TGI_3819P55107A01_c0v0_redact.pdf

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FOUO: Public availability to be determined under 5 USC 552

TASK GROUP INSTRUCTION

AIM REV 20.11.4.0 (OCTOBER 2020)

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

NO.: S/A72976K CHT TK AIR 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 72976K, ACCOMPLISH CHT TANK AERATION UPGRADE

PREPARING ACTIVITY:

PREPARED BY: CODE PHONE DATE

HIDEKUNI SHINMEI 234. 315-243-2371 20 FEB 2025

APPROVED BY: CODE PHONE DATE

HIDEO HARADA 234. 315-243-5176 20 FEB 2025

CONCURRED BY: CODE PHONE DATE

CONCURRED BY: CODE PHONE DATE

CONCURRED BY: CODE PHONE DATE

CONCURRED BY: CODE PHONE DATE

REASON FOR WORK/NEED FOR CHANGE:

CHANGE INSTRUCTIONS:

SPECIAL REQUIREMENTS:

CLEANLINESS FOR PIPING SYSTEM/EQUIPMENT LEVEL II.

CLEANLINESS FOR PIPING SYSTEM/EQUIPMENT LEVEL III.

CLASS P-2 PIPING.

CLASS P-3b PIPING.

THIS WORK AFFECTS A FIRE AONE 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.: S/A72976K CHT TK AIR AY A 0

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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.

1-15 QA28

(1-10)

J1-2 Map (1-2)

M1-3 QA20

(1-2)

QA28

(1-2)

1. SCOPE/PURPOSE

1.1 Title: S/A 72976K Collection, Holding and Transfer (CHT) Tank Aeration Upgrade; accomplish

1.2 Location of Work:

1.2.1 Wardroom Galley (3-34-0-Q)

1.2.2 Passage (3-40-1-L)

1.2.3 Ladies Room (3-50-1-L)

1.2.4 Legal Office (3-89-1-Q)

1.2.5 Fan Room (3-98-3-Q)

1.2.6 Crew and Troop Messroom and FWD Battle Dressing STA (4-30-0-L)

1.2.7 Fan Room (4-30-5-Q)

1.2.8 FWD Repair No. 2 (4-30-7-Q)

1.2.9 Load Center No. 11 (4-34-1-Q)

1.2.10 Galley (4-52-0-Q)

1.2.11 Passage (4-52-2-L)

1.2.12 Bakery (4-59-0-Q)

1.2.13 Crew Living Space (Staff) (5-30-01-L)

1.2.14 Crew Living Space (5-52-0-L)

1.2.15 N4 (C7F) Storeroom (6-30-1-A)

1.2.16 Main GSK/SD Storeroom (6-40-0-A)

1.2.17 Storeroom (6-52-4-A)

1.2.18 Passage (6-61-2-L)

1.2.19 Learning Resouce Center (6-64-6-Q)

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

1.2.20 Shipfitter Storeroom (6-86-2-A)

1.2.21 EIC (6-72-2-Q)

1.2.22 B Division Storeroom (6-76-2-A)

1.2.23 AC MCHRY Room No. One and Refer MCHRY Room (7-40-0-E)

1.2.24 Trunk (7-40-5-T)

1.2.25 SD Storeroom (7-48-0-A)

1.2.26 SD Storeroom No. One (7-98-1-A)

1.2.27 Medical Storeroom (7-98-2-A)

1.2.28 Fire Room (8-76-0-E)

1.2.29 Engine Room (8-86-0-E)

1.2.30 Fueling Station No. One, Frames between 50 and 52, Starboard (Stbd)

1.2.31 Fueling Station No. 3, Frames between 96 and 102, Stbd

1.2.32 Underwater Hull, Weather, Frames between 31 and 32, Stbd

1.2.33 Freeboard Weather, Frames between 31 and 32, Stbd

1.2.34 Underwater Hull, Weather, Frames between 53 and 54, Port

1.2.35 Freeboard Weather, Frames between 53 and 54, Port

1.2.36 Freeboard Weather, Frames between 51 and 52, Stbd

1.2.37 Distillate Fuel or Ballast (9-40-0-F)

1.2.38 Clean Salt Water Ballast (9-40-1-W)

1.2.39 Clean Salt Water Ballast (9-40-2-W)

1.2.40 CHT Tank No. One (8-48-0-W)

1.2.41 Distillate Fuel Marine Tank (8-48-2-F)

1.2.42 Distillate Fuel or Ballast (9-86-1-F)

1.2.43 Oily Waste Holding Tank (9-90-0-F)

1.2.44 Waste Oil Tank (9-94-0-F)

1.2.45 CHT Tank No. 3 (8-98-1-W)

1.2.46 CHT Tank No. 4 (8-98-2-W)

1.2.47 Clean Salt Water Ballast (9-98-1-W)

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1.2.48 Intel Storeroom (7-102-1-A)

1.3 Identification:

1.3.1 Quantity (One Lot), Structural Work for S/A 72976K CHT Tank Aeration Upgrade

Remarks: See 2.3 through 2.5 for material and detail

1.3.2 Quantity (One Lot), Sheet Metal Work for S/A 72976K CHT Tank Aeration Upgrade

Remarks: See 2.6 for material and detail

1.3.3 Quantity (62 SF in Total), Foundation of Blower for CHT Tank Aeration in 7-40-0-E, including bilge area, where new material is installed and disturbed by the hot work

1.3.3.1 Quantity (31 SF), Foundation of Blower, Frames between 45 and 47, Stbd

Remarks: See Sheet 2 Key Plan 14-B and Sheet 3 Plan 18-A of 2.3 for location detail

