TGI_3819P52302A01_redac(1).pdf

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FOUO: Public availability to be determined under 5 USC 552

TASK GROUP INSTRUCTION

AIM REV 20.11.4.0 (OCTOBER 2020)

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

NO.: S/A 81205K CMWD 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:

F/O - (RE) S/A 81205K, ACOOMPLISH MODS OF CMWD PP

PREPARING ACTIVITY:

PREPARED BY: CODE PHONE DATE

SHINICHI ITO 234. 315-243-4297 22-FEB-2025

APPROVED BY: CODE PHONE DATE

HIDEO HARADA 234. 315-243-5176 22-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 III.

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.

HOT WORK IN MAGAZINE AND ADJACENT SPACES IAW S6740-AA-SAF-010 AND NAVSEA OP 4.

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.: S/A 81205K CMWD 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.

1-11 Sketch (1)

QA20

(1-4)

J1-4 QA28

(1)

QA17

(1)

M1-5 QA28

(1-5)

Engrg Inst (1)

Map (1-3)

1. SCOPE/PURPOSE

1.1 Title: S/A 81205K, Modification of Countermeasure Washdown (CMWD) Piping; accomplish

1.2 Location of Work:

1.2.1 Anchor and Line Handling Space (2-F-0-Q)

1.2.2 CIWS Local Control Room, Storeroom and Workshop No. One (1-C-0-Q)

1.2.3 Main Deck Weather, Frames between B and C, Port and Stbd

1.2.4 Storeroom (2-14-2-A)

1.2.5 Officer Living Space (2-14-0-L)

1.2.6 Passage (2-40-0-L)

1.2.7 Fan Room (1-17-1-Q)

1.2.8 Fan Room (1-17-2-Q)

1.2.9 Fan Room (1-34-1-Q)

1.2.10 Fan Room (1-34-2-Q)

1.2.11 Fan Room (1-36-0-Q)

1.2.12 Fan Room (1-36-2-Q)

1.2.13 Fan Room (1-38-0-Q)

1.2.14 Fan Room (1-38-2-Q)

1.2.15 Fan Room (1-40-1-Q)

1.2.16 Fan Room (1-40-2-Q)

1.2.17 Fan Room (2-109-4-Q)

1.2.18 Officer Washroom, Water Closet, Shower and Decontamination Station (2-111-4-L)

1.2.19 Augmentee Living Space (4-18-0-L)

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

1.2.20 Freeboard Weather, Frames between 21 and 22, Port

1.2.21 Passage (4-52-2-L)

1.2.22 Load Center No. 21/22 (4-57-2-Q)

1.2.23 Load Center Switchboard Room No. 2 Annex (4-63-2-Q)

1.2.24 Chief Petty Officer Living Space (4-64-2-L)

1.2.25 Mooring Station No. 2 (4-52-6-Q)

1.2.26 Hot Potable Water Plant No. 2 (4-56-2-E)

1.2.27 Freeboard Weather, Frames between 63 and 65, Port

1.2.28 Passage (4-86-0-L)

1.2.29 Vending Machine Room (4-86-2-Q)

1.2.30 Mail Bag Storeroom (4-91-2-A)

1.2.31 SR (4-90-2-L)

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

1.2.33 Laundry Receiving and Issue Room (5-89-2-A)

1.2.34 Ship Fitter STRM (5-86-6-A)

1.2.35 Void (4-86-4-V)

1.2.36 Freeboard Weather, Frames between 86 and 94, Port

1.2.37 Passage (4-121-6-L)

1.2.38 Machine Shop (4-124-0-Q)

1.2.39 Metalsmith Shop (4-133-2-Q)

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

1.2.41 SR (3-129-2-L)

1.2.42 DCRS 1A (3-131-2-Q)

1.2.43 Passage (4-109-01-L)

1.2.44 SR (4-113-2-L)

1.2.45 SR (4-109-8-L)

1.2.46 Secondary Damage Control and After Repair 3 (4-115-4-Q)

1.2.47 Crew Washroom, Shower and Decontamination Station (5-112-2-L)

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

1.2.48 Crew Washroom, Water Closet, Shower and Decontamination Station (5-109-2-L)

1.2.49 Freeboard Weather, Frames between 112 and 117, Port

1.2.50 Void (4-109-10-V)

1.2.51 Passage (3-121-0-L)

1.2.52 Passage (3-133-4-L)

1.2.53 Stern Mooring Station (3-143-0-Q)

1.2.54 Tactical System Maintenance (2-133-4-Q)

1.2.55 Nixie Equipment Room (2-147-0-Q)

1.2.56 CIWS 20MM Magazine No. 2 (2-147-1-M)

1.2.57 Second Deck Weather, Frames between 148 and 150, Port and Stbd

1.2.58 Main Deck Weather, Frames between 61 and 62, Port and Stbd

1.2.59 Passage (1-62-1-L)

1.2.60 Ceremonial Passage (1-64-0-L)

1.2.61 25MM Magazine (1-62-2-M)

1.2.62 Fan Room (1-62-3-Q)

1.2.63 01 Level Weather, Frames between 62 and 64, Port and Stbd

1.2.64 Passage (01-67-01-L)

1.2.65 Captain’s Passage (01-67-0-L)

1.2.66 Captain’s Bath (01-64-0-L)

1.2.67 AFFF STA No. 2 (4-132-2-Q)

1.2.68 Passage (4-98-6-L)

1.2.69 Passage (4-76-4-L)

1.2.70 Personnel Office (4-76-6-Q)

1.2.71 AFFF STA No. One (4-83-1-Q)

1.2.72 Passage (4-76-3-L)

1.2.73 DC Central (4-81-1-Q)

1.2.74 Passage (4-52-1-L)

1.2.75 Passage (4-52-2-L)

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

1.2.76 Crew Messroom (4-40-0-L)

1.2.77 Crew & Troop Messroom & FWD Battle Dressing STA (4-30-0-L)

1.2.78 Passage (4-27-0-L)

1.2.79 Quarterdeck & Passage (3-64-0-L)

1.2.80 Passage (3-52-0-L)

1.2.81 Passage (3-40-2-L)

1.2.82 Passage (3-30-01-L)

1.2.83 Passage (2-64-0-L)

1.2.84 Ceremonial Passage (1-64-0-L)

1.2.85 Passage (01-67-01-L)

1.2.86 Passage (02-67-0-L)

1.2.87 C7F Force Protection Office (02-64-0-Q)

1.2.88 Pilot House (03-64-0-C)

1.2.89 Disbursing Office (4-79-2-Q)

1.2.90 Ship Fitting Storeroom (5-86-6-L)

1.2.91 Fan Room (3-60-4-Q)

1.3 Identification:

1.3.1 Quantity (One Lot), CMWD System Piping Group One

Remarks: See Sheet 2 through 4 of 2.5, 2.6, 2.12, and 2.13 for details

1.3.1.1 Quantity (One EA), CMWD Group One Sprinkling 4-21-8 Pressure Switch Root Valve Mfr Id: 803-4384536-11A2AF Type: Globe, In-Line Stop, Union End Size: 0.25-Inch IPS Item No: V5 on 2.6

