TGI_3819P51403A01_c0v0.pdf

PDF 317 KB Posted

Attached to
USS BLUE RIDGE 5C1 DSRA TYCOM 3 (YOKOSUKA, JAPAN)
Solicitation number
N6264925RA024
Issued by

About this file

This document is a Task Group Instruction (TGI) for mechanical cleaning of the No. 3 Air Conditioning (A/C) Plant Condenser on the USS Blue Ridge (LCC-19), located in Air Conditioning Machinery Room No. 3. The detailed work instruction covers a comprehensive process including removing and reinstalling condenser water heads, performing a mechanical cleaning of the seawater side of the condenser, conducting a borescope inspection of all 332 tubes, installing new tube inserts and anodes, and completing a shop hydrostatic test at 270 PSIG using clean fresh water.

The TGI is part of a larger maintenance package for the USS Blue Ridge, with a planned work period from January 12, 2026 through December 13, 2027. The specific task involves Level III cleaning, visual inspections, and precise technical procedures including torquing fasteners, applying specific adhesives, and installing new gaskets and O-rings. The document includes multiple appendices detailing job summary information, material lists, and a deficiency form, with the work to be performed by contractors at Commander, Fleet Activities Yokosuka (CFAY) Naval Base in Japan.

View the file

Other files

File Type Posted
EXHIBIT - Contract Data Requirements List (CDRL)_R2.pdf PDF
TGI_3819P25502_A01_c0v0_FY26.pdf PDF
TGI_3819P22102_A01_c0v0_FY26.pdf PDF
TGI_3819P22101_A01_c0v0_FY26.pdf PDF
TGI_3819P14207_A01_c1v2_FY26.pdf PDF
TGI_3819P14205A01_c2v2_FY26.pdf PDF
TGI_3819P14116A01_c0v0_FY26.pdf PDF
TGI_3819P14114A01_c0v0_FY26.pdf PDF
TGI_3819P14113A01_c0v0_FY26.pdf PDF
TGI_3819P13505A01_c0v0_FY26.pdf PDF
TGI_3819P13411A01_c1v1_FY26.pdf PDF
TGI_3819P13339A01_c0v0_FY26.pdf PDF
TGI_3819P12352A01_c1v0_FY26.pdf PDF
TGI_3819P12350A01_c0v0_FY26.pdf PDF
TGI_3819P12347_A01_c0v0_FY26.pdf PDF
TGI_3819P12346_A01_c0v0_FY26.pdf PDF
TGI_3819P12343A01_c1v1_FY26.pdf PDF
TGI_3819P12329A01_c1v1_FY26.pdf PDF
TGI_3819P12326_A01_c1v0_FY26.pdf PDF
TGI_3819P12325_A01_c0v01_FY26.pdf PDF
TGI_3819P12308A01_c0v0_FY26.pdf PDF
TGI_3819P12307A01_c0v0_FY26.pdf PDF
Attachment V Contract Data Sheet.pdf PDF
TGI_3819P23103_A03_c0v0.pdf PDF
TGI_3819P22102_T01_c0v0.pdf PDF
TGI_3819P14208T01_c0v0.pdf PDF
TGI_3819P14208A01_c1v1.pdf PDF
TGI_3819P14122A01_c0v0.pdf PDF
TGI_3819P14121A01_c0v0.pdf PDF
TGI_3819P13422A01_c0v0.pdf PDF
TGI_3819P13411A01_c1v1.pdf PDF
TGI_3819P12351A01_c0v0.pdf PDF
TGI_3819P12350A01_c0v0.pdf PDF
TGI_3819P12347_A01_c0v0.pdf PDF
TGI_3819P12345_A01_c1v3.pdf PDF
TGI_3819P12332A01_c1v1.pdf PDF
TGI_3819P12327_A01_c1v1.pdf PDF
TGI_3819P12324_A01_c2v1.pdf PDF
TGI_3819P12313A01_c0v0.pdf PDF
Attachment VIII Source of Repair Instruction.pdf PDF
Attachment II Price Proposal Form N6264925RA024.xlsx XLSX spreadsheet
TGI_3819P25502_A01_c0v0.pdf PDF
TGI_3819P22101_T09_c0v0.pdf PDF
TGI_3819P14208T02_c0v0.pdf PDF
TGI_3819P14204A01_c0v0.pdf PDF
TGI_3819P13507A01_c0v0.pdf PDF
TGI_3819P13505A01_c0v0.pdf PDF
TGI_3819P12389A01_c0v0.pdf PDF
TGI_3819P12360A01_c0v0.pdf PDF
TGI_3819P12359_A01_c0v0.pdf PDF
Show 40 more

50 files listed here. See the rest on GovTribe.