1.3.3.2 Quantity (31 SF), Foundation of Blower, Frames between 46 and 48, Port

Remarks: See Sheet 2 Key Plan 14-B and Sheet 3 Plan 21-A of 2.3 for location detail

1.3.4 Quantity (111 SF in Total), Foundation of Blower for CHT Tank Aeration in 8-86-0-E, including grating support and bilge area, where new material is installed and disturbed by the hot work

1.3.4.1 Quantity (54 SF), Foundation of Blower, Frames between 91 and 93, Stbd

Remarks: See Sheet 2 Key Plan 11-B and Sheet 4 Plan 26-A of 2.3 for location detail

1.3.4.2 Quantity (57 SF), Foundation of Blower, Frames between 92 and 94, Stbd

Remarks: See Sheet 2 Key Plan 14-B and Sheet 5 Plan 34-A of 2.3 for location detail

1.3.5 Quantity (15 SF), Interior Surface of Distillate Fuel or Ballast (9-40-0-F), Frames between 45 and 47, Stbd, where new material is installed and disturbed by the hot work

Remarks: See Sheet 2 Key Plan 14-B and Sheet 3 Plan 18-A of 2.3 for location detail

1.3.6 Quantity (25 SF), Interior Surface of Clean Salt Water Ballast Tank (9-40-2-W), Frames between 46 and 48, Port, where new material is installed and disturbed by the hot work

Remarks: See Sheet 2 Key Plan 14-B and Sheet 3 Plan 21-A of 2.3 for location detail

1.3.7 Quantity (15 SF), Interior Surface of Clean Salt Water Ballast Tank (9-40-1-W), Frames between 45 and 47, Stbd, where disturbed by hot work

Remarks: See Sheet 2 Key Plan 14-B and Sheet 3 Plan 18-A of 2.3 for location detail

1.3.8 Quantity (15 EA), Machinery Work for S/A 72976K

1.3.8.1 Quantity (2 EA), New Low Pressure Air Valve

Part No.:803-4384536-71B1AF Type: Globe, In-Line Stop Size: 1.50 Inch IPS Item No.: V1 (Label Plate No. L-1 and L-2) of 2.11

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

1.3.8.2 Quantity (2 EA), New Low Pressure Air Valve

Part No.:803-4384536-61B1AF Type: Globe, In-Line Stop Size: 1.25 Inch IPS Item No.: V1 (Label Plate No. L1 and L2) of 2.12

1.3.8.3 Quantity (4 EA), New Low Pressure Air Valve

Part No.:803-4384536-11B1AF Type: Globe, In-Line Stop Size: 0.25 Inch IPS Item No.: V1 (Label Plate No. L1 (Frame 50 and 100) and L7 (Frame 51 and 96)) of 2.15

1.3.8.4 Quantity (4 EA), New Low Pressure Air Valve

Specification: MIL-V-22549 Type: Relief Size: 1.00 Inch IPS Item No.: V5 (Label Plate No. L4 and L5) of 2.13 and V5 (Label Plate No. L5 and L6) of 2.14

1.3.8.5 Quantity (3 EA), Remote Operating Gear for Label Plate No. L2, L5, and L6 of 2.9 Remarks: See 2.9 and 2.10 for material and detail.

1.3.9 Quantity (One EA), Power System

Remarks: See 2.20, 2.22, 2.23, 2.25 and 2.26 for details.

1.3.10 Quantity (One EA), Lighting System

Remarks: See 2.21 and 2.22 for details.

1.3.11 Quantity (One EA), Interior Communication System

Remarks: See 2.22 and 2.31 for details.

1.3.12 Quantity (One EA), Controller for Collection, Holding and Transfer (CHT) Aeration Motor for Tank 8-98-1-W Remarks: See 2.20 for details.

1.3.13 Quantity (One EA), Controller for CHT Aeration Motor for Tank 8-98-2-W Remarks: See 2.20 for details.

1.3.14 Quantity (One EA), Controller for Starboard CHT Aeration Motor Remarks: See 2.20 for details.

1.3.15 Quantity (One EA), Controller for Port CHT Aeration Motor Remarks: See 2.20 for details.

1.3.16 Quantity (One Lot), Various System Piping and Low Pressure Air (LP) CHT Tank Aeration Blower for S/A 72976K

1.3.16.1 Quantity (One Lot), CHT Tank Aeration System Blower

See 2.13, 2.14, 2.18, 2.24, 2.25 and 2.26 for details

1.3.16.2 Quantity (One Lot), Main Lube Oil (LO) Drain and After Journal Bearing Drain Piping Remarks: See 2.29 for details

1.3.16.3 Quantity (One Lot), Forward and After Shore LP Air Piping Remarks: See, 2.11, 2.12 and 2.30 for details

1.3.16.4 Quantity (One Lot), Forward and After LP Air Piping for CHT Tank Aeration Blower

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

Remarks: See 2.13, 2.14 and 2.32 for details

1.3.16.5 Quantity (2 EA), Air Filter for Shore LP Air Piping

Remarks: See Revision Note and Sheet of 2.33 for details

1.3.16.6 Quantity (One Lot), LP Air Piping for CHT Blowback

Remarks: See 2.15 and Sheet 40 of 2.40 for details

1.3.16.7 Quantity (2 AY), Gas Sampling Valve and Piping for CHT Tank No. 3 and No. 4 Remarks: See 2.34 and 2.35 for details

