TGI_3819P49501A01_c0v1.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.: 82269K N7 OFC UP GR 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 82269K, ACCOMPLISH STRL, STML, INSL & ELEC WORKS

PREPARING ACTIVITY:

PREPARED BY: CODE PHONE DATE

YUUJI MATSUYAMA 231B. 315-243-4476 6-SEP-2024

APPROVED BY: CODE PHONE DATE

RYOUTA TAKAGI 231B. 315-243-4502 6-SEP-2024

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:

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.: 82269K N7 OFC UP GR AY A 0

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SHIP: LCC-19 CHG/VER: 0/1

LIST OF EFFECTIVE PAGES

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

1-7 J 1-2 M 1-5 Sketch (1)

1. SCOPE/PURPOSE

1.1 Title: S/A 82269K, LCC 19 ESLP N7 Theater Security Cooperation Office; accomplish

1.2 Location of Work:

1.2.1 Commander Seventh Fleet (C7F) Force Protection Office (02-64-0-Q)

Remarks: Compartment name will be changed to N7 Theater Security Cooperation Office by this S/A.

1.2.2 Fan Room (02-64-2-Q)

1.2.2.1 Vent Plenum for HVAC Recirculating System (RS) 02-67-4

1.2.3 Passage (02-67-0-L)

1.2.4 Deputy Chief of Staff/Director of Operations Bath (02-67-4-L)

1.2.5 Deputy Chief of Staff/Director of Operations Stateroom (02-67-6-L)

1.2.6 Combat Information Center Plot (02-67-1-C)

1.2.7 Theater SEC Cooperation Stateroom (02-71-2-L)

1.2.8 Operations Office (02-72-0-C)

1.2.9 Captain’s Cabin (01-64-01-L)

1.2.10 Captain’s Bath (01-64-0-L)

1.2.11 Captain’s Stateroom (01-64-2-L)

1.2.12 Radar Room No. One (01-64-4-Q)

1.2.13 Passage (01-67-01-L)

1.2.14 Fleet Weather N-314 (01-72-0-Q)

1.2.15 Ultra High Frequency (UHF) Radio Room No. One (01-72-1-Q)

1.2.16 Passage (1-64-0-L)

1.2.17 Passage (1-71-2-L)

1.2.18 Radio Transmitter Room No. 2 (1-72-0-C)

1.2.19 Maritime Operations Command Center (2-65-01-C)

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SHIP: LCC-19 CHG/VER: 0/1

1.2.20 Landing Force Command Area (2-65-2-C)

1.2.21 Senior Leader Center (2-69-2-Q)

1.2.22 Joint Operations Center (2-76-0-C)

1.2.23 Automatic Data Processing (ADP) Equipment Room No. One (3-76-3-Q)

1.2.24 Main Deck Weather, Frames between 64 and 67, Starboard (Stbd)

1.2.25 02 Level Weather, Frames between 64 and 67, Stbd

1.2.26 Passage (01-72-2-L)

1.2.27 IC and Gyro Room No.2 (5-86-0-C)

1.2.28 Joint Message CTR (3-91-0-C)

1.3 Identification:

1.3.1 Quantity (One Lot), S/A 82269 K LCC 19 ESLP N7 Theater Security Cooperation Office

Remarks: See 2.3 through 2.9 for materials and details.

1.3.1.1 Quantity (One Lot), Decorative Board in 02-67-0-L

Material: Steel Remarks: See Sketch Enclosure-01 for location

1.3.1.2 Quantity (One Lot), Unused Bracket in 02-67-0-L

Material: Steel Remarks: See Sketch Enclosure-01 for location

1.3.2 Quantity (One EA), Power System for Receptacle

Remarks: See 2.3, 2.10, 2.11 and 2.19 for details.

1.3.3 Quantity (One EA), Lighting System

Remarks: See 2.3, 2.10, 2.12 and 2.19 for details.

1.3.4 Quantity (One EA), Interior Communication System

Remarks: See 2.3, 2.10, 2.13, 2.14 and 2.19 for details.