On GovTribe

Work with this file

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file

Text version

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.: #3 AC PLANT COND 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:

F/O - ACCOMPLISH MECHANICAL CLEANING OF NO. 3 A/C PLANT CONDENSER

PREPARING ACTIVITY:

PREPARED BY: CODE PHONE DATE

REIYA KIMURA 234. 315-243-5507 09-MAY-2024

APPROVED BY: CODE PHONE DATE

HIDEO HARADA 234. 315-243-5176 09-MAY-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:

CLEANLINESS FOR PIPING SYSTEM/EQUIPMENT LEVEL III.

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.: #3 AC PLANT COND 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.

1-5 J1 M1-3

QA28(1)

1. SCOPE/PURPOSE

1.1 Title: No. 3 Air Conditioning (A/C) Plant Condenser Mechanical Cleaning; accomplish

1.2 Location of Work:

1.2.1 Air Conditioning Machinery Room No. 3 (7-64-2-E)

1.3 Identification:

1.3.1 Quantity (One EA), Condenser, No. 3 A/C Plant

Mfr: YORK INTERNATIONAL CORPORATION Mfr ID: 376-67967 Number of Tube: 332 Tube Size: 3/4 Inch OD x 0.049 THK X 126 Inch LG Tube Material: 70-30 CNA Weight of Water head Inlet Outlet Head: 338 LBS Weight of Water head Return Head: 266 LBS

CAGE: 66935

APL: 043020362

1.4 Security Classification: None.

1.5 Initial Condition:

1.5.1 Potential Asbestos Hazard

1.6 Contractor work start date:

1.7 Contractor work completion date:

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 TM S9514-

EL-MMA-010

AIR CONDITIONING PLANT, HFC-

236fa, 250-TON CAPACITY, LCC-

19 CLASS

5 N

4 TM S9086-

HY-STM-

010/CH-254

Condensers Heat Exchangers And Air Ejectors

7 N

5 TM S9AA0-

AB-GOS-

010/GSO

General Specifications for Overhaul of Surface Ships (GSO)

11 N

6 TM S9086-

RK-STM-

010/CH-505

Piping Systems 6 N

1/12/2026

6/12/2027

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

7 TM S9086-

RJ-STM-

010/CH-504

PRESS., TEMP. and Other Mechanical and Electromechanical Measuring Instruments

7 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

4. GENERAL REQUIREMENTS:

4.1. Not Applicable

5. PROCEDURE:

5.1 Remove each condenser water head from the condenser listed in 1.3.1 in accordance with 2.3.

5.1.1 Restore each piping flange mating surface exposed by disassembly of piping system. Repair by removing each high spot, burr, abrasion, and foreign matter, where removal can be accomplished by a hand tool. Take precautions to maintain phonographic finish on each flange that has it.

5.1.2 Restore each mating surface exposed by condenser water head removal. Repair by removing each high spot, burr, abrasion, and foreign matter, where removal can be accomplished by hand tool.

5.1.3 Accomplish a visual inspection of each piping flange connection, condenser water head, and tube insert in accordance with 2.3. Allowable warpage, cracking, elongated/distorted bolt hole, missing thread, leakage path, and excessive corrosion: None.

5.1.3.1 Submit one legible copy, in hard copy or approved transferrable media, of a report listing results of the requirements of 5.1.3 to the SUPERVISOR.

5.2 Accomplish the mechanical cleaning of the seawater side of the condenser listed in 1.3.1 in accordance with paragraph 254-6.2 of 2.4, using 2.3 for guidance.

5.2.1 Remove each existing tube insert from the inlet end of the tubes.

5.2.2 Ensure General Cleaning must be Level III in accordance with Section 505j2 of 2.5.

5.3 Accomplish a borescope inspection of each internal surface on a total of 332 tubes (100 percent) for the condenser listed in 1.3.1 in accordance with Paragraph 254-2.6.4.3 of 2.4. Allowable marine growth, scale, and mineral deposit: None.