1.3.16.8 Quantity (One Lot), Auxiliary (AUX) Seawater Cooling Piping Remarks: See 2.36 for details

1.3.16.9 Quantity (One Lot), Oily Waste Transfer Piping

Remarks: See 2.37 for details

1.3.16.10 Quantity (One Lot), Oily Waste Drain Piping

Remarks: See 2.38 for details

1.3.16.11 Quantity (One Lot), Dirty Drain Piping

Remarks: See 2.39 for details

1.3.16.12 Quantity (One Lot), Plumbing Drain Piping

Remarks: See 2.9 for details

1.4 Security Classification: None.

1.5 Initial Condition:

1.5.1 Dry Dock Work.

1.5.2 Potential Asbestos Hazard.

1.5.3 Potential Lead Hazard.

1.6 Contractor work start date:

1.7 Contractor work complication 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 DWG 113-

8274445

FOUNDATIONS CHT AERATION

UPGRADE (7-40-0-E) & (8-86-0-E)

B Y AL

L

4 LAR SRFY-

0002-A-25

DRAWING CORRECTION AND

DESIGN CHANGE FOR CHT

AERATION BLOWER NO. 2 FDN

- Y AL

L

5 DWG 603-

8274464

FLOOR PLATING

MODIFICATIONS INCIDENT CHT

AERATION UPGRADE ENGINE

ROOM (8-86-0-E)

B Y AL

L

6 DWG 501-

8353356

DUCT MOD R5-63-1 CREW

LIVING SPACE (5-52-0-L)

A Y AL

L

1/12/2026

5/15/2027

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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

7 TM T-9630-

AB-MMD-

Corrosion Control Assessment and Maintenance Manual (CCAMM)

3 N

8 TM NAVSEA

4790/14

Tank and Void Structural and Coating Condition Survey (MRC G1N5)

- N

9 DWG 505-

8472433

PLUMBING DRAIN PIPING MODS

GARBAGE DISPOSAL DRAIN

MODS 3RD DK AND BLW, FR 30-

A Y AL

L

10 LAR

2976/LCC19/

25L034

CORRECTION FOR ROG OF GBG

GRINDER WASTE DR OVBD

DISCH "6-32-1" INSTALLATION

- Y AL

L

11 DWG 513-

8274302

LP AIR SYS MODS SHORE AIR

PIPING INSTALLATION FWD CHT

B Y AL

L

12 DWG 513-

8274301

LP AIR SYS MOD SHORE AIR PP

INSTL AFT CHT

B Y AL

L

13 DWG 513-

8274498

PIPING INSTALLATION AFT CHT

TANK COMPRESSORS

B Y AL

L

14 DWG 513-

8274499

LP AIR SYS PIPING

INSTALLATION FWD CHT TANK

B Y AL

L

15 DWG 513-

8472432

CHT SYSTEM UPGRADE LP AIR

MODS FOR CHT BLOW BACK

3RD DK, FR 51-101 STBD,

WEATHER

A Y AL

L

16 DWG 803-

4384536

Valves; Bronze; 1/4"-2" Union End;

Globe; In-Line & Angle; Stop Check & Needle

N N

17 TM 0948-LP-

012-5000

Standard Navy Valves 32 N

18 DWG 513-

8274303

LOW PRESSURE AIR SYS CHT

TANK AERATION PP DIAGRAM

B Y AL

L

19 TM S9086-

RK-STM-

010/CH505

PIPING SYSTEMS 6 N

20 DWG 302-

8274440

POWER MODIFICATION CHT

AERATION UPGRADE

B Y AL

L

21 DWG 303-

8786995

LIGHTING SYSTEM

MODIFICATIONS CHT TANK

AERATION UPGRADE

- Y AL

L

22 PDD

302/303-

ELM-250183

SUPPL INFO FOR SOD 2976 CHT

AERATION UPGRADE

- Y AL

L

23 LAR SRFY-

0280-24

Drawing discrepancy and adjust location of new motor controllers

- Y AL

L

24 DWG 513-

8274465

PROCUREMENT SPEC INCID

CHT AERATION UPGRADE

B Y AL

L

25 DWG 545-

8274462

CHT AERATION UPGRADE

ARRANGEMENT ENGINE ROOM

C Y AL

L

26 DWG 545-

8274463

A/C MACHY ROOM NO.1

ARANGEMENT CHT AERATION

UPGRADE 7-40-0-E

A Y AL

L

27 MIL MIL-

STD-2003

Electric Plant Installation Standard Methods for Surface Ships and Submarines

B N

28 TM S9AA0-

AB-GOS-

010/GSO

General Specifications for Overhaul of Surface Ships (GSO)

11 N

29 DWG 211-

8783624

MAIN LUBE OIL DRAIN

MODIFICATION INCIDENTAL TO

CHT ENGINE ROOM 8-86-0-E

- Y AL

L

30 LAR

72976/LCC1

9/25L156

SCD2976 STRENGTH TEST

PRESSURE CORRECTION

- Y AL

L

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REF.

NO.

DOCUMENT

/DRAWING

NUMBER

DOCUMENT/DRAWING TITLE REV CHG

NO.