1.3.2 Quantity (One Lot), CMWD System Piping Group 2

Remarks: See 2.7, Sheet 3 of 2.11, and 2.12 for details

1.3.2.1 Quantity (One EA), CMWD Group 2 Sprinkling 4-63-8 Pressure Switch Root Valve Mfr Id: 803-4384536-11A2AF Type: Globe, In-Line Stop, Union End Size: 0.25-Inch IPS Item No: V5 on 2.7

1.3.3 Quantity (One Lot), CMWD System Piping Group 3

Remarks: See 2.8, 2.12, 2.14, and Mapping Plan Enclosure-05 for details

1.3.4 Quantity (One Lot), CMWD System Piping Group 4

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

Remarks: See 2.9, Sheet 5 (Plan 38-A) of 2.5, Sheet 2 of 2.11, and 2.12 for details

1.3.5 Quantity (One Lot), CMWD System Piping Group 3A

Remarks: See 2.10, 2.12, and Mapping Plan Enclosure-05 for details

1.3.6 Quantity (One Lot), Plumbing Drain Piping

Remarks: See Sheet 4 (Plan 27-A and 30-A) of 2.7 for details

1.3.7 Quantity (One EA), Power System for CMWD Piping System

Remarks: See 2.21 for details

1.3.8 Quantity (One EA), Interior Communication System for CMWD Piping System Remarks: See 2.22 for details

1.3.9 Quantity (One EA), Lighting System Power Source for Alarm Switchboard Remarks: See 2.23 for details

1.3.10 Quantity (One Lot), Structural Work for S/A 81205K CMWD Piping System Remarks: See Engrg Inst Enclosure-01, 2.3, and 2.4 for detail

1.3.11 Quantity (35 SF), Wear Resistant Deck Tile Covering System in 4-121-6-L [Existing] Remarks: See Sketch Enclosure-02 for location detail

1.3.12 Quantity (35 SF), Chemical-Resistant Floorings System in 4-121-6-L Specification: MIL-PRF-32584, Type IV Color: 706 Navy blue color coat with white flake Remarks: See Sketch Enclosure-02 for location detail

1.3.13 Quantity (40 SF), Fourth Deck Plating in 4-121-6-L, Frames between 130 and 133, including vertical structural surface up to height of One inch from complete chemical-resistant floorings system level, Port

Remarks: See Sketch Enclosure-02 for location detail

1.4 Security Classification:

1.4.1 Spaces - 1.2.2, 1.2.56, and 1.2.61.

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: 4/2/2027

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

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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

3 DWG 613-

8506634

ARRANGEMENT MODIFICATIONS

COUNTERMEASURE

WASHDOWN UPGRADE DC

CENTRAL (4-81-1-Q)

A Y AL

L

4 DWG 113-

8506635

FOUNDATION MODIFICATIONS

COUNTERMEASURE

WASHDOWN UPGRADE

A Y AL

L

5 DWG 506-

8506467

WDCM SYSTEM MODIFICATION

ADDITIONAL WDCM NOZZLES

FWD FRAME 113

A Y AL

L

6 DWG 506-

8507855

CMWD SYSTEM MODIFICATION

CONTROL VALVE INSTL - GROUP

1 BERTHING (4-18-2-L)

A Y AL

L

7 DWG 506-

8507856

CMWD SYSTEM MODIFICATION

CONTROL VALVE INSTL - GROUP

2 PASSAGE (4-52-2-L)

A Y AL

L

8 DWG 506-

8507857

CMWD SYSTEM MODIFICATION

CONTROL VALVE INSTL - GROUP

3 PASSAGE (4-86-0-L)

A Y AL

L

9 DWG 506-

8507858

CMWD SYSTEM MODIFICATION

CONTROL VALVE INSTL - GROUP

4 PASSAGE (4-121-4-L)

A Y AL

L

10 DWG 506-

8507859

CMWD SYSTEM MODIFICATION

CONTROL VALVE INSTL - GROUP

3A PASSAGE (4-109-01-L)

A Y AL

L

11 DWG 506-

8507860

CMWD SYSTEM MODIFICATION

ADDITIONAL WDCM NOZZLES

A Y AL

L

12 LAR

PSNSIMF-

0361-24

BLUE RIDGE (LCC19)

WASHDOWN CONTROL VALVE

MATERIAL CHANGES

- Y AL

L

13 LAR SRFY-

0252-24

S/A 81205 DWG DISCREPANCY

FOR CMWD PP WORK

- Y AL

L

14 LAR SRFY-

0255-24

S/A 81205 DWG DISCREPANCY

FOR CMWD PP WORK

- Y AL

L

15 PDD 100-

ELM-250136

INSTL OF PATCH FOR REMOVAL

PP INCID TO SCD 11205

- Y AL

L

16 DWG 506-

2492277

AGC19 WASHDOWN SYS-DIAG-

ARR

A Y AL

L

17 DWG 506-

6307896

AFFF SYSTEM UPDATE FM HELO

CM WASHDOWN PP

INSTALLATION

- Y AL

L

18 PDD 505-

ELM-150925

WELD SIZE OF SOCKET

WELDING.

- Y AL

L

19 DWG 810-

4714432

STD Pipe Hangers Fabrication

DETS & INSTL

L N

20 MIL MIL-

STD-1627

Bending of Pipe or Tube for Ship Piping Systems

C N

21 DWG 302-

8507931

POWER SYSTEM INSTALLATION

WASH DOWN COUNTER

MEASURE DECK HOUSE AND

CIWS

A Y AL

L

22 DWG 401-

8516554

IC CKT CM, FR, AND HF ALARM

INSTL WDCM

A Y AL

L

23 DWG 303-

8516261

LIGHTING SYSTEM

MODIFICATIONS WDCM ALARM

A Y AL

L

24 DWG 113-

5293062

FDN - MISC ELECTRICAL

EQUIPMENT (SHOCK)

E Y AL

L

25 DWG 302-

8435746

LCC19 60Hz Power Distribution One- Line

A Y 23

26 DWG 803-

4384536

Valves, BRZ, 1/4" - 2" Union End Globe, In-Line & ANG, Stop, Stop Check & Needle

N N

27 TM 0948-LP-

012-5000

Standard Navy Valves 32 N

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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

28 DWG 506-

2492278

WASHDOWN SYS - DIAG MATL

SPEC

B N

29 TM S9086-

RK-STM-

010/CH-505

Piping Systems 6 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 Accomplish each structural work for S/A 81205K listed in 1.3.10 in accordance with Enclosure-01, 2.3, and 2.4.