1.3.5 Quantity (One EA), Electronics System

Remarks: See 2.3, 2.9, 2.15, 2.16, and 2.19 for details.

1.4 Security Classification:

1.4.1 Space - 1.2.1, 1.2.6, 1.2.8, 1.2.12, 1.2.18 through 1.2.20, 1.2.22, 1.2.27 and 1.2.28.

1.5 Initial Condition:

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SHIP: LCC-19 CHG/VER: 0/1

1.5.1 Potential Asbestos Hazard

1.5.2 Lead Control

1.6 Contractor work start date: 1/12/2026

1.7 Contractor work completion date: 6/12/2027

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 613-

8784724

N7 THEATER SECURITY COOP

OFFICE UPGRADE

ARRANGEMENT & DETAIL

MODIFICATIONS

- Y AL

L

4 DWG 604-

8784725

N7 THEATER SCTY COOP

UPGRADE - BULKHEAD & DOOR

MODIFICATIONS, 02 LVL FR 67-

- Y AL

L

5 DWG 605-

8784726

N7 THEATER SEC COOP OFC

UPGR PAINT, INSULATION &

DECK COVERING

MODIFICATIONS

- Y AL

L

6 DWG 145-

8784727

N7 THEATER SECURITY COOP

UPGRADE - COMPT & ACCESS &

LABEL PLATE MODIFICATIONS

- Y AL

L

7 DWG 501-

8786650

HVAC MODS R02-67-2 02 LVL, FR

64-70

- Y AL

L

8 LAR SRFY -

0116 - 24

CORR for discrepancies found in

SCD 12269 K LCC ESLP N7

THEATER SCTY COOP OFC

- Y AL

L

9 PDD 413-

ELM-240371

SUPPL INFOFOR INSTL OF

CANES EQPT IN N7 THEATER

SCTY COOP OFC (02-64-0-Q)

- Y AL

L

10 PDD

301/401-

ELM-240323

SUPPL INFO FOR INSTL OF

ELEC/ELEX EQPT IN N7

THEATER SCTY COOP OFC (02-

64-0-Q)

- Y AL

L

11 DWG 302-

8787004

POWER SYSTEM

MODIFICATIONS N7 OFFICE

UPGRADE

- Y AL

L

12 DWG 303-

8786985

LIGHTING SYSTEM

MODIFICATIONS INCIDENTAL TO

N7 OFFICE UPGRADES

- Y AL

L

13 DWG 401-

8787122

IC CIRCUIT J INSTALL

INCIDENTAL TO N7 THEATER

SEC COOP OFC UP

- Y AL

L

14 DWG 401-

8787123

IC CKT B & DL INSTALL

INCIDENTAL TO N7 THEATER

SEC COOP OFC UP

- Y AL

L

15 DWG 413-

8787160

SECRET CANES MODS

INCIDENTAL TO N7 OFFICE (02-

64-0-Q) UPGRADE

- Y AL

L

16 DWG 413-

8787161

UNCLASSIFIED CANES MODS

INCIDENTAL TO N7 OFFICE (02-

64-0-Q) UPGRADE

- Y AL

L

17 DWG 111-

2491063

DK HSE ENCL BHD MN DK-3 LEV H Y AL

L

18 DWG 111-

2491068

STRUCT BHD IN DKHSE MN DK-

03 LEV

K Y 3,1 1,1 1A

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SHIP: LCC-19 CHG/VER: 0/1

REF.

NO.

DOCUMENT

/DRAWING

NUMBER

DOCUMENT/DRAWING TITLE REV CHG

NO.

COPY

REQ’D

(Y/N)

SOURCE

DOC

(Y/N)

PARA SEC PG CHP

19 LAR SRFY -

0105 - 24

INSTALLATION OF ELEC/ELEX

EQPT

- 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 the structural, sheet metal, insulation, and preservation work for SA 82269K listed in 1.3.1 in accordance with 2.3 through 2.9, using 2.17 and 2.18 for guidance.