COPY

REQ’D

(Y/N)

SOURCE

DOC

(Y/N)

PARA SEC PG CHP

31 DWG 401-

8787141

IC CIRCUIT FD RELOCATION

INCIDENTAL TO CHT TANK

AERATION UPGRADE

- Y AL

L

32 DWG 545-

1916591

GAGE BOARDS STANDARD

SIZES

K Y AL

L

33 DWG 513-

8274500

LP AIR SYS SHORE AIR PIPING

UPGRADE INSTALLATION

B Y AL

L

34 DWG 505-

8472430

CHT SYSTEM UPGRADE INSTALL

GAS SAMPLING VALVES 2ND

PLATF, CHT TANKS NO.3 & 4

A Y AL

L

35 LAR

72976/LCC1

9/25L155

SCD2976 PIPING

CLASSIFICATION CORRECTION

- Y AL

L

36 DWG 209-

8783527

AUX SW COOLING SYS PP MODS

INCID TO CHT TK UPGRADE

ENGINE ROOM

- Y AL

L

37 DWG 508-

8783526

OILY WASTE TRANSFER MOD

INCID TO CHT TANK UPGRADE

ENGINE ROOM

- Y AL

L

38 DWG 508-

8783550

OILY WASTE DRAIN PP MOD

INCID TO CHT TANK UPGRADE

ENGINE ROOM

- Y AL

L

39 DWG 514-

8783528

DIRTY DRAIN PIPING MOD INCID

CHT TK UPGRD ENGINE ROOM

- Y AL

L

40 DWG 810-

6071616

Auxiliary Gageboard Details & Typical Supports

- Y 40

41 DWG 810-

4714432

STD Pipe Hangers Fabrication

DETS & INSTL

L N

42 MIL MIL-

STD-1627

Bending of Pipe or Tube for Ship Piping Systems

C N

43 TM S9086-

HK-STM-

010/CH-241

Propulsion Reduction Gears, Couplings, Clutches, and Associated Components

4 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 Pump out, clean and dry the bilge area located in 1.2.23 and 1.2.29 free from oil, debris, and other foreign matter.

5.2 Accomplish each structural work for S/A 72976K listed in 1.3.1 in accordance with 2.3 through 2.5.

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

5.3 Accomplish each sheet metal work for S/A 72976K listed in 1.3.2 in accordance with 2.6.

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

5.4 Accomplish the requirements of 009-32 of 2.1, including Table 3, Line(s) 13, for each equipment and area listed in 1.3.3 and 1.3.4.

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5.5 Accomplish the requirements of 009-32 of 2.1, including Table 4, Line(s) 11, for each area listed in 1.3.5 and Table 4, Line(s) 17, for each area listed in 1.3.6 and 1.3.7.

5.5.1 Submit new coating data applied to the SUPERVISOR in accordance with 2.7 and 2.8.

5.6 Accomplish machinery work for S/A 72976K listed in 1.3.8 in accordance with 2.9 through 2.15.

5.6.1 Accomplish a bonnet ring torque check of each new valve listed in 1.3.8.1 through 1.3.8.3, using 2.16 and 2.17 for guidance

5.6.1.1 Tighten the bonnet ring of each valve in accordance with Table 4.3.5-10 of 2.17.

5.6.2 Accomplish a mechanical joint tightness test of each new valve listed in 1.3.8.1 through 1.3.8.3 for body-to-bonnet joint tightness with stem in the half-open position, using clean fresh water at 150 PSIG for a minimum of 3 minutes, using 2.18 for guidance. Allowable external leakage: None.

(V)(G) “MECHANICAL JOINT TIGHTNESS TEST”

5.6.2.1 Hydrostatic test equipment must conform to the requirements in paragraph 505-11.1.3 of 2.19.

5.6.2.2 Document hydrostatic test results on QA Form 28 Enclosure-01-1.

5.6.2.3 Remove test fluid and dry interior and exterior surfaces. Allowable residual fluid: None.

5.6.3 Accomplish a shop test and setting of each new valve listed in 1.3.8.4, using 2.13 and 2.14 for guidance.

(I) “LIFTING TEST”

5.6.3.1 Hydrostatic test equipment must conform to the requirements in paragraph 505-11.1.3 of 2.19.

5.6.3.2 Ensure the test medium is clean dry air.

5.6.3.3 Ensure the lifting pressure is 13 PSIG.

5.6.3.4 Document hydrostatic test results on QA Form 28 Enclosure-01-2.

5.6.3.5 Attach a metal tag to each valve, stamped with ship name and hull number, valve number or identification, valve lifting pressure, and date valve tested and set.

5.6.4 Install each new remote operating gear listed in 1.3.8.5 in accordance with 2.9 and 2.10.

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

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

5.6.4.3 Lubricate each helix cable with new silicon grease conforming to A-A-59173.

5.6.4.4 Engrave each turns indicator plate in accordance with detail 63-A of 2.9.

5.6.4.5 Verify each remote operating gear for ease of operation and alignment by opening and closing each valve from its remote operating station through 3 complete cycles. Allowable binding: None.

(V) “VALVE CYCLING” (Label Plate No. L2 of 2.9)

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(V) “VALVE CYCLING” (Label Plate No. L5 of 2.9)

(V) “VALVE CYCLING” (Label Plate No. L6 of 2.9)

5.7 Accomplish electrical removals, modifications and installations of the system listed in 1.3.9 through 1.3.11 in accordance with 2.20 through 2.26 and 2.31.

5.7.1 Electrical installations must be in accordance with 2.27.

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

5.8 Inspect each protective device of the equipment listed in 1.3.12 through 1.3.15.

5.8.1 Verify that size and setting of each overload heater are correctly used under full load running current of each motor in accordance with Section 302g of 2.28, using 2.20 for guidance.

(V) "SIZE/SETTING"

5.8.2 Verify that each fuse is correctly sized in accordance with Section 302g of 2.28, using 2.20 for guidance.

(V) "SIZE"

5.9 Remove, fabricate and install new each various piping for accomplishment of S/A 72976K listed in 1.3.16 in accordance with 2.9, 2.11 through 2.15, 2.18, 2.29, 2.30 and 2.32 through 2.40.