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

5.2 Accomplish the requirements for removal, installation, and modification of each system listed in 1.3.7 through

1.3.9 in accordance with 2.21 through 2.23, using 2.24 and Sheet 235 of 2.25 for guidance.

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

5.3 Prepare each new valve listed in 1.3.1.1 and 1.3.2.1 for installation, using 2.6, 2.7 and 2.26 for guidance.

5.3.1 Accomplish a bonnet ring torque check and tighten each bonnet ring of each new valve in accordance with Table 4.3.5-10 of 2.27, using 2.26 for guidance.

5.3.1.1 Torque of each bonnet ring of each new valve is 18 to 20 foot pounds.

5.3.2 Accomplish a shop test of each new valve, using 2.26, 2.28 and 2.29 for guidance.

5.3.2.1 Shop test equipment must conform to the requirements in Paragraph 505-11.1.3 of 2.29.

5.3.2.2 Accomplish a mechanical joint tightness test of each new valve for body-to-bonnet joint tightness with stem in the half-open position, using clean fresh water at 150 PSIG (not less than 150 PSIG and not more than 153 PSIG) for a minimum of 3 minutes. Allowable external leakage: None.

(V) "MECHANICAL JOINT TIGHTNESS TEST"

5.3.2.3 Document each shop test result on QA Form 28 Enclosure-03-1.

5.4 Accomplish modification of CMWD piping of S/A 81205K listed in 1.3.1 through 1.3.5 in accordance with 2.5 through 2.15, using 2.16 through 2.19 for guidance.

5.4.1 Remove existing, fabricate, and install new each plumbing drain piping listed in 1.3.6 in accordance with 2.7.

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

5.4.2 Remove each existing and install new pipe hanger in accordance with 2.5 through 2.11, using 2.19 for guidance.

5.4.3 Bend each new pipe in accordance with 2.20.

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

5.4.5 Accomplish the requirements of 009-71 of 2.1 for hydrostatic test, using clean, fresh water at 225 PSIG, for each new and disturbed CMWD piping systems.

5.4.5.1 Document shop hydrostatic test results on QA Form 28 Enclosure-04-1 through Enclosure-04-5.

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

5.4.6.1 Accomplish nondestructive testing in accordance with Line 9.

5.4.6.2 Accomplish the requirements of 099-911YO of 2.2, using QA Form 20 Enclosure-06-1 and Enclosure-06-2.

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

5.4.6.3 Accomplish the requirements of 009-09 of 2.1 for welding procedure of each joint shown on Mapping Plan Enclosure-05.

5.4.7 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.

5.4.7.1 Document the test on QA Form 17 Enclosure-07-1.

5.4.8 Accomplish clad weld of penetration sleeve on shell plating in accordance with 2.8 and 2.10.

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

5.4.8.2 Accomplish nondestructive testing in accordance with Line 10.

5.4.8.3 Accomplish the requirements of 099-911YO of 2.2, using QA Form 20 Enclosure-06-3 and Enclosure-06-4.

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

5.4.8.4 Accomplish the requirements of 009-09 of 2.1 for welding procedure of each joint shown on Mapping Plan Enclosure-05.

5.4.9 Accomplish the requirements of 009-71 of 2.1 for a static head pressure test of each new CMWD system drain piping listed in 1.3.1 through 1.3.5, using clean, fresh water for a minimum of 30 minutes. Allowable leakage: None.

5.4.10 Accomplish flow check of CMWD system drain piping listed in 1.3.1 through 1.3.5 using clean fresh water.

Allowable external leakage: None.

(V)(G)”FLOW CHECK”

5.4.11 Accomplish flow check of plumbing drain piping listed in 1.3.6 using clean fresh water. Allowable external leakage: None.

(V)(G)”FLOW CHECK”

5.4.12 Cycle each valve from fully closed to fully open to fully closed 4 times. Allowable binding: None.

(V) “VALVE CYCLING”

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

5.5 Accomplish the requirements of 009-26 of 2.1, including Attachment C, for removal of each existing equipment listed in 1.3.11 and installation of each new equipment listed in 1.3.12.

5.5.1 Accomplish the requirements of 009-32 of 2.1, including Table 3, Line(s) 6, Column(s) A, B, and D, for each area listed in 1.3.13. Primer must conform to MIL-PRF-23236, Type V, VI, or VII.

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

5.7 Notes:

5.7.1 Planner: Code 234 S. Ito, 243-4297

Planner: Code 231B R. Takagi, 243-9982 Planner: Code 232 K. Nakamura, 070-7787-1977 Planner: Code 233 Y. Kimura, 080-6845-2423 Engineer: Code 250 K. Matsunari, 243-5816 Engineer: Code 260 K. Sakai, 243-4342

5.7.2 Program Manager’s Representative (PMR) will be onsite during install and testing.

PMR: Mr Edward Twigg, (315) 243-4242 E-mail Address: Edward.i.twigg.ctr@us.navy.mil

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

5.7.4 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 bulkhead normally used to control air flow in the event of a shipboard fire. A non- flammable closure is required in accordance with COMNAVDEASYSCOM 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.

5.7.5 Opening, initial cleaning, and closing of each space listed in 1.2.35 and 1.2.50 will be covered by following TGI No(s).

Void (4-86-4-V): 3819P12381 (KTR TGI) Void (4-109-10-V): 3819P12382 (KTR TGI)

5.7.6 Preservation work for new and disturbed surfaces of each space listed in 1.2.35 and 1.2.50 will be covered by following TGI No(s).

Void (4-86-4-V): 3819P12381 (KTR TGI) Void (4-109-10-V): 3819P12382 (KTR TGI)

5.7.7 Preservation work for new and disturbed exterior surfaces of freeboard will be covered by TGI No.

3819P11001A01 (KTR TGI).