5.1.1 Drill hole(s) on each existing structural stanchion for gas free inspection.

5.1.2 Accomplish build up weld for remaining hole(s) on each structural stanchion.

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

5.1.4 Remove each existing decorative board and unused bracket listed in 1.3.1.1 and 1.3.1.2.

5.1.5 Accomplish the requirements of 009-11 of 2.1.

5.1.5.1 Accomplish the requirements of 009-12 of 2.1.

5.1.6 Accomplish the requirements of 009-32 of 2.1.

5.2 Accomplish the requirements for each modification of each system listed in 1.3.2 through 1.3.4 in accordance with 2.3, 2.10, 2.11 through 2.14 and 2.19.

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

5.2.2 Accomplish the requirements of 009-25 of 2.1 for the local air hose test of each new and disturbed cable penetration. Allowable leakage: None.

5.3 Accomplish the requirements of removals, modifications and installations for the system listed in 1.3.5 in accordance with 2.3, 2.9, 2.15, 2.16, and 2.19, using 2.17 for guidance.

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

5.3.2 Install each new label plate.

5.4 Confirm that all personnel have exited the space prior to closure of the space listed in 1.2.2.1. Designate one person to account for all personnel who may have entered the space.

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

5.6 Notes:

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SHIP: LCC-19 CHG/VER: 0/1

5.6.1 Planner: Code 231B Y. Matsuyama, 243-4476

Planner: Code 233 M. Takemura, 080-9350-1458 Planner: Code 233 I. Tochigi, 080-9350-1457 Engineer: Code 250 M. Orishimo, 243-4330 Engineer: Code 260 A. Ishiwata, 243-4434 Engineer: Code 270 N. Hirose, 243-4352

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

5.6.3 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.

5.6.4 Fabrication, including 6XXX series aluminum welding of the following equipment will be covered by TGI No(s).

3819P49501F01 (SRF-JRMC TGI).

Desk end partition: Elevation 66-A of 2.3.

Desk middle partition: Elevation 62-A of 2.3.

Privacy curtain: Elevation 70-A of 2.3.

Mounting plate: Detail: 69-C of 2.3.

Workstation: Ref. No. One of 2.3.

5.6.5 Periodic Maintenance Requirements (PMR) will provide one person on-site to resolve any technical issues that may arise.

5.6.6 PMR Technical Representative:

Point of Contact: Mr. Edward (Bud) Twigg., 243-4242 Email Address: edward.twigg.ctr@srf.navy.mil

5.6.7 JCN EXSA-ZBZ9 is related to this TGI.

5.7 Government Furnished Material (GFM):

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

5.7.2 SRF-JRMC will provide material listed in Appendix “M”.

5.8 SRF-JRMC will provide the following service work: (TGI No. 3819P49501S02).

5.8.1 [C740] Crane and crane rigging service.

5.8.2 [X99E] Utility service, electrical.

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

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

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

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

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SHIP: LCC-19 CHG/VER: 0/1

5.8.7 [C292] Visual TEMPEST Configuration Control Inspection (VTCCI).

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J-1

SHIP: LCC-19 CHG/VER: 0/1

APPENDIX "J"

TGI JOB SUMMARY INFORMATION SHEET

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

VERSION:

CASREP

CAT:

82269K N7 OFC UP GR AY A 0 1

CU PHASE TITLE:

(RE) F/O - S/A 82269K, ACCOMPLISH STRL, STML, INSL & ELEC WORKS

PRIMARY COMPONENT:

COMPONENT UNIT LIST (FOR ASSEMBLIES):

CMPT 02-64-0-Q FN R-DD C- CMPT 02-64-0-Q MS VNT R02-67-4 DT R-DR

C- CKT 1JF IC (01-72-2)-1L-C4B LF (01-72-2)-1L-C4D LF CKT J IC (02-67-2)-1P-C

RC (02-67-2)-1P-F RC CMPT 02-67-0-L MS CKT B IC (02-67-2)-1P-A RC (02-67-

2)-1P-B RC (02-67-2)-1P-G RC (02-67-2)-1P-D RC CKT DL IC (02-67-2)-1P-H RC (02-67-

2)-1P-J RC CMPT 02-64-2-Q MS LDB 02-67-1 PA

ATTACHMENT LIST:

1. ENCLOSURE-01 (3819P49501A01-Sketch.pdf) saved on 06-SEP-2024 0000.

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

YAGINUMA ,TAKEHIDE

JO: KO: TOTAL MAN HRS: PLANNING ACCEPTANCE:

3819P49501 A01

TOTAL MAT’L COST TOTAL DURATION:

CU PHASE DESCRIPTION:

The purpose of this TGI is to S/A 82269 K LCC 19 ESLP N7 theater security cooperation office.

Location of Work:

Commander Seventh Fleet Force Protection Office (02-64-0-Q) Fan Room (02-64-2-Q) Vent Plenum for HVAC Recirculating System (RS) 02-67-4 Passage (02-67-0-L) Deputy Chief of Staff/Director of Operations Bath (02-67-4-L) Deputy Chief of Staff/Director of Operations Stateroom (02-67-6-L) Combat Information Center Plot (02-67-1-C) Theater SEC Cooperation Stateroom (02-71-2-L) Operations Office (02-72-0-C) Captain’s Cabin (01-64-01-L) Captain’s Bath (01-64-0-L) Captain’s Stateroom (01-64-2-L) Radar Room No. One (01-64-4-Q) Passage (01-67-01-L) Fleet Weather N-314 (01-72-0-Q) Ultra High Frequency (UHF) Radio Room No. One (01-72-1-Q) Passage (1-64-0-L) Passage (1-71-2-L) Radio Transmitter Room No. 2 (1-72-0-C) Maritime Operations Command Center (2-65-01-C) Landing Force Command Area (2-65-2-C) Senior Leader Center (2-69-2-Q) Joint Operations Center (2-76-0-C) Automatic Data Processing (ADP) Equipment Room No. One (3-76-3-Q) Main Deck Weather, Frames between 64 and 67, Starboard (Stbd) 02 Level Weather, Frames between 64 and 67, Stbd

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J-2

SHIP: LCC-19 CHG/VER: 0/1

CU PHASE DESCRIPTION:

Passage (01-72-2-L) IC and Gyro Room No.2 (5-86-0-C) Joint Message CTR (3-91-0-C)

TASK NAME

SHOP TSD/WC TS CREW# MHRS

HIGH RAD

HOURS

RC

GRID#

5.1 SMTL HRs, SFTR HRs, WELD HRs, PNTR HRs, INSL HRs, CARP HRs, RGRS HRs, ELEC HRs, ELEX HRs, QA HRs

22 KE PC

5.2 ELEC HRs, SFTR HRs, WELD HRs, SMTL HRs, INSL

HRs, ELEX HRs

22 KE PC

5.3 ELEX HRs, SFTR HRs, WELD HRs, INSL HRs 22 KE PC

5.4 SFTR HRs 22 KE PC

5.5 PNTR HRs, QA HRs 22 KE PC

Structural, Sheet Metal and Insulation Work: CFM for all paint, grit, including disposal cost, thinner, fire watch cost, lead analysis cost, deck covering, tile, wear resistant deck tile, weld pin, --- continue to below ---

22 MQ CS

--- continued from above --- asbestos sampler cost and analysis cost for duct, compartment insulation, and deck covering, adhesive for laminate and insulation, misc such as electrodes, gases, fastener, covering materials, and other consumable.

22 MQ CS

Electrical Work: CFM for air compressor rental and fuel oil cost, asbestos take and analysis cost, label plate, nameplate, fastener, plastic bag, insulation tape, cable band and other consumable materials.

22 MQ CS

Electronics Work CFM for cable banding, cable block inserts, cable hungers, banding material, screws, nuts, washers, air compressor rental/fuel oil cost, fire watch cost, and other consumables.