5.9.1 Accomplish the requirement of 099-906YO of 2.2 for LO system listed in 1.3.16.2.

5.9.2 Accomplish the requirements of 009-09 of 2.1.

5.9.3 Notify the Ship’s Engineering Officer before opening the LO system piping listed in 1.3.16.2.

5.9.4 Establish clean work area as follow.

5.9.4.1 An area requiring a cleanliness/ accountability level at least equal to that required for in-shop repair of similar equipment to permit the easy recovery of any dropped tools, material, etc. This area shall be free of excess moisture and contaminants, i.e., abrasive materials resulting from blasting, grinding, or other particle generating processes.

(V)(G) “CLEAN WORK AREA”

5.9.5 Remove each existing main LO drain and after journal bearing drain piping listed in 1.3.16.2 for accomplishment piping work of S/A 72967K in accordance with 2.29.

5.9.5.1 Disestablish the clean work area after Cleanliness Level II is maintained.

5.9.6 Bend pipe in accordance with 2.42.

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

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

5.9.8.1 Document shop hydrostatic test results on QA Form 28 Enclosure-02-1.

5.9.9 Accomplish the requirements of 009-71 of 2.1 for hydrostatic test, using clean, fresh water at 50 PSIG, for each new and disturbed LP air CHT tank aeration blower piping systems.

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5.9.9.1 Document shop hydrostatic test results on QA Form 28 Enclosure-02-2.

5.9.10 Accomplish the requirements of 009-71 of 2.1 for hydrostatic test, using clean, fresh water at 189 PSIG, for each new and disturbed LP air for CHT shore connection blowback piping systems.

5.9.10.1 Document shop hydrostatic test results on QA Form 28 Enclosure-02-3.

5.9.11 Accomplish the requirements of 009-71 of 2.1 for hydrostatic test, using clean, fresh water at 50 PSIG, for each new and disturbed CHT tank gas sampling piping systems.

5.9.11.1 Document shop hydrostatic test results on QA Form 28 Enclosure-02-4.

5.9.12 Accomplish the requirements of 009-71 of 2.1 for hydrostatic test, using clean, fresh water at 84 PSIG, for each new and disturbed AUX seawater cooling piping systems.

5.9.12.1 Document shop hydrostatic test results on QA Form 28 Enclosure-02-5.

5.9.13 Accomplish the requirements of 009-71 of 2.1 for hydrostatic test, using system fluid at 50 PSIG, for each new and disturbed lube oil drain piping systems.

5.9.13.1 Document shop hydrostatic test results on QA Form 28 Enclosure-02-6.

5.9.14 Accomplish the requirements of 009-71 of 2.1 for hydrostatic test, using clean, fresh water at 149 PSIG, for each new and disturbed oily waste transfer piping systems.

5.9.14.1 Document shop hydrostatic test results on QA Form 28 Enclosure-02-7.

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

5.9.15.1 Document shop hydrostatic test results on QA Form 28 Enclosure-02-8.

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

5.9.16.1 Document shop hydrostatic test results on QA Form 28 Enclosure-02-9.

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

5.9.17.1 Document shop hydrostatic test results on QA Form 28 Enclosure-02-10.

5.9.18 Notify the Ship’s Engineering Officer before opening the LO piping listed in 1.3.16.2 to establish and maintain a physical security watch.

5.9.19 Establish clean work area as follow.

5.9.19.1 An area requiring a cleanliness/ accountability level at least equal to that required for in-shop repair of similar equipment to permit the easy recovery of any dropped tools, material, etc. This area shall be free of excess moisture and contaminants, i.e., abrasive materials resulting from blasting, grinding, or other particle generating processes.

(V)(G) “CLEAN WORK AREA”

5.9.20 Prior to final closure of the LO piping listed in 1.3.16.2, verify no foreign material has entered or remains in the system in accordance with Paragraph 241-5.2.1 of 2.43.

FOUO

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

5.9.21 Final close inspection must be made jointly with the SUPERVISOR and the ship’s Engineering Officer or designated representative.

(V)(G) “CLEANLINESS”

5.9.22 Install new main LO drain and after journal bearing drain piping listed in 1.3.16.2 in accordance with 2.29.

5.9.23 Disestablish the clean work area.

5.9.24 Install new label plate(s) using, 2.9, 2.11 through 2.15 and 2.18 for guidance.

5.9.25 Install new pipe hanger(s) in accordance with 2.41.

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

5.9.27 Accomplish the requirements of 009-25 of 2.1 for air hose test of new weld on pipe penetration sleeve and plumbing drain penetration sleeve on shell plating. Allowable leakage: None

5.9.28 Accomplish clad weld of penetration sleeve on shell plating in accordance with 2.9.

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

5.9.28.2 Accomplish nondestructive testing in accordance with Line 10.

5.9.28.3 Accomplish the requirements of 099-911YO of 2.2, using QA Form 20 Enclosure-04-1 and Enclosure-04-2.

Each joint identification number must be in accordance with Mapping Plan Enclosure-03.

5.9.28.4 Accomplish the requirements of 009-09 of 2.1 for welding procedure of each joint shown on Mapping Plan Enclosure-03.

5.9.29 Accomplish the requirements of 009-25 of 2.1 for running air test of new weld on CHT gas sampling piping listed in 1.3.16.7. Allowable leakage: None

5.9.30 Accomplish flow check of plumbing drain and dirty drain piping listed in 1.3.16.11 and 1.3.16.12, using clean, fresh water. Allowable external leakage: None.