5.7.8 JCN EXSA-ZCD2 is related to this TGI.

5.8 Government Furnished Material (GFM):

5.8.1 All GFM listed in each S/A drawing will be provided as kitted material by SRF-JRMC.

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

5.9 SRF-JRMC will provide the following service work: (TGI No. 3819P52302S02)

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

5.9.1 [C740] Crane and crane rigging service.

5.9.2 [X99E] Utilities service, electrical.

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

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) symbol(s).

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

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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:

S/A 81205K CMWD PP AY A 0 0

CU PHASE TITLE:

F/O - (RE) S/A 81205K, ACOOMPLISH MODS OF CMWD PP

PRIMARY COMPONENT:

COMPONENT UNIT LIST (FOR ASSEMBLIES):

CMWD 2-F-0-Q PP CMWD 4-109-8-L PP CMWD 4-109-01-L PP CMWD 4-113-2-L

PP CMWD 4-115-4-Q PP PLMB DR 4-52-2-L PP CMWD 2-14-2-A PP CMWD 2-14-O-

L PP CMWD 2-40-0-L PP CMWD 2-109-4-Q PP CMWD 2-111-4-L PP CMWD

2-133-4-Q PP CMWD 2-147-0-Q PP CMWD 2-147-1-M PP CMWD 01 LVL WEATHER PP

CMWD 3-121-0-L PP CMWD 3-133-4-L PP CMWD 3-143-0-Q PP CMWD 1-17-1-

Q PP CMWD 1-17-2-Q PP CMWD 1-34-1-Q PP CMWD 1-34-2-Q PP CMWD

1-36-0-Q PP CMWD 1-36-2-Q PP CMWD 1-38-O-Q PP CMWD 1-38-2-Q PP

CMWD 1-40-1-Q PP CMWD 1-40-2-Q PP CMWD 1-62-1-L PP CMWD 1-64-0-

L PP CMWD 1-62-2-M PP CMWD 1-62-3-Q PP CMWD 01-67-0-L PP CMWD

01-67-01-L PP CMWD 01-64-0-L PP CMWD 4-121-6-L PP CMWD 4-124-0-Q PP

CMWD 4-133-2-Q PP CMWD 4-86-4-V PP CMWD 2ND DK WEA (P) PP CMWD 2ND

DK WEA (S) PP CMWD MN DK WEATHER PPVOID 4-86-4-V VD CMWD 1-C-0-Q PP CMWD

4-86-2-Q PP CMWD 4-18-0-L PP CMWD 4-52-2-L PP CMWD 4-57-2-Q PP

CMWD 4-63-2-Q PP CMWD 4-64-2-L PP CMWD 4-86-0-L PP CMWD 4-90-2-

L PP CMWD 4-91-2-A PP CMWD 3-129-2-L PP CMWD 3-131-2-Q PP CMWD

5-86-0-C PP CMWD 5-89-2-A PP CMWD 5-86-6-A PP CMWD 5-121-2-L PP

CMWD 5-112-2-L PP CMWD 5-109-2-L PP PP 4-132-2 PA (4-132-2)-4P-A CB

(4-132-2)-4P-B CB (4-84-1)-4P-C CB (4-84-1)-4P-D CB (4-83-1)-1L-H C- CKT CM

IC IC/SM-10 SB 4-81-1-Q SB IC/SM-20 SB 4-81-1-Q SB (4-132-2)-4P-C C- (4-132-2)-4P-D C- (4-132-2)-4P-E C- (4-84-1)-4P-C C- (4-84-1)-4P-D C- (4-132-2)-4P-A C- (4-132-2)-4P-B

C- CMPT 4-86-0-L MSCMPT 4-121-6-L MS CMPT 4-115-4-Q MS SHELL PLATING

PORT MS VOID 4-109-10-V VDCMPT 2-111-4-L MS CMPT 4-132-2-Q MS CMPT 4-86-2-Q

MS CMPT 03-64-0-C MS CMPT 4-63-2-Q MS CMPT 4-109-01-L MS CMPT 2-109-4-

Q MS CMPT 5-112-2-L MS CMPT 5-86-6-A MSCMPT 4-18-0-L MSCMPT 4-52-2-L MS

CMPT 4-81-1-Q MS

ATTACHMENT LIST:

1. ENCLOSURE-01 (3919P52302A01-Engrg Inst.pdf) saved on 19-FEB-2025 0000.

2. ENCLOSURE-02 (3819P52302A01-Sketch.pdf) saved on 19-FEB-2025 0000.

3. ENCLOSURE-03 (3819P52302A01-QA28-01.docx) saved on 19-FEB-2025 0000.

4. ENCLOSURE-04 (3819P52302A01-QA28-02.docx) saved on 19-FEB-2025 0000.

5. ENCLOSURE-05 (3819P52302A01-Map.pdf) saved on 19-FEB-2025 0000.

6. ENCLOSURE-06 (3819P52302A01-QA20.pdf) saved on 19-FEB-2025 0000.

7. ENCLOSURE-07 (3819P52302A01-QA17.pdf) saved on 19-FEB-2025 0000.

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

TAKAHASHI ,YASUHIKO

JO: KO: TOTAL MAN HRS: PLANNING ACCEPTANCE:

3819P52302 A01

TOTAL MAT’L COST TOTAL DURATION:

CU PHASE DESCRIPTION:

The purpose of this TGI is to accomplish modification of countermeasure washdown piping of S/A 81205K.

Location of Work:

Anchor and Line Handling Space (2-F-0-Q) CIWS Local Control Room, Storeroom and Workshop No. One (1-C-0-Q)

FOUO

J-2

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

CU PHASE DESCRIPTION:

Main Deck Weather, Frames between B and C, Port and Stbd Storeroom (2-14-2-A) Officer Living Space (2-14-0-L) Passage (2-40-0-L) Fan Room (1-17-1-Q) Fan Room (1-17-2-Q) Fan Room (1-34-1-Q) Fan Room (1-34-2-Q) Fan Room (1-36-0-Q) Fan Room (1-36-2-Q) Fan Room (1-38-0-Q) Fan Room (1-38-2-Q) Fan Room (1-40-1-Q) Fan Room (1-40-2-Q) Fan Room (2-109-4-Q) Officer Washroom, Water Closet, Shower and Decontamination Station (2-111-4-L) Augmentee Living Space (4-18-0-L) Freeboard Weather, Frames between 21 and 22, Port Passage (4-52-2-L) Load Center No. 21/22 (4-57-2-Q) Load Center Switchboard Room No. 2 Annex (4-63-2-Q) Chief Petty Officer Living Space (4-64-2-L) Mooring Station No. 2 (4-52-6-Q) Hot Potable Water Plant No. 2 (4-56-2-E) Freeboard Weather, Frames between 63 and 65, Port Passage (4-86-0-L) Vending Machine Room (4-86-2-Q) Mail Bag Storeroom (4-91-2-A)