22 MQ CS

Process Funding Document. 10 CT OM

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M-1

SHIP: LCC-19 CHG/VER: 0/1

APPENDIX “M”

TGI MATERIAL LIST

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

VERSION:

CASREP

CAT:

82269K N7 OFC UP GR AY A 0 1

CU PHASE TITLE:

(RE) F/O - S/A 82269K, ACCOMPLISH STRL, STML, INSL & ELEC WORKS

MATERIAL REFERENCES

REF

NO.

DOCUMENT/DRAWING

NUMBER

DOCUMENT/DRAWING TITLE REV

1 ELM-240371 -

2 ELM-240323

3 SRFY-0105-24

4 303-8786985

JOB ORDER: KEY OP:

3819P49501 A01

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 INSULATI, ORDERED FOR KTR

ORIG: C231B Y. MATSUYAMA

PHONE: 243-4476

9Q 5640 008096312 NA 4 N 42495065 30/EA

002 M INSULATI, ORDERED FOR KTR

ORIG: C231B Y. MATSUYAMA

PHONE: 243-4476

9Q 5640 008096315 NA 4 N 42495069 20/EA

003 M TAPE,TEX, ORDERED FOR

KTR

ORIG: C231B Y. MATSUYAMA

PHONE: 243-4476

9B 8315 002671632 NA 4 N 42495070 5/RO

004 M TAPE,TEX, ORDERED FOR

KTR

ORIG: C231B Y. MATSUYAMA

PHONE: 243-4476

9B 8315 002671633 NA 4 N 42495071 5/RO

NOTES:

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M-2

SHIP: LCC-19 CHG/VER: 0/1

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 SHEET,ME, ORDERED FOR

KTR

ORIG: C231B Y. MATSUYAMA

PHONE: 243-4476

9B 9515 002306693 NA 4 N 42495072 1/SH

006 M RIVET,BLIND, ORDERED FOR

KTR

ORIG: C231B Y. MATSUYAMA

PHONE: 243-4476

9B 5320 004096841 NA 4 N 42495053 1/HD

007 M SCREW, PANHEAD, PHIL,

STEEL DECORATIVE ROUND

HEAD PHILLIPS SCREWS, 1/4"-

20 THREAD SIZE, 2" LONG

EQUIVALENT ITEM: W.W.

GRAINGER INC, CAGE: 1RM19,

ITEM#: 2EE71, 100EA/PG.

ORDERED FOR KTR

ORIG: C231B Y. MATSUYAMA

PHONE: 243-4476

9B 5305 LL9310956 NA 4 N 42497413 1/PG

008 M SCREW, PANHEAD, PHIL,

STEEL DECORATIVE ROUND

HEAD PHILLIPS SCREWS, 1/4"-

20 THREAD SIZE, 1" LONG

EQUIVALENT ITEM: W.W.

GRAINGER INC, CAGE: 1RM19,

ITEM#: 2EE60, 100EA/PG.