(V)(G) "FLOW CHECK"

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

(V) "VALVE CYCLING" (Label Plate No. L1 of 2.9)

(V) "VALVE CYCLING" (Label Plate No. L2 of 2.9)

(V) "VALVE CYCLING" (Label Plate No. L3 of 2.9) (2EA)

(V) "VALVE CYCLING" (Label Plate No. L4 of 2.9) (3EA)

(V) "VALVE CYCLING" (Label Plate No. L5 of 2.9)

(V) "VALVE CYCLING" (Label Plate No. L6 of 2.9)

(V) "VALVE CYCLING" (Label Plate No. L-1 of 2.11)

(V) "VALVE CYCLING" (Label Plate No. L-2 of 2.11)

FOUO

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

(V) "VALVE CYCLING" (Label Plate No. L-3 of 2.11)

(V) "VALVE CYCLING" (Label Plate No. L-4 of 2.11)

(V) "VALVE CYCLING" (Label Plate No. L-6 of 2.11)

(V) "VALVE CYCLING" (Label Plate No. L1 of 2.12)

(V) "VALVE CYCLING" (Label Plate No. L2 of 2.12)

(V) "VALVE CYCLING" (Label Plate No. L3 of 2.12)

(V) "VALVE CYCLING" (Label Plate No. L4 of 2.12)

(V) "VALVE CYCLING" (Label Plate No. L5 of 2.12)

(V) "VALVE CYCLING" (Label Plate No. L1 of 2.14)

(V) "VALVE CYCLING" (Label Plate No. L2 of 2.14)

(V) "VALVE CYCLING" (Label Plate No. L3 of 2.14)

(V) "VALVE CYCLING" (Label Plate No. L4 of 2.14)

(V) "VALVE CYCLING" (Label Plate No. L7 of 2.14)

(V) "VALVE CYCLING" (Label Plate No. L8 of 2.14)

(V) "VALVE CYCLING" (Label Plate No. L10 of 2.14)

(V) "VALVE CYCLING" (Label Plate No. L11 of 2.14)

(V) "VALVE CYCLING" (Label Plate No. L1 of 2.13)

(V) "VALVE CYCLING" (Label Plate No. L2 of 2.13)

(V) "VALVE CYCLING" (Label Plate No. L3 of 2.13)

(V) "VALVE CYCLING" (Label Plate No. L6 of 2.13)

(V) "VALVE CYCLING" (Label Plate No. L7 of 2.13)

(V) "VALVE CYCLING" (Label Plate No. L9 of 2.13)

(V) "VALVE CYCLING" (Label Plate No. L10 of 2.13)

(V) "VALVE CYCLING" (Label Plate No. L12 of 2.13)

(V) "VALVE CYCLING" (Label Plate No. L1 of 2.15) (2EA)

(V) "VALVE CYCLING" (Label Plate No. L2 of 2.15) (2EA)

(V) "VALVE CYCLING" (Label Plate No. L7 of 2.15) (2EA)

(V) "VALVE CYCLING" (Label Plate No. L1 of 2.34)

FOUO

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

(V) "VALVE CYCLING" (Label Plate No. L2 of 2.34)

5.10 Accomplish the requirements of 009-11 of 2.1 for installation of new insulation and lagging in accordance with 2.36.

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

5.12 Notes:

5.12.1 Planner: Code 234 H. Shinmei, 243-2371

Planner: Code 231B T. Ando, 243-4372 Planner: Code 232 R. Muramoto, 243-0089 Planner: Code 233 K. Uchimura, 080-9350-1432 Engineer: Code 250 T. Ukigai, 243-0954 Engineer: Code 260 K. Sakai, 243-4342 Engineer: C270 M. Nakayama, 243-6677

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

5.12.3 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 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.

5.12.4 Opening, initial cleaning, and closing of each space listed in 1.2.37 through 1.2.47 will be covered by the following TGI No(s).

Distillate Fuel or Ballast (9-40-0-F): 3819P12316A01 (KTR TGI).

Clean Salt Water Ballast (9-40-1-W): 3819P12316A01 (KTR TGI).

Clean Salt Water Ballast (9-40-2-W): 3819P12337A01 (KTR TGI).

CHT Tank No. One (8-48-0-W): 3819P12355A01(KTR TGI).

Distillate Fuel Marine Tank (8-48-2-F): 3819P12305A01 (KTR TGI).

Distillate Fuel or Ballast (9-86-1-F): 3819P12319A01 (KTR TGI).

Oily Waste Holding Tank (9-90-0-F): 3819P12351A01 (KTR TGI).

Waste Oil Tank (9-94-0-F): 3819P12352A01 (KTR TGI).

CHT Tank No. 3 (8-98-1-W): 3819P12356A01 (KTR TGI).

CHT Tank No. 4 (8-98-2-W): 3819P12357A01 (KTR TGI).

Clean Salt Water Ballast (9-98-1-W): 3819P12344A01 (KTR TGI).

5.12.5 Preservation work for new and disturbed exterior surfaces of underwater hull and freeboard weather will be covered by TGI No(s). 3819P11001A01 (KTR TGI).

5.12.6 Preservation work for new and disturbed interior surface of each space listed in 1.2.42 and 1.2.43 will be covered by the following TGI No(s).

Distillate Fuel or Ballast (9-86-1-F): 3819P12319A01 (KTR TGI).

Oily Waste Holding Tank (9-90-0-F): 3819P12351A01 (KTR TGI).