SR (4-90-2-L)

IC and Gyro Room No. 2 (5-86-0-C) Laundry Receiving and Issue Room (5-89-2-A) Ship Fitter STRM (5-86-6-A) Void (4-86-4-V) Freeboard Weather, Frames between 86 and 94, Port Passage (4-121-6-L) Machine Shop (4-124-0-Q) Metalsmith Shop (4-133-2-Q) Physical Fitness Room (5-121-2-L)

SR (3-129-2-L)

DCRS 1A (3-131-2-Q)

Passage (4-109-01-L)

SR (4-113-2-L)

SR (4-109-8-L)

Secondary Damage Control and After Repair 3 (4-115-4-Q) Crew Washroom, Shower and Decontamination Station (5-112-2-L) Crew Washroom, Water Closet, Shower and Decontamination Station (5-109-2-L) Freeboard Weather, Frames between 112 and 117, Port Void (4-109-10-V) Passage (3-121-0-L) Passage (3-133-4-L) Stern Mooring Station (3-143-0-Q) Tactical System Maintenance (2-133-4-Q) Nixie Equipment Room (2-147-0-Q) CIWS 20MM Magazine No. 2 (2-147-1-M) Second Deck Weather, Frames between 148 and 150, Port and Stbd

FOUO

J-3

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

CU PHASE DESCRIPTION:

Main Deck Weather, Frames between 61 and 62, Port and Stbd Passage (1-62-1-L) Ceremonial Passage (1-64-0-L) 25MM Magazine (1-62-2-M) Fan Room (1-62-3-Q) 01 Level Weather, Frames between 62 and 64, Port and Stbd Passage (01-67-01-L) Captain’s Passage (01-67-0-L) Captain’s Bath (01-64-0-L) AFFF STA No. 2 (4-132-2-Q) Passage (4-98-6-L) Passage (4-76-4-L) Personnel Office (4-76-6-Q) AFFF STA No. One (4-83-1-Q) Passage (4-76-3-L) DC Central (4-81-1-Q) Passage (4-52-1-L) Passage (4-52-2-L) Crew Messroom (4-40-0-L) Crew & Troop Messroom & FWD Battle Dressing STA (4-30-0-L) Passage (4-27-0-L) Quarterdeck & Passage (3-64-0-L) Passage (3-52-0-L) Passage (3-40-2-L) Passage (3-30-01-L) Passage (2-64-0-L) Ceremonial Passage (1-64-0-L) Passage (01-67-01-L) Passage (02-67-0-L) C7F Force Protection Office (02-64-0-Q) Pilot House (03-64-0-C) Disbursing Office (4-79-2-Q) Ship Fitting Storeroom (5-86-6-L) Fan Room (3-60-4-Q)

TASK NAME

SHOP TSD/WC TS CREW# MHRS

HIGH RAD

HOURS

RC

GRID#

5.1 SFTR , WELD , SMTL , PNTR , RGRS , QA , INSL 22 KE PC

5.2 ELEC , SFTR , WELD , QA 22 KE PC

5.3 IMCH 22 KE PC

5.4 PFTR , WELD , OMCH , ELEC , RGRS , SFTR , INSL ,

PNTR , QA , SMTL , CARP

22 KE PC

5.5 CARP , PNTR , QA 22 KE PC

5.6 PNTR , QA 22 KE PC

Piping Work CFM: for marine chemist cost, fire watches cost, tank watch cost, lead sampling and analysis cost, asbestos sampling and analysis cost for pipe lagging, air compressor rental/fuel oil cost, pipe/flat bar/bolt/nut and liner for pipe hangers, all paints, misc as plastic bag/sheet, covering material, ---continue to below---

22 MQ CS

---continued from above---brazing/welding rods, electrodes, tapes, gases, saw blades, grinding discs, and other consumable.

22 MQ CS

FOUO

J-4

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

TASK NAME

SHOP TSD/WC TS CREW# MHRS

HIGH RAD

HOURS

RC

GRID#

Structural Work CFM: for all deck covering, paints, thinners, fire watch cost, confined space watch cost, asbestos sampler and analysis cost for compartment insulation, lead sampling/ analysis cost, air compressor rental cost and fuel oil cost for air hose test, PT and MT inspection cost, ---continue to below---

22 MQ CS

---continued from above---and misc such as electrode, gases, temporary covering materials, and other consumables.

22 MQ CS

Machinery Work CFM: for misc (plastic sheets/bags and other consumable).

22 MQ CS

Electrical Work CFM: for asbestos sampling and analysis cost for cable penetration, plastic bags, terminal lugs, fasteners, insulation tapes, cable banding materials, covering materials, fire watch cost, and other consumables.

22 MQ CS

Preservation Work CFM: for all deck covering, paints, thinners, grits including disposal cost, bond coat, underlayment, grout, alcohol, color flake, color chip, and seal coat, Sampler/Analyze asbestos and lead, and MISC such as covering material and other consumable.

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:

S/A 81205K CMWD PP AY A 0 0

CU PHASE TITLE:

F/O - (RE) S/A 81205K, ACOOMPLISH MODS OF CMWD PP

MATERIAL REFERENCES

REF

NO.

