1.5 Accomplish the requirements of 009-71 of 2.1 for hydrostatic test, using clean, fresh water at 473 PSIG, for each new and disturbed 350 PSI start air piping systems.

5.1.5.1 Document shop hydrostatic test results on QA Form 28 Enclosure-09-2.

5.1.6 Accomplish a shop hydrostatic test of each complete hose assembly of start air piping system for evidence of external leakage and/or deformation, using clean fresh water at 2,250 PSIG for one minute to 5 minutes in accordance with Chapter 7 of 2.6, using Paragraph 505-11.1.3 of 2.7 for guidance. Allowable external leakage and/or deformation: None.

(I)(G) “HYDROSTATIC TEST”

5.1.6.1 Document shop test record on QA Form 28 Enclosure-09-3.

5.1.6.2 Install a new identification tag on each hose assembly in accordance with Paragraph 7-4 of 2.6 and 2.3.

5.1.7 Accomplish the requirements of 009-25 of 2.1 for a local air hose test of each new weld of each penetration sleeve. Allowable leakage: None.

5.1.8 Cycle each valve listed in 1.3.1.1 through 1.3.1.9, from fully closed to fully open to fully closed 4 times.

Allowable binding: None.

(V) “VALVE CYCLING”

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

5.2 Accomplish modification of halon system piping listed in 1.3.2 in accordance with 2.8 through 2.10.

5.2.1 Accomplish the requirements of 009-12 of 2.1, including Table One, Column(s) A, Lines One through 10.

5.2.1.1 Accomplish the requirements of 009-09 of 2.1.

5.2.1.2 Accomplish nondestructive testing in accordance with Lines 13.

5.2.1.3 Accomplish the requirements of 099-911YO of 2.2, using QA Form 20 Enclosure-08-1 through Enclosure-08-

24. Each joint identification number must be in accordance with Mapping Plan Enclosure-05.

5.2.2 Accomplish the requirements of 009-71 of 2.1 for hydrostatic test, using clean, fresh water at 1,600 PSIG, for each new and disturbed halon piping system.

FOUO

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

5.2.2.1 Document onboard shop hydrostatic test results on QA Form 28 Enclosure-10-1.

5.2.3 Accomplish the requirements of 009-71 of 2.1 for hydrostatic test, using clean, fresh water at 2,800 PSIG, for each new and disturbed CO2 piping system.

5.2.3.1 Document onboard shop hydrostatic test results on QA Form 28 Enclosure-10-2.

5.2.4 Accomplish dehydration and vacuum for each halon system piping in accordance with Test Notes T-3 of 2.8.

5.2.5 Disconnect and reconnect each halon system piping and hose assembly listed in 1.3.2.1 and valve listed in

1.3.2.2 for onboard hydrostatic test, dehydration and vacuum of halon system piping listed in 1.3.2 in accordance with 2.8, using 2.11 for guidance as controlled assembly.

5.2.5.1 Restore each mating surface exposed by removal. Repair by removing high spots, burrs, abrasions, and foreign matter, where removal can be accomplished by hand tools.

5.2.6 Connect each mechanical joint shown on Mapping Plan Enclosure-06.

5.2.6.1 Document the controlled assembly joints on QA Form 34A Enclosure-19-1.

(I) "CONTROLLED ASSEMBLY JOINT INSTALLATION"

5.2.7 Accomplish the requirements of 009-12 of 2.1, including Table 2, Column A, Lines One through 7.

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

5.3 Accomplish modification of AFFF system piping listed in 1.3.3 with associated work in accordance with 2.12 through 2.14, using 2.30 for guidance.

5.3.1 Accomplish the requirements of 009-12 of 2.1, including Table One, Column(s) A, Lines One through 10.

5.3.2 Accomplish the requirements of 009-71 of 2.1 for hydrostatic test, using clean, fresh water at 203 PSIG, for each new and disturbed AFFF piping systems.

5.3.2.1 Document shop hydrostatic test results on QA Form 28 Enclosure-11-1.

5.3.3 Accomplish the requirements of 009-12 of 2.1, including Table 2, Column A, Lines One through 7.

5.3.4 Accomplish the requirements of 009-25 of 2.1 for a local air hose test of each new weld of the watertight/airtight structural boundary. Allowable leakage: None.

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

5.4 Accomplish modification of FO service system piping listed in 1.3.4 in accordance with 2.14 through 2.16, using

2.31 for guidance.

5.4.1 Accomplish the requirements of 009-12 of 2.1, including Table One, Column(s) A, Lines One through 10.

5.4.2 Accomplish the requirements of 009-71 of 2.1 for hydrostatic test, using clean, fresh water at 50 PSIG, for each new and disturbed FO service piping systems.

5.4.2.1 Document shop hydrostatic test results on QA Form 28 Enclosure-12-1.

5.4.3 Accomplish a shop hydrostatic test of each complete hose assembly of FO service piping system for evidence of external leakage and/or deformation, using clean fresh water at 1,600 PSIG for one minute to 5 minutes

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

in accordance with Chapter 7 of 2.6, using Paragraph 505-11.1.3 of 2.7 for guidance. Allowable external leakage and/or deformation: None.

(I)(G) “HYDROSTATIC TEST”

5.4.3.1 Document shop test record on QA Form 28 Enclosure-12-2.

5.4.3.2 Install a new identification tag on each hose assembly in accordance with Paragraph 7-4 of 2.6 and 2.16.

5.4.4 Accomplish the requirements of 009-71 of 2.1 for a low pressure air tightness test, using low pressure air at 50 PSIG, for each field weld joint of new and disturbed FO service piping systems.

5.4.4.1 Document air tightness test results on QA Form 28 Enclosure-12-3.

5.4.5 Accomplish the requirements of 009-12 of 2.1, including Table 2, Column A, Lines One through 7.

5.4.6 Accomplish the requirements of 009-25 of 2.1 for a local air hose test of each new weld of the watertight/airtight structural boundary. Allowable leakage: None.

5.4.7 Install each new silicone coated aluminized cloth spray shield to each mechanical joint of the FO service system piping listed in 1.3.4 in accordance with ASTM-F1138.

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

5.5 Accomplish modification of FO transfer system piping listed in 1.3.5 in accordance with 2.17.

5.5.1 Bend each new pipe in accordance with 2.5.

5.5.2 Accomplish the requirements of 009-12 of 2.1, including Table One, Column(s) A, Lines One through 10.

5.5.3 Accomplish the requirements of 009-71 of 2.1 for hydrostatic test, using clean, fresh water at 50 PSIG, for each new and disturbed FO transfer piping systems.

5.5.3.1 Document shop hydrostatic test results on QA Form 28 Enclosure-13-1.

5.5.4 Accomplish the requirements of 009-71 of 2.1 for a low pressure air tightness test, using low pressure air at 50 PSIG, for each field weld joint of new and disturbed FO transfer piping systems.