5.12.7 Location of Work 1.2 are according to booklet DWG 845-2491606 Rev. X.

5.12.8 JCN: EXSA-ZBV2 is related to this TGI.

5.13 Government Furnished Material (GFM):

FOUO

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

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

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

5.14 SRF-JRMC will provide the following service work: (TGI No. 3819P55107S02)

5.14.1 [C740] Crane and crane rigging service.

5.14.2 [X99E] Utility service, electrical.

5.14.3 [X99M] Utility service, including water supply, steam supply, and low pressure air except for onboard blasting work.

5.14.4 [C106.1] Provide safety inspection for SRF-JRMC employees.

5.14.5 [C106.2] Provide gas free inspection for SRF-JRMC employees.

5.14.6 [C133] QA Inspection for (G) symbol (s) and review of coating application data.

5.14.7 [C135] QA Inspection for (G) symbol (s).

FOUO

J-1

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

APPENDIX "J"

TGI JOB SUMMARY INFORMATION SHEET

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

VERSION:

CASREP

CAT:

S/A72976K CHT TK AIR AY A 0 0

CU PHASE TITLE:

(RE) F/O - S/A 72976K, ACCOMPLISH CHT TANK AERATION UPGRADE

PRIMARY COMPONENT:

COMPONENT UNIT LIST (FOR ASSEMBLIES):

LPA 7-86-2 V- LPA 7-47-2 V- LPA 6-86-2 V- CHT AER S 8-48-0-W MO CHT AER P 8-

48-0-W MO CHT AER 8-98-2-W MO CHT AER 8-98-1-W MO CHT AER 8-48-0-W ID CHT

AER S 8-48-0-W CT CHT AER P 8-48-0-W CT CHT AER 8-98-2-W CT CHT AER 8-98-1-W CT

CMPT 6-30-1-A MSBLST 9-40-1-W TK FO STOR 8-48-2-F TK FO/BLST 9-86-1-F TK

CHT 8-98-1-W TK CMPT 4-52-2-L MSFB FR F-40 STBD FB LP AIR 3RD DK WEA S PP

FO/BLST 9-40-0-F TK BLST 9-98-1-W TK CMPT 5-30-01-L MS LPA 8-97-7 V-

LPA AER BLO#1A RLF V- LPA AER BLO#1B RLF V- LPA AER BLO#2A RLF V- LPA AER

BLO#2B RLF V- LP AIR 8-86-0-E PP WO 9-90-0-F TK CMPT 6-52-4-A MSPLMB DR 4-30-0-L

PP FB FR 40-98 STBD FB (5-63-2)-1L-H9 LF CMPT 7-40-0-E MSCMPT 8-86-0-E MSWO 9-

94-0-F TK CMPT 4-30-7-Q MS BLST 9-40-2-W TK CHT 8-48-0-W TK CHT 8-98-2-W TK

CMPT 5-52-0-L MSUH FWD-FR40 STBD UH UH FR40-98 PORT UH CKT FD IC

LPA 6-32-1 OP LPA 6-53-2 OP LPA 6-55-2 OP FB FR 40-98 PORT FB OWD

8-86-0-E STM PP POL CTL 8-86-0-E PP LP AIR 8-86-0-E HS LP AIR 7-40-0-E PP LP AIR 6-40-0- A PP LP AIR 6-52-4-A PP LP AIR 6-61-2-L PP LP AIR 6-64-6-Q PP LP AIR 6-72-2-Q PP LP AIR 6-76-2-A PP LP AIR 6-86-2-A PP PLMB DR 4-30-7-Q PP PLMB DR 5-30-0-L PP PLMB DR 6-

30-1-A PP PLMB DR 5-52-0-L PP PLMB DR 6-52-4-A PP LO 8-86-0-E PP LO 8-86-0-E

PP SEW 7-98-2-A PP SEW 7-98-1-A PP ASW 8-86-0-E PP LPA AER BLO#1A BL LPA

AER BLO#1B BL LPA AER BLO#2A BL LPA AER BLO#2B BL ASW 8-86-0-E IN

ATTACHMENT LIST:

1. ENCLOSURE-01 (3819P55107A01-QA28-01.docx) saved on 14-FEB-2025 0000.

2. ENCLOSURE-02 (3819P55107A01-QA28-02.docx) saved on 14-FEB-2025 0000.

3. ENCLOSURE-03 (3819P55107A01-Map.pdf) saved on 12-FEB-2025 0000.

4. ENCLOSURE-04 (3819P55107A01-QA20.docx) saved on 12-FEB-2025 0000.

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

YAGINUMA ,TAKEHIDE

JO: KO: TOTAL MAN HRS: PLANNING ACCEPTANCE:

3819P55107 A01

TOTAL MAT’L COST TOTAL DURATION:

CU PHASE DESCRIPTION:

The purpose of this TGI is to accomplish S/A 72976K CHT tank Aeration.

Location of Work:

See Paragraph 2.1 in TGI 3819P55107A01.

TASK NAME

SHOP TSD/WC TS CREW# MHRS

HIGH RAD

HOURS

RC

GRID#

5.1 SFTR , LBR 22 KE PC

5.2 SFTR , WELD , PNTR , ELEC , QA 22 KE PC

5.3 SMTL , WELD , INSL , PNTR: , RGRS:, QA 22 KE PC

5.4 PNTR , QA 22 KE PC

5.5 PNTR , CARP QA 22 KE PC

FOUO

J-2

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

TASK NAME

SHOP TSD/WC TS CREW# MHRS

HIGH RAD

HOURS

RC

GRID#

5.6 OMCH , IMCH , SFTR , WELD , SMTL INSL , CARP ,

RGRS , PNTR , QA

22 KE PC

5.7 ELEC , SFTR , WELD , SMTL , INSL , RGRS , PNTR , QA 22 KE PC

5.8 ELEC 22 KE PC

5.9 PFTR , WELD , IMCH , BLRM , OMCH SFTR , SMTL

INSL , CARP , RGRS , PNTR , QA , ELEC .