DOCUMENT/DRAWING

NUMBER

DOCUMENT/DRAWING TITLE REV

JOB ORDER: KEY OP:

3819P52302 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

100 M INSULATI, ORIG: C231B,

RIKAKO TAKAGI, 243-9982

ORDERED FOR KTR

9Q 5640 008096312 NA 4 N 50455376 22/EA

101 M INSULATI, ORIG: C231B,

RIKAKO TAKAGI, 243-9982

ORDERED FOR KTR

9Q 5640 008096315 NA 4 N 50455378 5/EA

102 M SOUND CO, ORIG: C231B,

RIKAKO TAKAGI, 243-9982

ORDERED FOR KTR

9Q 5640 007565866 NA 4 N 50455381 10/EA

103 M INSULATI, ORIG: C231B,

RIKAKO TAKAGI, 243-9982

ORDERED FOR KTR

9B 2510 016490178 NA 4 N 50455198 3/EA

104 M CAP,SNAP, ORIG: C231B,

RIKAKO TAKAGI, 243-9982

ORDERED FOR KTR

9B 5325 007377648 NA 4 N 50455199

100/EA

105 M ADHESIVE, ORIG: C231B,

RIKAKO TAKAGI, 243-9982

ORDERED FOR KTR

9B 8040 002738708 NA 4 Y 50455119 1/GL

106 M TAPE,TEX, ORIG: C231B,

RIKAKO TAKAGI, 243-9982

ORDERED FOR KTR

9B 8315 002671632 NA 4 N 50455383 1/RO

107 M TAPE,TEX, ORIG: C231B,

RIKAKO TAKAGI, 243-9982

ORDERED FOR KTR

9B 8315 002671633 NA 4 N 50455385 1/RO

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

108 M CORK AND, ORIG: C231B,

RIKAKO TAKAGI, 243-9982

ORDERED FOR KTR

9B 5330 002919598 NA 4 N 50455201 1/SH

109 M NUT, HEX, 1/2"-13UNC, NUT,

HEX HD, PLAIN, 1/2"-13UNC-

2B, STEEL, GRADE 2, MIL-DTL-

1222 TYPE I, ANY ZINC

COATING.

ORIG: C231B, RIKAKO TAKAGI,

243-9982

ORDERED FOR KTR

LL7005212 NA 4 N 18/EA

110 M WASHER,FLAT,0.531"ID,

WASHER, FLAT, 1/2"(0.500")

SIZE; 1/2" (0.500"), 0.531"ID X

1.062"OD X 0.095"THK, MATL:

STEEL, ASME B18.21.1, TYPE A

ORIG: C231B, RIKAKO TAKAGI,

243-9982

ORDERED FOR KTR

LL4945815 NA 4 N 18/EA

200 M RUBBER SHEET SOLID, ORIG:

C232 K. NAKAMURA, 070-7787-

ORDERED FOR KTR

FOR VLV CMWD COV 4-131-8

9B 5330 014905051 NA 4 N 50455214 1/SH

300 M STUD, WELDING, ORIG: C233

Y. KIMURA

ORDERED FOR KTR

9B 5307 LL9100490 NA 4 N 50457626 20/EA

301 M STUD,WELDING, ORIG: C233 Y.

KIMURA

ORDERED FOR KTR

9B 5307 012931818 NA 4 N 50455465 30/EA

302 M STUD, WELDING, ORIG: C233

Y. KIMURA

ORDERED FOR KTR

9B 5307 LL9100491 NA 4 N 50457627 50/EA

400 M SILICA PIPE COVER, SILICA

PIPE COVER, 1/2 INCH IPS X 2-

1/2 INCH THK X 36 INCH LG,

NON-ASBESTOS

ORDERED FOR KTR

C234 S.ITO 243-4297

LL6995234 NA 4 N 2/EA

401 M CEMENT,INSULATION,H,

ORDERED FOR KTR

C234 S.ITO 243-4297

9Q 5640 002264540 NA 4 Y 50455387 1/BG

402 M ADHESIVE, ORDERED FOR

KTR

C234 S.ITO 243-4297

9B 8040 002738708 NA 4 Y 50455126 1/GL

403 M CLOTH,PLAIN WEAVE,

ORDERED FOR KTR

C234 S.ITO 243-4297

9B 8305 012901776 NA 4 N 50455390 1/RO

404 M INSULATI, SIZE: 4 INCH IPS,

SIZE: 4-1/2 INCH ID X 3/4 INCH

THK X 6FT LG, UI: EA/6FT (ONE

CONTINUOUS LENGTH

REQUIRED), MATL: NON-

HALOGEN

ORDERED FOR KTR

C234 S.ITO 243-4297

9B 5640 LL9607848 NA 4 N 50457438 2/EA

405 M INSULATI, FOR SIZE: 5 INCH

IPS, SIZE: 5-5/8 INCH ID X 3/4

INCH THK X 6FT LG, UI: EA/6FT

(ONE CONTINUOUS LENGTH

REQUIRED), MATL: NON-

HALOGEN

ORDERED FOR KTR

C234 S.ITO 243-4297

9B 5640 LL9607849 NA 4 N 50457440 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