ORDERED FOR KTR

ORIG: C231B Y. MATSUYAMA

PHONE: 243-4476

9B 5305 LL9310957 NA 4 N 42497414 1/PG

009 M INSULATI, ORDERED FOR KTR

ORIG: C231B Y. MATSUYAMA

PHONE: 243-4476

9B 2510 016490178 NA 4 N 42495073 5/EA

010 M PIPE,MET, ORDERED FOR KTR

ORIG: C231B Y. MATSUYAMA

PHONE: 243-4476

9B 4710 008925914 NA 4 N 42495049 10/FT

011 M PIPE,METALLIC, ORDERED

FOR KTR

ORIG: C231B Y. MATSUYAMA

PHONE: 243-4476

9B 4710 008925912 NA 4 N 42495054 10/FT

012 M BAR,META, ORDERED FOR

KTR

ORIG: C231B Y. MATSUYAMA

PHONE: 243-4476

9B 9510 001891558 NA 4 N 42495051 10/FT

013 M ANGLE,STRUCTURAL,

ORDERED FOR KTR

ORIG: C231B Y. MATSUYAMA

PHONE: 243-4476

9B 9520 002774940 NA 4 N 42495057 10/FT

014 M SHEET,ME, ORDERED FOR

KTR

ORIG: C231B Y. MATSUYAMA

PHONE: 243-4476

9B 9535 002326880 NA 4 N 42495074 1/SH

015 M PLATE,ME, SIZE: 1'X2', 1EA

ORDERED FOR KTR

ORIG: C231B Y. MATSUYAMA

PHONE: 243-4476

9B 9515 001533184 NA 4 N 42495075 2/SF

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M-3

SHIP: LCC-19 CHG/VER: 0/1

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 RIVET,BL, ORDERED FOR KTR

ORIG: C231B Y. MATSUYAMA

PHONE: 243-4476

9B 5320 010342844 NA 4 N 42495076 2/HD

301 1 1 M STANDOFF,THREADED,S,

ORIG: C233 I. TOCHIGI, 080-

9350-1457

ORDERED FOR KTR

9B 5340 002726544 NA 4 N 42405297 1/HD

302 2 1 M SCREW,CAP,HEXAGON H,

ORIG: C233 I. TOCHIGI, 080-

9350-1457

ORDERED FOR KTR

9B 5305 000680508 NA 4 N 42405298 1/HD

303 3 1 M WASHER,FLAT, ORIG: C233 I.

TOCHIGI, 080-9350-1457

ORDERED FOR KTR

9B 5310 001411795 NA 4 N 42405300 28/EA

304 4 1 M STANDOFF,THREADED,S,

ORIG: C233 I. TOCHIGI, 080-

9350-1457

ORDERED FOR KTR

9B 5340 002829526 NA 4 N 42405302 1/HD

305 5 1 M NUT,SELF-LOCKING,HE, ORIG:

C233 I. TOCHIGI, 080-9350-

ORDERED FOR KTR

9B 5310 004838790 NA 4 N 42405303 4/EA

306 6 1 M WASHER,FLAT, ORIG: C233 I.

TOCHIGI, 080-9350-1457

ORDERED FOR KTR

9B 5310 013960977 NA 4 N 42405304 1/HD

307 7 1 M SCREW,CAP,HEXAGON H,

ORIG: C233 I. TOCHIGI, 080-

9350-1457

ORDERED FOR KTR

9B 5305 001159526 NA 4 N 42405167 1/HD

350 4 2 M JUNCTION BOX, ORDERED

FOR KTR

ORIG: C233 M. TAKEMURA,

080-9350-1458

9B 5975 001948877 NA 4 N 42405305 6/EA

351 5 2 M COVER,JUNCTION BOX,

ORDERED FOR KTR

ORIG: C233 M. TAKEMURA,

080-9350-1458

9B 5975 002810056 NA 4 N 42405306 6/EA

352 2 M CABLE,POWER,ELECTRI,

ORDERED FOR KTR

ORIG: C233 M. TAKEMURA,

080-9350-1458

9B 6145 012019498 NA 4 N 42405042 360/FT

353 1 2 M STANDOFF,THREADED,S,

ORDERED FOR KTR

ORIG: C233 M. TAKEMURA,

080-9350-1458

9B 5340 002829526 NA 4 N 42405308 35/EA

354 2 2 M SCREW,CAP,HEXAGON H,

ORDERED FOR KTR

ORIG: C233 M. TAKEMURA,

080-9350-1458

9B 5305 002693211 NA 4 N 42405310

131/EA

355 3 2 M WASHER,FLAT, ORDERED

FOR KTR

ORIG: C233 M. TAKEMURA,

080-9350-1458

9B 5310 001670821 NA 4 N 42405164

227/EA

356 6 2 M NUT,SELF-LOCKING,HE,

ORDERED FOR KTR

ORIG: C233 M. TAKEMURA,

080-9350-1458

9B 5310 004838790 NA 4 N 42405311 96/EA

FOUO

M-4

SHIP: LCC-19 CHG/VER: 0/1

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

361 11 2 M PAD, TAPPED ROUND, PAD,

TAPPED ROUND, 1/2"-13UNC-

2B X 1"LG, STEEL, CARBON,

AISI-1020, CENTERED,

CONCENTRIC INTERNAL

THREAD THRU HOLE 1" OD,

FINISH: PLAIN. BIW CATALOG

NO.53204-082.