(V) "BORESCOPE INSPECTION"

5.4 Install each condenser water head to the condenser listed in 1.3.1 in accordance with 2.3.

5.4.1 Remove existing, fit and install each new zinc anode to each water head.

5.4.2 Remove existing and install each new gasket and O-ring. Material must conform to each specification in Figure 7-14 of 2.3.

FOUO

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

5.4.3 Install each new tube insert to the inlet end of the tubes.

5.4.3.1 Apply adhesive conforming to MMM-A-189, Class 2 on each tube insert.

5.4.4 Torque each fastener in accordance with 2.3.

5.4.4.1 Submit one legible copy, in hard copy or approved transferrable media, of a report listing results of the requirements of 5.4.4 to the SUPERVISOR.

5.5 Accomplish testing of the condenser listed in 1.3.1 in accordance with 2.6.

5.5.1 Each master and backup test gage must conform to gage range and graduation shown on Table 504-6-1 of

2.7. The backup gage must be cross-checked to the master hydrostatic test gage up to the maximum test pressure just prior to start of testing. Master and backup gages must track within 2 percent of each other.

5.5.2 Accomplish a shop hydrostatic test for tube side of the condenser for evidence of external leakage and/or deformation. Allowable external leakage and/or deformation: None.

(V)(G) “VISUAL INSPECTION - SHOP HYDROSTATIC TEST”

5.5.3 Install each vent/drain piping to water heads prior to beginning hydrostatic test.

5.5.4 The tube side test pressure is 270 PSIG.

5.5.5 The test medium is clean fresh water.

5.5.6 Document shop hydrostatic test results on QA Form 28, Enclosure-01-1.

5.5.7 Ensure General Cleaning must be Level III in accordance with Section 505j2 of 2.5.

5.5.8 Install new label plate on the condenser engraving the hydrostatic test pressure and date tested.

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

5.7 Notes:

5.7.1 Planner: Code 234 R. Kimura, 243-5507

Planner: Code 232 R. Muramoto, 243-0089 Planner: Code 233 S. Ogawa, 090-6170-8579

5.7.2 Work Integration Manager (WIM): C333 T. Yaginuma, 080-5419-0598

5.7.3 Refrigerant work including leak check will be covered by TGI 3819P14202A01.

5.7.4 This TGI meets the intent of LCC CSWT File No. 514-002.

5.7.5 JCN EA05-ZAG3 is related to this TGI.

5.8 Government Furnished Material (GFM):

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

5.9 SRF-JRMC will provide following Service Work (TGI).

5.9.1 [C740] Crane and rigging service.

FOUO

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

5.9.2 [X99E] Utility service, electrical.

5.9.3 [X99M] Utility service, except electrical.

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

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

5.9.6 [C133] QA inspection for (G) symbols.

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:

#3 AC PLANT COND AY A 0 0

CU PHASE TITLE:

F/O - ACCOMPLISH MECHANICAL CLEANING OF NO. 3 A/C PLANT CONDENSER

PRIMARY COMPONENT:

COMPONENT UNIT LIST (FOR ASSEMBLIES):

#3 AC PLANT AE #3 AC COND/CHILLER CN

ATTACHMENT LIST:

1. ENCLOSURE-01 (3819P51403A01-QA28.docx) saved on 08-MAY-2024 0000.

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

YAGINUMA ,TAKEHIDE

JO: KO: TOTAL MAN HRS: PLANNING ACCEPTANCE:

3819P51403 A01

TOTAL MAT’L COST TOTAL DURATION:

CU PHASE DESCRIPTION:

The purpose of this TGI is to accomplish mechanical cleaning of No. 3 Air Conditioning (A/C) Plant Condenser.

Location of Work:

Air Conditioning Machinery Room No. 3 (7-64-2-E)

TASK NAME

SHOP TSD/WC TS CREW# MHRS

HIGH RAD

HOURS

RC

GRID#

5.1 BLRM HRs, INSL HRs, ELEC HRs, PFTR HRs 22 KE PC

5.2 BLRM HRs 22 KE PC

5.3 BLRM HRs 22 KE PC

5.4 BLRM HRs 22 KE PC

5.5 BLRM HRs, INSL HRs, ELEC HRs, PFTR HRs 22 KE PC

5.6 PNTR HRs, QA HRs 22 KE PC

CFM: $ for marine chemist cost, asbestos sampler and analysis cost, covering material, paint, label plate material and other consumable material (MISC).