5.5.4.1 Document air tightness test results on QA Form 28 Enclosure-13-2.

5.5.5 Accomplish the requirements of 009-12 of 2.1, including Table 2, Column A, Lines One through 7.

5.5.6 Install each new silicone coated aluminized cloth spray shield to each mechanical joint of the FO transfer system piping listed in 1.3.5 in accordance with ASTM-F1138.

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

5.6 Accomplish modification of jacket water drain system piping listed in 1.3.6 in accordance with 2.18.

5.6.1 Accomplish the requirements of 009-12 of 2.1, including Table One, Column(s) A, Lines One through 10.

5.6.2 Accomplish the requirements of 009-71 of 2.1 for hydrostatic test, using clean, fresh water at 68 PSIG, for each new and disturbed jacket water drain piping systems.

5.6.2.1 Document shop hydrostatic test results on QA Form 28 Enclosure-14-1.

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

5.6.3 Accomplish the requirements of 009-12 of 2.1, including Table 2, Column A, Lines One through 7.

5.6.4 Accomplish the requirements of 009-25 of 2.1 for a local air hose test of each new weld of each penetration sleeve. Allowable leakage: None.

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

5.7 Accomplish modification of LP air system piping listed in 1.3.7 in accordance with 2.19 and Enclosure-01.

5.7.1 Bend each new pipe in accordance with 2.5.

5.7.2 Accomplish the requirements of 009-12 of 2.1, including Table One, Column(s) A, Lines One through 10.

5.7.3 Accomplish the requirements of 009-71 of 2.1 for hydrostatic test, using clean, fresh water at 203 PSIG, for each new and disturbed LP air piping systems.

5.7.3.1 Document shop hydrostatic test results on QA Form 28 Enclosure-15-1.

5.7.4 Accomplish the requirements of 009-12 of 2.1, including Table 2, Column A, Lines One through 7.

5.7.5 Accomplish the requirements of 009-25 of 2.1 for a local air hose test of each new weld of each penetration sleeve. Allowable leakage: None.

5.7.6 Cycle each valve listed in 1.3.7.1 through 1.3.7.3, from fully closed to fully open to fully closed 4 times.

Allowable binding: None.

(V) “VALVE CYCLING”

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

5.8 Accomplish modification of MISC system piping listed in 1.3.8 in accordance with 2.20 and 2.21.

5.8.1 Accomplish the requirements of 009-12 of 2.1, including Table One, Column(s) A and B, Lines One through 10.

5.8.2 Accomplish the requirements of 009-71 of 2.1 for hydrostatic test, using clean, fresh water at 50 PSIG, for each new and disturbed lube oil (LO) drain piping systems.

5.8.2.1 Document shop hydrostatic test results on QA Form 28 Enclosure-16-1.

5.8.3 Accomplish the requirements of 009-71 of 2.1 for hydrostatic test, using clean, fresh water at 50 PSIG, for each new and disturbed oily waste transfer piping systems.

5.8.3.1 Document shop hydrostatic test results on QA Form 28 Enclosure-16-2.

5.8.4 Accomplish the requirements of 009-71 of 2.1 for hydrostatic test, using clean, fresh water at 50 PSIG, for each new and disturbed funnel drain piping systems.

5.8.4.1 Document shop hydrostatic test results on QA Form 28 Enclosure-16-3.

5.8.5 Accomplish the requirements of 009-12 of 2.1, including Table 2, Column A, Lines One through 7.

5.8.6 Accomplish following elevated non-destructive testing (ENDT) inspection for Class P-2 MISC system (each tank overflow, air escape and sounding tube (TLI)) piping listed in 1.3.8.

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

5.8.6.1 Accomplish liquid penetrant test on final layer of each Class P-2 onboard weld joint in accordance with Paragraph 4.3.a of 2.22. The accept or reject criteria must be in accordance with Paragraph 4.3.a of 2.22.

(l)(G) "ELEVATED NDT INSPECTION"

5.8.6.2 The area of ENDT is shown on Sketch Enclosure-03.

5.8.7 Accomplish an unobstructed air flow test for MISC system (each tank overflow and air escape) piping listed in

1.3.8 with pressure source at not greater than 100 PSIG to ensure free flow capability and to ensure removal of blanks, using compressed air in accordance with Paragraph 506h of 2.23. Allowable obstruction: None.

(V)(G) “UNOBSTRUCTED AIR FLOW TEST”

5.8.8 Accomplish the requirements of 009-71 of 2.1 for the drop test of each sounding tube (TLI) assembly listed in 1.3.8.

5.8.9 Accomplish flow check of LO drain and funnel drain system piping listed in 1.3.8, using clean, fresh water.

Allowable leakage: None.

(V)(G) “FLOW CHECK”

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

5.9 Accomplish modification of seawater system piping listed in 1.3.9 in accordance with 2.24.

5.9.1 Accomplish the requirements of 009-12 of 2.1, including Table One, Column(s) A, Lines One through 10.

5.9.2 Accomplish the requirements of 009-71 of 2.1 for hydrostatic test, using clean, fresh water at 243 PSIG, for each new and disturbed seawater piping systems.

5.9.2.1 Document shop hydrostatic test results on QA Form 28 Enclosure-17-1.

5.9.3 Accomplish the requirements of 009-12 of 2.1, including Table 2, Column A, Lines One through 7.

5.9.4 Accomplish the requirements of 009-11 of 2.1 to install each new insulation and lagging to seawater system piping listed in 1.3.9 with associated fittings, using 2.24 for guidance.

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

5.10 Accomplish modification of seawater system piping listed in 1.3.10 with associated work in accordance with

2.25 through 2.29 and Enclosure-02.

5.10.1 Bend each new pipe in accordance with 2.5.

5.10.2 Accomplish the requirements of 009-12 of 2.1, including Table One, Column(s) A and B, Lines One through 10.

5.10.3 Remove existing and install each new pump unit listed in 1.3.10.1, using 2.25 and 2.26 for guidance.

5.10.3.1 Align each piping to the pump. Piping must be supported independently and must not impose a strain.

5.10.4 Accomplish the requirements of 009-71 of 2.1 for hydrostatic test, using clean, fresh water at 50 PSIG, for each new and disturbed seawater suction piping systems.

5.10.4.1 Document shop hydrostatic test results on QA Form 28 Enclosure-18-1.

FOUO

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

5.10.5 Accomplish the requirements of 009-71 of 2.1 for hydrostatic test, using clean, fresh water at 54 PSIG, for each new and disturbed seawater discharge piping systems.

5.10.5.1 Document shop hydrostatic test results on QA Form 28 Enclosure-18-2.

5.10.6 Accomplish the requirements of 009-12 of 2.1, including Table 2, Column A, Lines One through 7.

5.10.7 Cycle each valve listed in 1.3.10.2 through 1.3.10.10, from fully closed to fully open to fully closed 4 times.

Allowable binding: None.

(V) “VALVE CYCLING”

5.10.8 Accomplish the requirements of 009-11 of 2.1 to install each new insulation and lagging to seawater system piping listed in 1.3.10 with associated fittings, using 2.25 through 2.29 for guidance.