406 M ADHESIVE, ORDERED FOR

KTR

C234 S.ITO 243-4297

9B 8040 002738708 NA 4 Y 50455130 3/GL

406 M ADHESIVE, ORDERED FOR

KTR

C234 S.ITO 243-4297

9B 8040 002738708 NA 4 Y 50455438 3/GL

407 M ADHESIVE, ORDERED FOR

KTR

C234 S.ITO 243-4297

9B 8040 008419773 NA 4 Y 50455179 4/PT

408 M INSULATI, FOR SIZE: 2 INCH

IPS, SIZE: 2-3/8 INCH ID X 3/4

INCH THK X 6FT LG, UI: EA/6FT

(ONE CONTINUOUS LENGTH

REQUIRED), MATL: NON-

HALOGEN

ORDERED FOR KTR

C234 S.ITO 243-4297

9B 5640 LL9607844 NA 4 N 50457446 2/EA

409 M INSULATI, FOR SIZE: 4 INCH

IPS, SIZE: 4-1/2 INCH ID X 3/4

INCH THK X 6FT LG, UI: EA/6FT

(ONE CONTINUOUS LENGTH

REQUIRED), MATL: NON-

HALOGEN

ORDERED FOR KTR

C234 S.ITO 243-4297

9B 5640 LL9607848 NA 4 N 50457450 2/EA

410 M INSULATI, FOR SIZE: 5 INCH

IPS, SIZE: 5-5/8 INCH ID X 3/4

INCH THK X 6FT LG, UI: EA/6FT

(ONE CONTINUOUS LENGTH

REQUIRED), MATL: NON-

HALOGEN

ORDERED FOR KTR

C234 S.ITO 243-4297

9B 5640 LL9607849 NA 4 N 50457453 3/EA

411 M INSULATI, FOR SIZE: 8 INCH

IPS, SIZE: 8-5/8 INCH ID X 3/4

INCH THK X 6FT LG, UI: EA/6FT

(ONE CONTINUOUS LENGTH

REQUIRED), MATL: NON-

HALOGEN

ORDERED FOR KTR

C234 S.ITO 243-4297

9B 5640 LL9607851 NA 4 N 50457454 2/EA

412 M ADHESIVE, ORDERED FOR

KTR

C234 S.ITO 243-4297

9B 8040 002738708 NA 4 Y 50455134 4/GL

413 M ADHESIVE, ORDERED FOR

KTR

C234 S.ITO 243-4297

9B 8040 008419773 NA 4 Y 50455183 5/PT

414 M INSULATI, FOR SIZE: 5 INCH

IPS, SIZE: 5-5/8 INCH ID X 3/4

INCH THK X 6FT LG, UI: EA/6FT

(ONE CONTINUOUS LENGTH

REQUIRED), MATL: NON-

HALOGEN

ORDERED FOR KTR

C234 S.ITO 243-4297

9B 5640 LL9607849 NA 4 N 50457455 2/EA

415 M INSULATI, FOR SIZE: 8 INCH

IPS, SIZE: 8-5/8 INCH ID X 3/4

INCH THK X 6FT LG, UI: EA/6FT

(ONE CONTINUOUS LENGTH

REQUIRED), MATL: NON-

HALOGEN

ORDERED FOR KTR

9B 5640 LL9607851 NA 4 N 50457457 2/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

416 M INSULATI, SIZE: 36 INCH W X

48 INCH L X 3/4 INCH THK,

MATL: NON-HALOGEN

ORDERED FOR KTR

C234 S.ITO 243-4297

9B 5640 LL9607854 NA 4 N 50457460 2/SH

417 M ADHESIVE, ORDERED FOR

KTR

C234 S.ITO 243-4297

9B 8040 002738708 NA 4 Y 50455143 4/GL

418 M ADHESIVE, ORDERED FOR

KTR

C234 S.ITO 243-4297

9B 8040 008419773 NA 4 Y 50455185 5/PT

419 M COUPLING,TUBE, ORDERED

FOR KTR

C234 S.ITO 243-4297

9B 4730 014635857 NA 4 N 50455202 4/EA

420 M COUPLING,TUBE, ORDERED

FOR KTR

C234 S.ITO 243-4297

9B 4730 007225475 NA 4 N 50455203 1/EA

421 M SLEEVE, ORDERED FOR KTR

C234 S.ITO 243-4297

9C 4730 LL4462308 NA 4 N 50457462 2/EA

422 M INSULATI, FOR SIZE: 6 INCH

IPS, SIZE: 6-5/8 INCH ID X 3/4

INCH THK X 6FT LG, UI: EA/6FT

(ONE CONTINUOUS LENGTH

REQUIRED), MATL: NON-

HALOGEN

ORDERED FOR KTR

C234 S.ITO 243-4297

9B 5640 LL9607850 NA 4 N 50457464 2/EA

423 M INSULATI, FOR SIZE: 8 INCH

IPS, SIZE: 8-5/8 INCH ID X 3/4

INCH THK X 6FT LG, UI: EA/6FT

(ONE CONTINUOUS LENGTH

REQUIRED), MATL: NON-

HALOGEN

ORDERED FOR KTR

C234 S.ITO 243-4297

9B 5640 LL9607851 NA 4 N 50457467 1/EA

424 M INSULATI, SIZE: 36 INCH W X

48 INCH L X 3/4 INCH THK,

MATL: NON-HALOGEN

ORDERED FOR KTR

C234 S.ITO 243-4297

9B 5640 LL9607854 NA 4 N 50457470 2/SH

425 M ADHESIVE, ORDERED FOR

KTR

C234 S.ITO 243-4297

9B 8040 002738708 NA 4 Y 50455147 4/GL

426 M ADHESIVE, ORDERED FOR

KTR

C234 S.ITO 243-4297

9B 8040 008419773 NA 4 Y 50455188 5/PT

427 M INSULATI, FOR SIZE: 8 INCH

IPS, SIZE: 8-5/8 INCH ID X 3/4

INCH THK X 6FT LG, UI: EA/6FT

(ONE CONTINUOUS LENGTH

REQUIRED), MATL: NON-

HALOGEN

ORDERED FOR KTR

C234 S.ITO 243-4297

9B 5640 LL9607851 NA 4 N 50457471 1/EA

428 M INSULATI, SIZE: 36 INCH W X

48 INCH L X 3/4 INCH THK,

MATL: NON-HALOGEN

ORDERED FOR KTR

C234 S.ITO 243-4297

9B 5640 LL9607854 NA 4 N 50457472 2/SH

429 M ADHESIVE, ORDERED FOR

KTR

C234 S.ITO 243-4297

9B 8040 002738708 NA 4 Y 50455158 3/GL

430 M ADHESIVE, ORDERED FOR

KTR

9B 8040 008419773 NA 4 Y 50455189 4/PT

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

431 M COUPLING,TUBE, ORDERED

FOR KTR

C234 S.ITO 243-4297

9B 4730 014635857 NA 4 N 50455204 4/EA

432 M SLEEVE, ORDERED FOR KTR

C234 S.ITO 243-4297

9C 4730 LL4462308 NA 4 N 50457473 2/EA

433 M BACKING, ORDERED FOR KTR

9C 4730 LL4326205 NA 4 N 50457475 2/EA

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

☐ NUCLEAR APPENDIX "D"

DEFICIENCY FORM

☐ NON-NUCLEAR

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

(Circle One)

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

LCC-19 S/A 81205K CMWD PP AY A 0

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

3819P52302 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 S/A 81205K CMWD PP AY A 0

3819P52302A01 ENCLOSURE-01

SHEET 1 OF 13819P52302A01

SKETCH

ENCLOSURE-02

Location Detail for Replacing Deck Covering in Passage (4-121-6-L)

PLAN VIEW

PASSAGE, FR 127 – 133, PORT

FWD

Passage 4-121-6-L

COMUSFLTFORCOMINST 4790.3 REV D CHG 3

07 Nov 2023

3819P52302A01 ENCLOSURE-03-1 TOTAL 1

SHOP TEST RECORD Page 1 of 2

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 LCC-19 EXSA-ZCD2 KTR N/A New CMWD Group One Sprinkling 4-21-8 Pressure Switch Root Valve

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. DWG 506-2492278, Rev. B

B. TM S9086-RK-STM-010/CH-505, Rev. 6

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

USED

PRESSURE

ACTUAL

MINIMUM

DURATION

ALLOWED

LEAKAGE

ACTUAL

LEAKAGE SAT/UNSAT SIGNATURE, BADGE NO. & DATE

J 5.3.2.2

Mechanical Joint Tightness Test

A,B Clean Fresh Water

150 PSIG 3 Minutes Minimum 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

3819P52302A01 ENCLOSURE-03-1 TOTAL 1

SHOP TEST RECORD Page 2 of 2

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 LCC-19 EXSA-ZCD2 KTR N/A New CMWD Group 2 Sprinkling 4-63-8 Pressure Switch Root Valve