ORDERED FOR KTR

ORIG: C233 M. TAKEMURA,

080-9350-1458

9B 5315 LL9307892 NA 4 N 42407422 9/EA

362 12 2 M SCREW,CAP,HEXAGON H,

ORDERED FOR KTR

ORIG: C233 M. TAKEMURA,

080-9350-1458

9B 5305 000712066 NA 4 N 42405162 6/EA

363 13 2 M WASHER,FLAT, ORDERED

FOR KTR

ORIG: C233 M. TAKEMURA,

080-9350-1458

9B 5310 013968392 NA 4 N 42405312 6/EA

364 14 2 M STANDOFF,THREADED,S,

ORDERED FOR KTR

ORIG: C233 M. TAKEMURA,

080-9350-1458

9B 5340 002726544 NA 4 N 42405313 2/EA

365 15 2 M SCREW,CAP,HEXAGON H,

ORDERED FOR KTR

ORIG: C233 M. TAKEMURA,

080-9350-1458

9B 5305 002253843 EY NA 4 N 42405250 4/EA

366 16 2 M WASHER,FLAT, ORDERED

FOR KTR

ORIG: C233 M. TAKEMURA,

080-9350-1458

9B 5310 013905131 NA 4 N 42405315 4/EA

367 17 2 M NUT,SELF-LOCKING,HE,

ORDERED FOR KTR

ORIG: C233 M. TAKEMURA,

080-9350-1458

9B 5310 004838792 NA 4 N 42405318 2/EA

368 18 2 M SWITCH ASSEMBLY,

ORDERED FOR KTR

ORIG: C233 M. TAKEMURA,

080-9350-1458

3B 5930 008732559 NA 4 N 42405034 1/EA

371 21 2 M SCREW,MACHINE, ORDERED

FOR KTR

ORIG: C233 M. TAKEMURA,

080-9350-1458

9B 5305 007195021 NA 4 N 42405161 3/EA

372 22 2 M BAR,METAL, ORDERED FOR

KTR

ORIG: C233 M. TAKEMURA,

080-9350-1458

9B 9510 001881690 NA 4 N 42405319 1/FT

375 3 M CABLE,SPECIAL PURPO,

ORDERED FOR KTR

ORIG: C233 M. TAKEMURA,

9B 6145 012029530 NA 4 N 42405025 360/FT

FOUO

M-5

SHIP: LCC-19 CHG/VER: 0/1

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

376 3 M STUFFING TUBE, ORDERED

FOR KTR

ORIG: C233 M. TAKEMURA,

080-9350-1458

9B 5975 002964092 NA 4 N 42405320 1/EA

377 3 M RUBBER SHEET,SOLID,

ORDERED FOR KTR

ORIG: C233 M. TAKEMURA,

080-9350-1458

9B 9320 002440193 NA 4 N 42405082 1/SF

378 3 M SWITCH ASSEMBLY,

ORDERED FOR KTR

ORIG: C233 M. TAKEMURA,

080-9350-1458

3B 5930 008732559 NA 4 N 42405038 1/EA

379 4 M TAPE,PRESSURE SENSI,

ORDERED FOR KTR

ORIG: C233 M. TAKEMURA,

9Q 7510 001325109 NA 4 N 42405158 2/RO

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 82269K N7 OFC UP GR AY A 0

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

3819P49501 A01

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 82269K N7 OFC UP GR AY A 0

SKETCH

3819P49501A01 ENCLOSURE-01 Sheet 1 of 1

Location of Decorative Board and Unused Bracket

Yuuji.Matsuyama.ja Oval

Yuuji.Matsuyama.ja_1 Line

Yuuji.Matsuyama.ja_2 Polygon

Yuuji.Matsuyama.ja_3 Line

Yuuji.Matsuyama.ja_4 Text Box Decorative Board

Yuuji.Matsuyama.ja_5 Text Box Unused Bracket

Yuuji.Matsuyama.ja_6 Line

Yuuji.Matsuyama.ja_7 Line

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