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

5.11 Notes:

5.11.1 Planner: Code 234 T. Shibano, 243-3583

Planner: Code 231B Y. Yoshihara, 243-9984 Planner: Code 231B N. Kurokawa, 243-0108 Planner: Code 232 M. Fudo, 243-4512 Planner: Code 233 K. Uchimura, 080-9350-1432 Planner: Code 234 Y. Yajima, 243-0977 Engineer: Code 250 I. Hayasaka, 243-4334 Engineer: Code 260 K. Sakai, 243-4342 Engineer: Code 260 Y. Yonesu, 243-6805 Engineer: Code 260 A. Ishiwata, 243-4344 Engineer: Code 260 S. Hamaguchi, 243-4343

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

5.11.3 Work per this instruction involves cutting an access (or removal of a door) through a fire zone bulkhead, through the hull of the ship above the turn of the bilge, through ventilation components (ducting, plenums, etc.), or through any air-tight, fume-tight or watertight bulkheads normally used to control air flow in the event of a shipboard fire. A nonflammable closure is required in accordance with COMNAVSEASYSCOM MSG R 261400Z JUL 12. The closure, if not continuously in use, shall be staged near the access, readily visible and accessible, so that any emergency responder can install the closure to affect proper air flow onboard the ship.

5.11.4 All Government Furnished Material (GFM) and Installing Activity Furnished (IAF) materials except hazmat material listed in each S/A drawing will be provided as kitted material.

5.11.5 Opening, initial cleaning, and closing of each space listed in 1.2.10 through 1.2.16 will be covered by the following TGIs.

Used Lube Oil Sump (6-122-1-F): 3819P12345A01 (KTR TGI) Oily Waste Tank (6-124-1-F): 3819P12346A01 (KTR TGI) Grey Water Tank (6-125-1-W): 3819P12353A01 (KTR TGI) Fuel Oil Drain Tank (6-126-1-F): 3819P12347A01 (KTR TGI) Distillate Fuel Overflow or Ballast (9-121-1-F): 3819P12306A01 (KTR TGI) Distillate Fuel or Ballast (9-127-1-F): 3819P12308A01 (KTR TGI) Jacket Water Tank (6-123-1-W): 3819P31003 A01 (KTR TGI)

5.11.6 Opening, initial cleaning, closing, and installation/removal of FMEs of each space listed in 1.2.17 through

1.2.19 will be covered by the following TGI.

FOUO

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

Fuel Oil Service Tank No. 1A (5-122-1-F): 3819P12301A01 (KTR TGI) Fuel Oil Service Tank No. 1B (5-123-1-F): 3819P12301A01 (KTR TGI) Lube Oil Service Tank (5-124-1-F): 3819P31003 A01(KTR TGI)

5.11.7 Item No. F21 (Boss Outlet, Branch) of 2.3 is acceptable to change to Boss Pilot from direction by Code 260 per e-mail discussion between Code 260 and Code 234 on 14 FEB 2025.

5.11.8 JCN EE01-L107 is related to this TGI.

5.12 Government Furnished Material (GFM):

5.12.1 SRF-JRMC will provide GFM listed in Appendix “M”.

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

5.13.1 [C740] Crane and crane rigging service.

5.13.2 [X99E] Utility service, electrical.

5.13.3 [X99M] Utility service, including low pressure air supply, water supply, and steam supply.

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

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

5.13.6 [C133] QA inspection for (G) symbol(s).

5.13.7 [C134] Analysis for existing material.

5.13.8 [C135] QA inspection for (G) symbol(s).

FOUO

J-1

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

APPENDIX "J"

TGI JOB SUMMARY INFORMATION SHEET

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

VERSION:

CASREP

CAT:

SA 79243K SSDG PP AY A 0 0

CU PHASE TITLE:

(RE) F/O - S/A 79243K, ACCOMPLISH MODIFICATION OF VARIOUS PIPING FOR SSDG

PRIMARY COMPONENT:

COMPONENT UNIT LIST (FOR ASSEMBLIES):

HLN ACTCO2 4-133-3-L PP FO/BLST 9-121-1-F TK WO 6-124-1-F TK SNDG TUBE 5-121-1-E TL

SNDG TUBE 5-121-1-E TL SNDG TUBE 5-121-1-E TL SNDG TUBE 5-121-1-E TL SNDG TUBE 6- 123-1-W TL SNDG TUBE 6-126-1-F TL FO/BLST 9-127-1-F TK AFFF 5-121-1-E PP FOS 5-121-1-E

PP PLMB DR 5-121-1-E PP SW 5-121-1-E PP FM 5-121-1-E PP CNDS DR 5-121-1-E PP

AIR FLASK NORM FL AIR FLASK STBY FL SNDG TUBE 5-121-1-E TL HP AIR 6-118-

1-Q PP LP AIR 6-118-1-Q PP SNDG TUBE 6-122-1-F TL SNDG TUBE 6-124-1-F TL POT

WTR 6-123-1-W TK SNDG TUBE 6-125-1-W TL LP AIR 5-121-1-E PPPOTW 5-121-1-E PP HP AIR 9-118-1-A PP SW 5-121-1-E IN LP AIR 7-109-1-E PPFOS 5-121-1-E SF FO AE/OVFL 5-121-1-E PP FW AE/OVFL 5-121-1-E PP LO AE/OVFL 5-121-1-E PP WO AE/OVFL 5-121-1-E PP WW AE/OVFL

5-121-1-E PP SSDG FO 5-121-1-E PP SSDG JW 5-121-1-E PP SSDG LO 5-121-1-E PP SSDG

SW 5-121-1-E PP BLST 5-121-1-E PP FO 5-121-1-E PP HP AIR 5-121-1-E PP HALON 5-121-

1-E PP POL CTL 5-121-1-E PP CMPT 5-121-1-E MS

ATTACHMENT LIST:

1. ENCLOSURE-01 (3819P31003A03-ENGRG INST-01.pdf) saved on 11-FEB-2025 0000.

2. ENCLOSURE-02 (3819P31003A03-ENGRG INST-02.pdf) saved on 13-FEB-2025 0000.

3. ENCLOSURE-03 (3819P31003A03-Sketch.pdf) saved on 13-FEB-2025 0000.

4. ENCLOSURE-04 (3819P31003A03-MAP-01.pdf) saved on 11-FEB-2025 0000.

5. ENCLOSURE-05 (3819P31003A03-MAP-02.pdf) saved on 11-FEB-2025 0000.

6. ENCLOSURE-06 (3819P31003A03-MAP-03.pdf) saved on 13-FEB-2025 0000.

7. ENCLOSURE-07 (3819P31003A03-QA20-01.docx) saved on 14-FEB-2025 0000.

8. ENCLOSURE-08 (3819P31003A03-QA20-02.docx) saved on 13-FEB-2025 0000.

9. ENCLOSURE-09 (3819P31003A03-QA28-01.docx) saved on 11-FEB-2025 0000.

10. ENCLOSURE-10 (3819P31003A03-QA28-02.docx) saved on 11-FEB-2025 0000.

11. ENCLOSURE-11 (3819P31003A03-QA28-03.docx) saved on 11-FEB-2025 0000.

12. ENCLOSURE-12 (3819P31003A03-QA28-04.docx) saved on 11-FEB-2025 0000.

13. ENCLOSURE-13 (3819P31003A03-QA28-05.docx) saved on 11-FEB-2025 0000.

14. ENCLOSURE-14 (3819P31003A03-QA28-06.docx) saved on 11-FEB-2025 0000.

15. ENCLOSURE-15 (3819P31003A03-QA28-07.docx) saved on 11-FEB-2025 0000.

16. ENCLOSURE-16 (3819P31003A03-QA28-08.docx) saved on 11-FEB-2025 0000.

17. ENCLOSURE-17 (3819P31003A03-QA28-09.docx) saved on 13-FEB-2025 0000.

18. ENCLOSURE-18 (3819P31003A03-QA28-10.docx) saved on 11-FEB-2025 0000.

19. ENCLOSURE-19 (3819P31003A03-QA34A.docx) saved on 14-FEB-2025 0000.

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

YAGINUMA ,TAKEHIDE

JO: KO: TOTAL MAN HRS: PLANNING ACCEPTANCE:

3819P31003 A03

TOTAL MAT’L COST TOTAL DURATION:

CU PHASE DESCRIPTION:

The purpose of this TGI is to accomplish modification of various piping for SSDG.

Location of Work:

Ship Service Diesel Generator No. One (5-121-1-E) DK Department Cleaning Gear Storeroom (6-118-1-A) 400 HZ Equipment Room (6-118-1-Q) Physical Fitness Room (5-121-2-L) Ships Service Diesel Generator Vestibule (4-133-3-L)

FOUO

J-2

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

CU PHASE DESCRIPTION:

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

JP5 (9-109-1-J)

"E" Division Storeroom (9-118-1-A) Distillate Fuel or Ballast (9-127-1-F) Used Lube Oil Sump Tank (6-122-1-F) Jacket Water Tank (6-123-1-W) Oily Waste Tank (6-124-1-F) Grey Water Drain Tank (6-125-1-W) Fuel Oil Drain Tank (6-126-1-F) Distillate Fuel Overflow or Ballast (9-121-1-F) Fuel Oil Service Tank No. 1A (5-122-1-F) Fuel Oil Service Tank No. 1B (5-123-1-F) Lube Oil Service Tank (5-124-1-F) Trunk (6-117-0-T) Escape Trunk (5-131-1-T) SSDG Enclosed Operating Station (5-133-1-E)

TASK NAME

SHOP TSD/WC TS CREW# MHRS

HIGH RAD

HOURS

RC

GRID#

5.1 PFTR , WELD , IMCH , OMCH , SFTR , PNTR , INSL ,

QA , BLRM

22 KE PC

5.2 PFTR , WELD , PNTR , OMCH , QA 22 KE PC

5.3 PFTR , WELD , PNTR , QA 22 KE PC

5.4 PFTR , WELD , PNTR , BLRM , QA , INSL OMCH 22 KE PC

5.5 PFTR , WELD , INSL , PNTR , INSL , QA , OMCH 22 KE PC

5.6 PFTR , WELD , PNTR , QA 22 KE PC

5.7 PFTR , WELD , PNTR , RGRS , INSL , QA , OMCH 22 KE PC

5.8 PFTR , WELD 4, PNTR , ELEC , QA 22 KE PC

5.9 PFTR , INSL , WELD , PNTR , RGRS , QA 22 KE PC

5.10 PFTR , INSL , BLRM , SFTR , IMCH , WELD , PNTR ,

RGRS , QA , OMCH

22 KE PC

Piping Work CFM: marine chemist cost, fire watch cost, tank watch cost, lead analysis cost, welding rod, air compressor rental cost, fuel oil cost, brazing rod, flux, acetylene gas, oxygen gas, argon gas, nitrogen gas, paint, label plate cost, pipe hanger, gasket sheet, saw blade, plastic bag, tape, covering material, NDT cost and MISC.

22 MQ CS

Structural Work CFM: for paints, thinner, fire watch cost, confined space watch cost, asbestos sampling/analysis cost, adhesive, anchor pin, air compressor rental cost and fuel oil cost for air hose test, and misc such as electrode, temporary covering material, tyvex suit, plastic bag, masking tape, and other consumable.

22 MQ CS

Machinery Work CFM: for Gasket and MISC. 22 MQ CS

Electrical Work CFM: for insulation tape, plastic bags, rope, and other consumable.

22 MQ CS

Lagging Work CFM: for asbestos sampler and analysis cost, paints, covering material, tyvek suit, and MISC such as other consumable material.

22 MQ CS

Process Funding Document. 10 CT OM

FOUO

M-1

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

APPENDIX “M”

TGI MATERIAL LIST

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

VERSION:

CASREP

CAT:

SA 79243K SSDG PP AY A 0 0

CU PHASE TITLE:

(RE) F/O - S/A 79243K, ACCOMPLISH MODIFICATION OF VARIOUS PIPING FOR SSDG

MATERIAL REFERENCES

REF

NO.

DOCUMENT/DRAWING

NUMBER

DOCUMENT/DRAWING TITLE REV

JOB ORDER: KEY OP:

3819P31003 A03

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 M COUPLING,PIPE, COUPLING,

1"IPS, CN 70-30

ORDERED FOR KTR, ORG:

C234,T. SHIBANO, TEL: 243-

9B 4730 014214718 NA 4 N 50455173 10/EA

002 M COUPLING,PIPE, COUPLING,

3/4"IPS, CN 70-30

ORDERED FOR KTR, ORG:

C234,T. SHIBANO, TEL: 243-

9B 4730 014214716 NA 4 N 50455174 10/EA

003 M COUPLING,PIPE, COUPLING,

1/2"IPS, CN 70-30

ORDERED FOR KTR, ORG:

C234,T. SHIBANO, TEL: 243-

9B 4730 014214717 NA 4 N 50455176 10/EA

004 M COUPLING,TUBE, COUPLING,

3/4"IPS, CN 90-10, SW

ORDERED FOR KTR, ORG:

C234,T. SHIBANO, TEL: 243-

9B 4730 014635878 NA 4 N 50455178 15/EA

NOTES:

FOUO

M-2

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

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

005 M ELBOW,PIPE, "ELBOW,

3/4""IPS, CN 90-10, SW

ORDERED FOR KTR, ORG:

C234,T. SHIBANO, TEL: 243-

3583"

9B 4730 014637038 NA 4 N 50455180 20/EA

006 M COUPLING,TUBE, COUPLING,

CN 90-10, 2"IPS, BW

ORDERED FOR KTR, ORG:

C234,T. SHIBANO, TEL: 243-

9B 4730 005423290 NA 4 N 50455181 10/EA

007 M COUPLING,TUBE, COUPLING,

CN 90-10, 1-1/2"IPS, BW

ORDERED FOR KTR, ORG:

C234,T. SHIBANO, TEL: 243-

9B 4730 007225467 NA 4 N 50455182 3/FV

008 M COUPLING, COUPLING, PIPE,

SOCKET WELD,

SIZE: 3/8"IPS,

MATL: CU-NI 90/10,

PSRESSURE: 400PSI,

DWG: 803-6397430,

PREMIER COPPER P/N:

99150060

ORDERED FOR KTR, ORG:

C234,T. SHIBANO, TEL: 243-

9C 4730 LL4462577 NA 4 N 50457557 20/EA

009 M COUPLING,TUBE, COUPLING,

1/4"IPS, CN 90-10

ORDERED FOR KTR, ORG:

C234,T. SHIBANO, TEL: 243-

9B 4730 014635868 NA 4 N 50455184 10/PG

010 M ELBOW,PIPE, ELBOW, 3/8"IPS,

CN 90-10, 90D, SR

ORDERED FOR KTR, ORG:

C234,T. SHIBANO, TEL: 243-

9B 4730 016051412 NA 4 N 50455186 10/EA

011 M COUPLING,TUBE, COUPLING,

2"IPS, CN 90-10

ORDERED FOR KTR, ORG:

C234,T. SHIBANO, TEL: 243-

9B 4730 005423290 NA 4 N 50455187 30/EA

012 M SLEEVE,, SLEEVE, BUTT

WELD, 1-1/4"IPS, CU-NI 90/10,

200 PSI, DWG 810-1385880

ORDERED FOR KTR, ORG:

C234,T. SHIBANO, TEL: 243-

9C 4730 LL4903762 NA 4 N 50457558 30/EA

013 M COUPLING,TUBE, COUPLING,

1-1/2"IPS, CN 90-10

ORDERED FOR KTR, ORG:

C234,T. SHIBANO, TEL: 243-

9B 4730 007225467 NA 4 N 50455190 10/FV

014 M COUPLING,TUBE, COUPLING,

2-1/2"IPS, CN 90-10

ORDERED FOR KTR, ORG:

C234,T. SHIBANO, TEL: 243-

9B 4730 007225471 NA 4 N 50455191 10/PG

015 M COUPLING,TUBE, COUPLING,

4"IPS, CN 90-10

ORDERED FOR KTR, ORG:

C234,T. SHIBANO, TEL: 243-

9B 4730 007225474 NA 4 N 50455192 10/EA

FOUO

M-3

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

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

016 M BACKINGR, BACKING RING, 4"

IPS, CU-NI 90/10, 200 PSIG,

MIL-STD-22

ORDERED FOR KTR, ORG:

C234,T. SHIBANO, TEL: 243-

9C 4730 LL4558786 NA 4 N 50457559 10/EA

017 M BACKING, BACKING RING,

SIZE:2"IPS,

MATL: CU-NI 90/10,

PRESSURE: 200PSIG,

SPEC: MIL-STD-22

ORDERED FOR KTR, ORG:

C234,T. SHIBANO, TEL: 243-

9C 4730 LL4558779 NA 4 N 50457560 20/EA

018 M BACKING, BACKING RING, 1-

1/2"IPS, CNA 90/10, 200PSIG

ORDERED FOR KTR, ORG:

C234,T. SHIBANO, TEL: 243-

9C 4730 LL4558777 NA 4 N 50457561 30/EA

019 M SLEEVE,, SLEEVE, 4"IPS, BUTT

WELD, CU-NI 70-30, 200PSI,

DWG: 810-1385880

ORDERED FOR KTR, ORG:

C234,T. SHIBANO, TEL: 243-

9C 4730 LL4462305 NA 4 N 50457562 30/EA

020 M BACKING, BACKING RING.

4"IPS, CNA 70/30, 200PSIG

ORDERED FOR KTR, ORG:

C234,T. SHIBANO, TEL: 243-

9C 4730 LL4358122 NA 4 N 50457563 30/EA

021 M BACKING, BACKING RING,

2"IPS, CNA 70/30, 200PSIG

ORDERED FOR KTR, ORG:

C234,T. SHIBANO, TEL: 243-

9C 4730 LL4558817 NA 4 N 50457564 20/EA

022 M SLEEVE,, SLEEVE, 2"IPS, BUTT

WELD, CNA 70-30, 200 PSI,

810-1385880

ORDERED FOR KTR, ORG:

C234,T. SHIBANO, TEL: 243-

9C 4730 LL4462301 NA 4 N 50457565 20/EA

023 M BOSS, PI, BOSS, PILOT,

1/4"IPS, SOCKET WELD,

COPPER NICKEL 70-30, 400

PSI

ORDERED FOR KTR, ORG:

C234,T. SHIBANO, TEL: 243-

9C 4730 LL4464623 NA 4 N 3/EA

400 M INSULATI, INSULATION, PIPE,

BRAND: K-FLEX ECO,

SPECIFICATION COMPLIANCE:

EB 4013,

FOR SIZE: 4" IPS,

SIZE: 4-1/2" ID X 3/4" THK X 6

FT LG,

UI: EA/6 FT(ONE CONTINUOUS

LENGTH REQUIRED),

MATL: NON-HALOGEN,

ORIG:C234 Y.YAJIMA, 243-0977

ORDERED FOR KTR

9B 5640 LL9607848 NA 4 N 50457566 8/EA

FOUO

M-4

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

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

401 M INSULATI, INSULATION, PIPE,

BRAND: K-FLEX ECO,

SPECIFICATION COMPLIANCE:

EB 4013,

FOR SIZE: 6" IPS,

SIZE: 6-5/8" ID X 3/4" THK X 6FT

LG,

UI: EA/6 FT(ONE CONTINUOUS

LENGTH REQUIRED),

MATL: NON-HALOGEN

ORIG:C-234 Y.YAJIMA, 243-

ORDERED FOR KTR

9B 5640 LL9607850 NA 4 N 50457567 3/EA

402 M ADHESIVE, ADHESIVE FOR

CLOTH,

ORDER FOR KTR

ORIG: C234 Y.YAJIMA, 243-

9B 8040 002738708 NA 4 Y 50455089 6/GL

403 M ADHESIVE, ADHESIVE FOR

PLASTIC TUBE

ORDER FOR KTR

ORIG: C234 Y.YAJIMA, 243-

9B 8040 008419773 NA 4 Y 50455175 6/PT

403 M ADHESIVE, ADHESIVE FOR

PLASTIC TUBE

ORDER FOR KTR

ORIG: C234 Y.YAJIMA, 243-

9B 8040 008419773 NA 4 Y 6/PT

404 M INSULATI, INSULATION, PIPE,

BRAND: K-FLEX ECO,

SPECIFICATION COMPLIANCE:

EB 4013,

FOR SIZE: 4-1/8" OD TUBE,

SIZE: 4-1/8" ID X 3/4" THK X 6FT

LG,

UI: EA/6 FT(ONE CONTINUOUS

LENGTH REQUIRED),

MATL: NON-HALOGEN,

ORDER FOR KTR

ORIG: C234 Y.YAJIMA, 243-

9B 5640 LL9607847 NA 4 N 50457568 2/EA

405 M INSULATI, ORDER FOR KTR

ORIG: C234 Y.YAJIMA, 243-

9B 5970 LL9607844 NA 4 N 50457569 12/EA

406 M INSULATI, INSULATION, PIPE,

BRAND: K-FLEX ECO,

SPECIFICATION COMPLIANCE:

EB 4013, FOR SIZE: 2-1/2" IPS,

SIZE: 2-7/8" ID X 3/4" THK X 6FT

LG, UI: EA/6 FT(ONE

CONTINUOUS LENGTH

REQUIRED), MATL: NON-

HALOGEN, **GSA ADVANTAGE

ITEM**

ORDER FOR KTR

ORIG: C234 Y.YAJIMA, 243-

9B 5970 LL9607845 NA 4 N 50457570 2/EA

FOUO

M-5

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

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

407 M INSULATI, INSULATION, PIPE,

BRAND: K-FLEX ECO,

SPECIFICATION COMPLIANCE:

EB 4013,

FOR SIZE: 8" IPS,

SIZE: 8-5/8" ID X 3/4" THK X 6

FT LG,

UI: EA/6 FT(ONE CONTINUOUS

LENGTH REQUIRED),

MATL: NON-HALOGEN,

ORDER FOR KTR

ORIG: C234 Y.YAJIMA, 243-

9B 5640 LL9607851 NA 4 N 50457571 2/EA

408 M INSULATI, INSULATION, PIPE,

BRAND: K-FLEX ECO,

SPECIFICATION COMPLIANCE:

EB 4013,

FOR SIZE: 3/4" IPS,

SIZE: 1-1/8" ID X 3/4" THK X 6FT

LG,

UI: EA/6 FT(ONE CONTINUOUS

LENGTH REQUIRED),

MATL: NON-HALOGEN,

**GSA ADVANTAGE ITEM**

ORDER FOR KTR

ORIG: C234 Y.YAJIMA, 243-

9B 5640 LL9607842 NA 4 N 50457572 3/EA

409 M INSULATI, ORDER FOR KTR

ORIG: C234 Y.YAJIMA, 243-

9B 5970 LL4783095 NA 4 N 50457573 2/EA

410 M INSULATI, INSULATION, PIPE,

BRAND: K-FLEX ECO,

SPECIFICATION COMPLIANCE:

EB 4013, FOR SIZE: 3" IPS,

SIZE: 3-1/2"ID X 3/4" THK X 6 FT

LG, UI: EA/6 FT(ONE

CONTINUOUS LENGTH

REQUIRED), MATL: NON-

HALOGEN,

DO NOT CROSS NSN: 5640-01-

607-0098(SIMC: X3),

ORIG:C-234 Y.YAJIMA, 243-

ORDERED FOR KTR

9B 5640 LL9607846 NA 4 N 50457574 2/EA

411 M SHIELD,SAFETY,PIPE, SHIELD,

7 INCH WIDE,

ORIG: CODE 234 Y.YAJIMA,

243-0977

ORDERED FOR KTR

9B 4730 010100999 NA 4 N 50455193 1/EA

412 M SHIELD,SAFETY,PIPE, SHIELD,

6 INCH WIDE,

ORIG: CODE 234 Y.YAJIMA,

243-0977

ORDERED FOR KTR

9B 4730 010100998 NA 4 N 50455194 1/EA

413 M SHEET,NONMETALLIC,P,

SHIELD, 4 INCH WIDE,

ORIG: CODE 234 Y.YAJIMA,

243-0977

ORDERED FOR KTR

9B 9390 013753347 NA 4 N 50455339 1/RO

414 M SHIELD,SAFETY,PIPE, 5"WIDE

ORI: C234 Y.YAJIMA, 243-0977

ORDERED FOR KTR

9B 4730 010100997 NA 4 N 50455195 1/EA

FOUO

M-6

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

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

415 M CLOTH,PLAIN WEAVE, GLASS

CLOTH, L/W

ORDER FOR KTR

C234 Y.YAJIMA, 243-0977

9B 8305 001487363 NA 4 N 50455340 1/RO

500 M INSULATI, ORIG C231B N.

KUROKAWA 243-0108

ORDER FOR KTR

9Q 5640 008096312 NA 4 N 50455342 5/EA

501 M SOUND CO, ORIG C231B N.

KUROKAWA 243-0108

ORDER FOR KTR

9Q 5640 007565866 NA 4 N 50455343 5/SH

502 M TAPE,TEX, ORIG C231B N.

KUROKAWA 243-0108

ORDER FOR KTR

9B 8315 002671632 NA 4 N 50455344 1/RO

503 M CAP, ORIG C231B N.

KUROKAWA 243-0108

ORDER FOR KTR

9Z 5340 LL4601470 NA 4 N 50457575 50/EA

504 M ADHESIVE, ORIG C231B N.

KUROKAWA 243-0108

ORDER FOR KTR

9B 8040 002738708 NA 4 Y 50455092 1/GL

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 SSDG PP AY A 0

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

3819P31003 A03

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 SSDG PP AY A 0

Kouhei.Sakai.ja Line

Kouhei.Sakai.ja_1 Line

Kouhei.Sakai.ja_2 Line

Kouhei.Sakai.ja_3 Line

Kouhei.Sakai.ja_4 Line

Kouhei.Sakai.ja_5 Line

Kouhei.Sakai.ja_6 Line

Kouhei.Sakai.ja_7 Line

Kouhei.Sakai.ja_8 Pencil

Kouhei.Sakai.ja_9 Pencil

Kouhei.Sakai.ja_10 Pencil

Kouhei.Sakai.ja_11 Pencil

Kouhei.Sakai.ja_12 Line

Kouhei.Sakai.ja_13 Line

Kouhei.Sakai.ja_14 Text Box

WEB FR117

Kouhei.Sakai.ja_15 Line

Kouhei.Sakai.ja_16 Line

Kouhei.Sakai.ja_17 Text Box

WEB FR113

Kouhei.Sakai.ja_18 Text Box

ENGRG INST

ENCLOSURE-01

Kouhei.Sakai.ja_19 Text Box

SHEET 1 OF 1

Kouhei.Sakai.ja_20 Text Box 3819P31003A03

3819P31003A03 ENGRG INST

ENCLOSURE-02

SHEET 1 OF 1

Takahiro.Shibano.ja Rectangle

Takahiro.Shibano.ja_1 Rectangle

Takahiro.Shibano.ja_2 Text Box ENDT areas are red frame

Takahiro.Shibano.ja_3 Text Box

SKETCH

Takahiro.Shibano.ja_4 Text Box

ENCLOSURE-03

Takahiro.Shibano.ja_5 Text Box 3819P31003A03

Takahiro.Shibano.ja_6 Text Box

SHEET 1 OF 3

Takahiro.Shibano.ja_7

Closed view of Sheet 9 (Elevation 66-D) of 2.20

Takahiro.Shibano.ja_8

Takahiro.Shibano.ja_9 Rectangle

Takahiro.Shibano.ja_10 Rectangle

Takahiro.Shibano.ja_11 Rectangle

Takahiro.Shibano.ja_12 Polygonal Line

Takahiro.Shibano.ja_13 Rectangle

Takahiro.Shibano.ja_14 Rectangle

Takahiro.Shibano.ja_15 Rectangle

Takahiro.Shibano.ja_16 Rectangle

Takahiro.Shibano.ja_17 Rectangle

Takahiro.Shibano.ja_18 Text Box ENDT areas are red frame

Takahiro.Shibano.ja_19 Text Box

SKETCH

Takahiro.Shibano.ja_20 Text Box

ENCLOSURE-03

Takahiro.Shibano.ja_21 Text Box 3819P31003A03

Takahiro.Shibano.ja_22 Text Box

SHEET 2 OF 3

Takahiro.Shibano.ja_23

Closed view of Sheet 10 (Elevation 77-D) of 2.20

Takahiro.Shibano.ja_24

Takahiro.Shibano.ja_25 Text Box ENDT area is red frame

Takahiro.Shibano.ja_26 Text Box

SKETCH

Takahiro.Shibano.ja_27 Text Box

ENCLOSURE-03

Takahiro.Shibano.ja_28 Text Box 3819P31003A03

Takahiro.Shibano.ja_29 Text Box

SHEET 3 OF 3

Takahiro.Shibano.ja_30

Closed view of Sheet 11 (Elevation 87-D) of 2.20

BHD AT CENTERLINE

"4" L

3819P31003A03

124 123

SSDG MACHINERY ROOM

5-121-1-E

NE\IDIESEL ENGINE

PLAN 1-A

START AIR INSTALLATION

5TH DECK, FR 121-125, STBD

II「P

1屹 NPS

TRANSV BHD 121

賽NPS

1 NPS

"A'’しー ， ， 2 ， ，

MAPPING PLAN

ENCLOSURE-04

蛉NPS

J"A"

FRAME RE FERENCE LI NE

□-し 121 ) ) 118 □✓D

”2',L

／：言E p::T「DRM

＿ ＿＿ ＿ � s-------

TRANSV BHD 121

E-DIV STRM

9-118-1-A

TRANSV BHD 118

¾ NPS

THIS JT ID NUMBER

IS COVERED BY

ICN 3819P31002

PLAN 1-B

START AIR INSTALLATION

2ND PLATF, FR 118-121, STBD

J "A"

SHEET 1 OF 4

1 30

1 29 1 28 1 27

EXST HALON

1 26

BOTTLE _ _\

1 25

SSDG ND, 1

5- 1 2 1 - 1 -E

4TH DK

1 是

SSDG EDS

］5- 1 33- 1 -E c!, I

- ＇ コ

［』 n

BHD 口//

1 麗 ＼

I Ill " I

叶'I

三＿ぎ

Jw TANK l

SVCE PLAT

FR 133

， 一 \へI/＜

"B,, EXST蛉CO2

ACTUATIじN

� I , I • □T 22" DIA じじMBusTIDN

AIR

（N[WSSDGNul

□---------s l □[/ `D e N

□2

EXST HALON CYL

(TYP)

NEW DIESEL EXHAUST PP

喝

ー」＞ーc s

N

い

日 じ ー」 D

A

N

H

I

ロ

T ーS

T x s

E

VハE

1||

SSDG ND. 1

5- 1 2 1 -1-E

5TH DK

PLAN 1-A

HALON INSTALLATION

5TH DECK, FR 125-133 (S)

SECTION 1-B

HALON INSTALLATION

5TH DECK, FR 132 LKG AFT (S)

3819P31003A03

MAPPING PLAN

ENCLOSURE-05

SHEET 1 OF 1

Takahiro.Shibano.ja_31

CJ-2

Takahiro.Shibano.ja_32 Line

Takahiro.Shibano.ja_33 Oval

Takahiro.Shibano.ja_34 Text Box

CJ-1

Takahiro.Shibano.ja_35 Line

Takahiro.Shibano.ja_36 Oval

Takahiro.Shibano.ja_37 Text Box

CJ-3

Takahiro.Shibano.ja_38 Line

Takahiro.Shibano.ja_39 Oval

Takahiro.Shibano.ja_40 Oval

Takahiro.Shibano.ja_41 Line

Takahiro.Shibano.ja_42 Text Box

CJ-4

Takahiro.Shibano.ja_43 Text Box For halon piping Location: Ships Service Diesel Generator No. One (5-121-1-E)

Takahiro.Shibano.ja_44 Text Box 3819P31003A03

Takahiro.Shibano.ja_45 Text Box

SHEET 1 OF 3

Takahiro.Shibano.ja_46 Text Box

MAPPING PLAN

Takahiro.Shibano.ja_47

ENCLOSURE-06

Takahiro.Shibano.ja_48 Line

Takahiro.Shibano.ja_49 Line

Takahiro.Shibano.ja_50 Text Box

CJ-7

Takahiro.Shibano.ja_51 Text Box

CJ-6

Takahiro.Shibano.ja_52 Text Box

CJ-8

Takahiro.Shibano.ja_53 Text Box

CJ-5

Takahiro.Shibano.ja_54 Oval

Takahiro.Shibano.ja_55 Oval

Takahiro.Shibano.ja_56 Line

Takahiro.Shibano.ja_57 Line

Takahiro.Shibano.ja_58 Line

Takahiro.Shibano.ja_59 Line

Takahiro.Shibano.ja_60 Text Box For CO2 piping Location: Ships Service Diesel Generator Vestibule (4-133-3-L)

Takahiro.Shibano.ja_61 Text Box 3819P31003A03

Takahiro.Shibano.ja_62 Text Box

SHEET 2 OF 3

Takahiro.Shibano.ja_63 Text Box

ENCLOSURE-06

Takahiro.Shibano.ja_64

MAPPING PLAN

Takahiro.Shibano.ja_65

CJ-9

Takahiro.Shibano.ja_66 Text Box

CJ-11

Takahiro.Shibano.ja_67 Text Box

CJ-10

Takahiro.Shibano.ja_68 Line

Takahiro.Shibano.ja_69 Line

Takahiro.Shibano.ja_70 Line

Takahiro.Shibano.ja_71 Oval

Takahiro.Shibano.ja_72 Oval

Takahiro.Shibano.ja_73 Oval

Takahiro.Shibano.ja_74 Oval

Takahiro.Shibano.ja_75 Text Box Closed view of CJ-9 through CJ-11

Takahiro.Shibano.ja_76 Rectangle

Takahiro.Shibano.ja_77 Text Box For CO2 piping Location: Ships Service Diesel Generator No. One (5-121-1-E)