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. DWG 506-2492278, Rev. B

B. TM S9086-RK-STM-010/CH-505, Rev. 6

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

K

EY

) PARAGRAPH

DESCRIBING

VALVE POSITION

GAGE

USED

(LTR

ACTUAL

LEAKAGE SAT/UNSAT SIGNATURE, BADGE NO. & DATE

J 5.3.2.2

Mechanical Joint Tightness Test

A,B Clean Fresh Water

150 PSIG 3 Minutes Minimum 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

3819P52302A01 ENCLOSURE-04-1 TOTAL 5

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 EXSA-ZCD2 KTR N/A CMWD SYSTEM PIPING GROUP ONE

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. S9086-RK-STM-010/CH-505 Rev. 6

B. DWG 506-8506467 Rev. A

C. DWG 506-8507855 Rev. A

D. LAR SRFY-0252-24 Rev “-“

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

K

EY

) PARAGRAPH

DESCRIBING

VALVE POSITION

GAGE

USED

(LTR

ACTUAL

LEAKAGE SAT/UNSAT SIGNATURE, BADGE NO. & DATE

H 5.4.5 for 1.3.1 A,B, C,D

Clean Fresh Water 225 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

3819P52302A01 ENCLOSURE-04-2 TOTAL 5

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 EXSA-ZCD2 KTR N/A CMWD SYSTEM PIPING GROUP 2

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. S9086-RK-STM-010/CH-505 Rev. 6

B. DWG 506-8507856 Rev. A

C. DWG 506-8507860 Rev. A

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

K

EY

) PARAGRAPH

DESCRIBING

VALVE POSITION

GAGE

USED

(LTR

ACTUAL

LEAKAGE SAT/UNSAT SIGNATURE, BADGE NO. & DATE

H 5.4.5 for 1.3.2 A,B, C

Clean Fresh Water 225 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

3819P52302A01 ENCLOSURE-04-3 TOTAL 5

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 EXSA-ZCD2 KTR N/A CMWD SYSTEM PIPING GROUP 3

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. S9086-RK-STM-010/CH-505 Rev. 6

B. DWG 506-8507857 Rev. A

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

K

EY

) PARAGRAPH

DESCRIBING

VALVE POSITION

GAGE

USED

(LTR

ACTUAL

LEAKAGE SAT/UNSAT SIGNATURE, BADGE NO. & DATE

H 5.4.5 for 1.3.3 A,B Clean Fresh Water 225 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

3819P52302A01 ENCLOSURE-04-4 TOTAL 5

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 EXSA-ZCD2 KTR N/A CMWD SYSTEM PIPING GROUP 4

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. S9086-RK-STM-010/CH-505 Rev. 6

B. DWG 506-8507858 Rev. A

C. DWG 506-8507860 Rev. A

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

K

EY

) PARAGRAPH

DESCRIBING

VALVE POSITION

GAGE

USED

(LTR

ACTUAL

LEAKAGE SAT/UNSAT SIGNATURE, BADGE NO. & DATE

H 5.4.5 for 1.3.4 A,B, C

Clean Fresh Water 225 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

3819P52302A01 ENCLOSURE-04-5 TOTAL 5

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 EXSA-ZCD2 KTR N/A CMWD SYSTEM PIPING GROUP 3A

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. S9086-RK-STM-010/CH-505 Rev. 6

B. DWG 506-8507859 Rev. A

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

K

EY

) PARAGRAPH

DESCRIBING

VALVE POSITION

GAGE

USED

(LTR

ACTUAL

LEAKAGE SAT/UNSAT SIGNATURE, BADGE NO. & DATE

H 5.4.5 for 1.3.5 A,B Clean Fresh Water 225 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

3819P52302A01 ENCLOSURE-05 3

SHEET 2 OF 33819P52302A01

MAPPING PLAN

ENCLOSURE-05

PLAN VIEW

FIFTH DECK, FR 112 – 116, PORT

DETAIL 2-A

SHELL PENETRATION

HJ-3

SHELL

SEE DETAIL 2-A

SHELL AT 5TH DECK

SHELL AT 4TH DECK

SHEET 3 OF 33819P52302A01

MAPPING PLAN

ENCLOSURE-05

PLAN VIEW

FIFTH DECK, FR 88 – 93, PORT

DETAIL 3-A

SHELL PENETRATION

HJ-4

SHELL

SEE DETAIL 3-ASHELL AT 5TH DECK

SHELL AT 4TH DECK

3819P52302A01 ENCLOSURE-06-1 TOTAL 4

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. LCC-19

3. JCN

EXSA-ZCD2

4. CWP/REC SER. NO.

N/A

5. LWC

KTR

6. DATE

20 FEB 2025

7. SYSTEM

PRIMARY STRUCTURE

8. COMPONENT

SHELL PLTG

9. DWG NO.

100-ELM-250136 REV. “-”

10. CWP STEP NO.

5.4.6.2

11. JOINT ID

HJ-1

12. JOINT DESIGN

B2V.1

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:

MIL-STD-1689A

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.

3819P52302A01 ENCLOSURE-06-1 TOTAL 4

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

3819P52302A01 ENCLOSURE-06-2 TOTAL 4

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. LCC-19

3. JCN

EXSA-ZCD2

4. CWP/REC SER. NO.

N/A

5. LWC

KTR

6. DATE

20 FEB 2025

7. SYSTEM

PRIMARY STRUCTURE

8. COMPONENT

SHELL PLTG

9. DWG NO.

100-ELM-250136 REV. “-”

10. CWP STEP NO.

5.4.6.2

11. JOINT ID

HJ-2

12. JOINT DESIGN

B2V.1

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:

MIL-STD-1689A

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

3819P52302A01 ENCLOSURE-06-2 TOTAL 4

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

3819P52302A01 ENCLOSURE-06-3 TOTAL 4

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. LCC-19

3. JCN

EXSA-ZCD2

4. CWP/REC SER. NO.

N/A

5. LWC

KTR

6. DATE

20 FEB 2025

7. SYSTEM

PRIMARY STRUCTURE

8. COMPONENT

SHELL PLTG

9. DWG NO.

506-8507859 REV. “A”

10. CWP STEP NO.

5.4.8.3

11. JOINT ID

HJ-3

12. JOINT DESIGN

CLAD WELD

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:

MIL-STD-1689A

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…