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:

#3 AC PLANT COND AY A 0 0

CU PHASE TITLE:

F/O - ACCOMPLISH MECHANICAL CLEANING OF NO. 3 A/C PLANT CONDENSER

MATERIAL REFERENCES

REF

NO.

DOCUMENT/DRAWING

NUMBER

DOCUMENT/DRAWING TITLE REV

1 S9514-EL-MMA-010

JOB ORDER: KEY OP:

3819P51403 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

300 M SEALER,CHEMICAL, ORDERED

FOR CONTRACTOR

ORIG: CODE 233, S. OGAWA

090-6170-8579

9B 6850 011329623 NA 4 Y 41135158 1/CN

301 M LUBRICANT,THREAD,

ORDERED FOR CONTRACTOR

ORIG: CODE 233, S. OGAWA

090-6170-8579

9B 9150 015976309 NA 4 Y 41135166 1/CN

400 1 M O-RING, C234 R.KIMURA, 243-

ORDER FOR KTR

SEAL, O-RING,

S9514-EL-MMA-010, FIG 7-14-2

9B 5331 002518839 NA 4 N 41295281 10/EA

401 1 M INSERT,TUBE FITTING, C234

R.KIMURA, 243-5507

ORDER FOR KTR

MATERIAL: INSERT, TUBE

FITTING

S9514-EL-MMA-010,FIG 7-1-77

9B 4730 011819598 NA 4 N 41295048

350/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

403 1 M O-RING, ORG: C234 R.KIMURA,

243-5507

ORDER FOR KTR

O-RING

S9514-EL-MMA-010, FIG 7-14-4

9B 5331 006413763 NA 4 N 41295282 10/EA

404 M ANODE,CORROSION PRE,

C234 R.KIMURA, 243-5507

ORDER FOR KTR

MATERIAL:

ANODE,CORROSION,

PREVENTIVE

SIZE: 0.840" OD X 72" LG

9B 5342 008136055 NA 4 N 41295283 1/EA

405 M GASKET, RUBBER GASKET,

SIZE: 3FT X 4FT X 1/8"THK,

SPEC: ASTM 2000D, M2-AA603-

A13-B13-EA14,

DWG: 804-5284201-S12,

CERTIFICATION SHEET

REQUIRED,

DO NOT CROSS TO NSN: 5330-

01-490-5044 (QDR SUBMITTED)

ORDERED FOR KTR

ORG: C234 R.KIMURA, 243-

9B 5330 LL4598269 NA 4 N 1/SH

406 1 M GASKET, ORG: C234

R.KIMURA, 243-5507

ORDER FOR KTR

MATERIAL: GASKET RUBBER,

NOMEN: S9514-EL-MMA-010,

FIG 7-14-15

9B 5330 010425984 NA 4 N 41295284 1/EA

407 1 M SEAL,NONMETALLIC ST, ORG:

C234 R.KIMURA, 243-5507

ORDER FOR KTR

MATERIAL: GASKET RUBBER,

NOMEN: S9514-EL-MMA-010,

FIG 7-14-14

9B 5330 010422696 NA 4 N 41295049 1/SP

408 M ADHESIVE, ADHESIVE FOR

RUBBER

ORIG: C234 R.KIMURA, 243-

ORDERED FOR KTR

9B 8040 008419773 NA 4 Y 41295062 2/PT

409 M ADHESIVE, ADHESIVE FOR

CLOTH,

ORDERED FOR KTR

ORIG: C234 R.KIMURA, 243-

9B 8040 002738708 NA 4 Y 41295059 1/GL

410 M INSULATI, INSULATION, PIPE,

BRAND: K-FLEX ECO,

SPECIFICATION COMPLIANCE:

EB 4013,

FOR 5" IPS,

SIZE: 5-1/2" ID X 3/4" THK X 6

FT LG,

UI: EA/6 FT(ONE CONTINUOUS

LENGTH REQUIRED),

MATL: NON-HALOGEN,

2EA/BOX. *MUST BE ORDERED

IN MULTIPLES OF 2EA*

ORIG: C234, R.KIMURA, 243-

ORDERED FOR KTR

9B 5640 LL9607849 NA 4 N 2/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

411 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,

2EA/BOX. *MUST BE ORDERED

IN MULTIPLES OF 2EA*

ORIG: C234, R.KIMURA, 243-

ORDERED FOR KTR

9B 5970 LL9607850 NA 4 N 2/EA

412 M INSULATION SHEET,

INSULATION, FLAT SHEET,

BRAND: K-FLEX ECO,

SPECIFICATION COMPLIANCE:

EB 4013, FOR SIZE: 36”W X

48”L X 3/4” THK, MATL: NON-

HALOGEN,

**GSA ADVANTAGE

AVAILABLE**

8SH/BOX.

ORDERED FOR KTR

ORIG: C234 R.KIMURA, 243-

9B 5640 LL9607854 NA 4 N 2/SH

413 M ADHESIVE, ADHESIVE FOR

TUBE INSERT

ORIG: C-234 R.KIMURA, 243-

ORDERED FOR KTR

9Q 8040 005437170 NA 4 Y 41295285 2/PT

414 M GASKET, RUBBER GASKET,

SIZE: 3FT X 4FT X 1/8"THK,

SPEC: ASTM 2000D, M2-AA603-

A13-B13-EA14,

DWG: 804-5284201-S12,

CERTIFICATION SHEET

REQUIRED,

DO NOT CROSS TO NSN: 5330-

01-490-5044 (QDR SUBMITTED)

ORDERED FOR KTR

ORG: C234 R.KIMURA, 243-

9B 5330 LL4598269 NA 4 N 1/SH

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 #3 AC PLANT COND AY A 0

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

3819P51403 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 #3 AC PLANT COND AY A 0

COMUSFLTFORCOMINST 4790.3 REV D CHG 3

07 Nov 2023

SHOP TEST RECORD Page 1 of 1

QA FORM 28 Planning must fill in blocks identified by a prior to issuing

1. SHIP HULL NO. 2. JCN 3. LWC/SHOP 4. CWP/REC SER NO. 5. SYSTEM/COMPONENT/ROTATABLE POOL SER NO.

USS BLUE RIDGE LCC19 EA05-ZAG3 KTR N/A No. 3 Air Conditioning Plant Condenser

6. REFERENCES: TEST REF (E.G., MS, TECH MAN) & OTHER REFS (E.G., VLV DWG) 7. TEST GAGE RANGE /INSTRUMENT USED SERIAL NO. CAL DUE DATE 8. RELIEF VLV SET POINT

A. TM S9514-EL-MMA-010 Rev. 5

B.

C.

D.

9. TEST REQUIREMENTS & RESULTS

TEST TYPE KEY H = STRENGTH AND POROSITY/ELEVATED PRESSURE TEST J = MECHANICAL JOINT TIGHTNESS ST = SEAT TIGHTNESS OP = OPERATIONAL O = OTHER

(SPECIFY): ______________________

TE

ST

T Y

PE

(S

EE

K

EY

) PARAGRAPH

DESCRIBING

VALVE POSITION

AND POINT OF

ENTRY

REF

LTR

GAGE

USED

(LTR

FROM

BLK 7)

REQUIRED

MEDIUM

MEDIUM

USED

REQUIRED

PRESSURE

ACTUAL

PRESSURE

MINIMUM

DURATION

ACTUAL

DURATION

ALLOWED

LEAKAGE

ACTUAL

LEAKAGE SAT/UNSAT SIGNATURE, BADGE NO. & DATE

H 5.5 A Clean Fresh Water

270 PSIG 30 minutes None

10. REMARKS. (CRAFTSMAN/QAI SUBMIT A DF TO RESOLVE UNSAT DATA)

11. QA INSPECTOR/SHOP SUPERVISOR SIGNATURE/BADGE NO. (RECORD

REVIEWED FOR FINAL ACCEPTANCE)

DATE 12. QAS SIGNATURE/BADGE NO. (RECORD HAS BEEN REVIEWED FOR

COMPLETENESS)

DATE

3819P51403A01 ENCLOSURE-01-1 TOTAL 1

File details come from the government source that posted it. Updated .