Takahiro.Shibano.ja_78 Line

Takahiro.Shibano.ja_79 Polygonal Line

Takahiro.Shibano.ja_80 Polygonal Line

Takahiro.Shibano.ja_81 Polygonal Line

Takahiro.Shibano.ja_82 Text Box

ENCLOSURE-06

Takahiro.Shibano.ja_83 Text Box 3819P31003A03

Takahiro.Shibano.ja_84 Text Box

SHEET 3 OF 3

Takahiro.Shibano.ja_85

MAPPING PLAN

COMUSFLTFORCOMINST 4790.3 REV D CHG 3

07 Nov 2023

3819P31003A03 ENCLOSURE-07-1 TOTAL 172

WELDING IN PROCESS CONTROL/NONDESTRUCTIVE TEST RECORD

QA FORM 20 (FRONT)

When the form is used for production welding, the blocks marked with a must be completed by the planner. 1. PAGE 1 OF 2

2. SHIP USS BLUE RIDGE

HULL NO. LCC19

3. JCN

EE01-L107

4. CWP/REC SER. NO.

N/A

5. LWC

KTR

6. DATE

12 Feb 2025

7. SYSTEM

Start Air System

8. COMPONENT

Start Air Piping

9. DWG NO.

Mapping Plan Enclosure-04

10. CWP STEP NO.

5.1.2.3

11. JOINT ID

PJ-1

12. JOINT DESIGN

P-14

13. INST LOCATION: [ ] STBD

COMPT: [ ] C/L

FR: [ ] PORT

14. WELDED LOCATION:

[ ] SHOP

[ ] FIELD

BASE MATERIAL DATA

15. COMP DATA 16. MATERIAL 17. SIZE 18. THICKNESS 19. MATL SPEC 20. MIC NO.

COMPONENT A:

COMPONENT B:

21. [ ] SEAL RING

[ ] BACK RING/STRIP

22. MATERIAL 23. SIZE 24. THICKNESS 25. MATL SPEC 26. MIC NO.

WELDING MATERIAL SPECIFICATIONS AND DATA

27. TYPE OF FILLER(S) 28. SIZE 29. MATL 30. MIL-SPEC 31. MIC NO.

WELD HISTORY

32. WELDING

STANDARD:

S9074-AR-GIB-

010A/278

33. WELDING

PROCEDURE:

34. DATA SHEET 35. POSITION: [ ] VERT [ ] FLAT [ ] FIXED [ ] 45 DEG

[ ] HORZ [ ] OVHD [ ] ROLLED

36. ACCESSIBILITY:

[ ] 12”OR LESS

[ ] UNRESTRICTED

37. PREHEAT TEMP 38. PREHEAT METHOD 39. POST HEAT. START TIME:

TEMP REQD: STOP TIME:

40. PURGE

GAS:

41. FLOW RATE 42. SHIELD GAS 43. FLOW RATE 44. CUP SIZE 45. TUNGSTEN SIZE

46. WELD LAYER 47. PROCESS 48. QUAL EXP DATE 49. AMPS 50. INTERPASS TEMP 51. WELDER SIGNATURE 52. DATE

53. INSPECTION DATA CONTAINED ON REVERSE OF THIS PAGE

REMARKS:

94. FINAL DISPOSITION:

[ ] ACCEPT

[ ] REJECT

95. NDT SUPERVISOR DATE

THE PERSON DESIGNATED TO SIGN FOR AN ACTION VERIFIES, BASED ON PERSONAL

OBSERVATION OR CERTIFIED RECORDS, AND CERTIFIES BY THEIR SIGNATURE THAT

THE ACTION HAS BEEN PERFORMED IN ACCORDANCE WITH THE SPECIFIED

REQUIREMENTS.

3819P31003A03 ENCLOSURE-07-1 TOTAL 172

WELDING IN PROCESS CONTROL/NONDESTRUCTIVE TEST RECORD

QA FORM 20 (BACK) PAGE 2 OF 2

NDT INSPECTION DATA

54. INSPECTION STANDARD 55. WELD CLASS 56. ACCEPTANCE STANDARD 57. ACCEPT CLASS

58. WELD PREP 59. INSP METHOD 60. ACCEPT/REJECT 61. NDT INSPECTOR SIGNATURE 62. DATE

COMPONENT A [ ] ACCEPT [ ] REJECT

COMPONENT B [ ] ACCEPT [ ] REJECT

63. JOINT FITUP [ ] ACCEPT [ ] REJECT

64. INSP LAYER 65. INSP METHOD 66. INSP PROC NO 67. ACCEPT/REJECT 68. NDT INSPECTOR SIGNATURE 69. DATE

[ ] ACCEPT [ ] REJECT

[ ] ACCEPT [ ] REJECT

[ ] ACCEPT [ ] REJECT

[ ] ACCEPT [ ] REJECT

[ ] ACCEPT [ ] REJECT

70. NDT INSPECTION DATA REPAIR NO._____ Defect: L W D

71. Repair Method: Excavation: L W D

72. INSP LAYER 73. INSP METHOD 74. INSP PROC NO. 75. ACCEPT/REJECT 76. NDT INSPECTOR SIGNATURE 77. DATE

[ ] ACCEPT [ ] REJECT

[ ] ACCEPT [ ] REJECT

78. NDT INSPECTION DATA REPAIR NO._____ Defect: L W D

79. Repair Method: Excavation: L W D

80. INSP LAYER 81. INSP METHOD 82. INSP PROC NO. 83. ACCEPT/REJECT 84. NDT INSPECTOR SIGNATURE 85. DATE

[ ] ACCEPT [ ] REJECT

[ ] ACCEPT [ ] REJECT

86. NDT INSPECTION DATA REPAIR NO._____ Defect: L W D

87. Repair Method: Excavation: L W D

88. INSP LAYER 89. INSP METHOD 90. INSP PROC NO. 91. ACCEPT/REJECT 92. NDT INSPECTOR SIGNATURE 93. DATE

[ ] ACCEPT [ ] REJECT

[ ] ACCEPT [ ] REJECT

53. REMARKS (Continued):

THE PERSON DESIGNATED TO SIGN FOR AN ACTION VERIFIES, BASED ON PERSONAL

OBSERVATION OR CERTIFIED RECORDS, AND CERTIFIES BY THEIR SIGNATURE THAT

3819P31003A03 ENCLOSURE-07-2 TOTAL 172

WELDING IN PROCESS CONTROL/NONDESTRUCTIVE TEST RECORD

QA FORM 20 (FRONT)

When the form is used for production welding, the blocks marked with a must be completed by the planner. 1. PAGE 1 OF 2

2. SHIP USS BLUE RIDGE

HULL NO. LCC19

3. JCN

EE01-L107

4. CWP/REC…