22 KE PC

5.10 INSL 22 KE PC

5.11 PNTR , QA 22 KE PC

Structure Work CFM: for lead analysis cost, firewatch cost, tankwatch cost, fastener, air compressor rental cost and fuel oil cost for air hose test, asbestos sampler cost and analysis cost for compartment insulation and deck covering, and misc such as electrode, gases, temporary covering and closure material, and other consumable.

22 MQ CS

Sheet Metal Work CFM: for asbestos sampler cost and analysis cost for duct insulation, fastener, and misc such as electrode, gases, and other consumable.

22 MQ CS

Preservation Work CFM: for all paints, thinner, grits including disposal cost, deck covering material cost, fuel oil, dryer for compressor, dehumidifier, air conditioner, tankwatch cost, and MISC such as temporary covering and closure material, and other consumable.

22 MQ CS

Machinery Work CFM for metal tag and MISC. 22 MQ CS

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

22 MQ CS

Piping Work CFM: for marine chmist cost, firewatch cost, electrode, gases, covering material, pipe hangers, NDT cost, asbestos sample take and analyze, lead sampling/analysis cost, air compressor rental cost and fuel oil cost for local air hose test, label pate cost and MISC.

22 MQ CS

Lagging Work CFM asbestos sample take and analyze cost and 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:

S/A72976K CHT TK AIR AY A 0 0

CU PHASE TITLE:

(RE) F/O - S/A 72976K, ACCOMPLISH CHT TANK AERATION UPGRADE

MATERIAL REFERENCES

REF

NO.

DOCUMENT/DRAWING

NUMBER

DOCUMENT/DRAWING TITLE REV

JOB ORDER: KEY OP:

3819P55107 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

101 M INSULATI, ORIG: C231B, T.

ANDO 243-4372

ORDERED FOR KTR

9Q 5640 008096312 NA 4 N 50455358 40/EA

102 M INSULATI, ORIG: C231B, T.

ANDO 243-4372

ORDERED FOR KTR

9Q 5640 008096315 NA 4 N 50455360 40/EA

103 M TAPE,TEX, ORIG: C231B, T.

ANDO 243-4372

ORDERED FOR KTR

9B 8315 002671632 NA 4 N 50455361 3/RO

104 M ADHESIVE, ORIG: C231B, T.

ANDO 243-4372

ORDERED FOR KTR

9B 8040 002738708 NA 4 Y 50455109 3/GL

105 M CAP,SNAP, ORIG: C231B, T.

ANDO 243-4372

ORDERED FOR KTR

9B 5325 007377648 NA 4 N 50455196

200/EA

106 M INSULATI, ORIG: C231B, T.

ANDO 243-4372

ORDERED FOR KTR

9Q 5640 013713264 NA 4 N 50455363 5/SH

107 M CLOTH,PL, ORIG: C231B, T.

ANDO 243-4372

ORDERED FOR KTR

9B 8305 001487363 NA 4 N 50455365 1/RO

108 M ADHESIVE, ORIG: C231B, T.

ANDO 243-4372

ORDERED FOR KTR

9B 8040 005508835 NA 4 Y 50455249 1/GL

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

109 M BEAM,STRUCTURAL, ORIG:

C231B, T. ANDO 243-4372

ORDERED FOR KTR

9B 9520 012852112 NA 4 N 50455461 20/FT

110 M ANGLE,ST, ORIG: C231B, T.

ANDO 243-4372

ORDERED FOR KTR

9B 9520 002774913 NA 4 N 50455367 10/FT

111 M ANGLE,STRUCTURAL, ORIG:

C231B, T. ANDO 243-4372

ORDERED FOR KTR

3B 9520 009545666 NA 4 N 50455462 20/FT

112 M PLATE,ME, ORIG: C231B, T.

ANDO 243-4372

ORDERED FOR KTR

9B 9515 001533184 NA 4 N 50455237 2/SF

113 M PIPE,METALLIC, ORIG: C231B,

T. ANDO 243-4372

ORDERED FOR KTR

9B 4710 002778707 NA 4 N 50455248 10/FT

114 M PLATE,ME, ORIG: C231B, T.

ANDO 243-4372

ORDERED FOR KTR

QTY: 4 SF

1 FT X 4 FT X 1 PM

9B 9515 002243092 NA 4 N 50455238 4/SF

200 M GREASE,A, ORIG: C232, R.

MURAMOTO 243-0089

ORDERED FOR KTR

9B 9150 001450161 NA 4 Y 50435001 3/TU

300 M PAD, TAPPED ROUND, PAD,

TAPPED ROUND, 1/4"-20UNC-

2B X 1"LG, STEEL, CARBON,

AISI-1020, CENTERED,

CONCENTRIC INTERNAL

THREAD THRU HOLE 5/8" OD,

FINISH: PLAIN.

BIW CATALOG NO.53204-155

C233 K. UCHIMURA, 080-9350-

ORDERED FOR KTR

9B 5340 LL9003506 NA 4 N 50457596 6/EA

301 M PAD, TAPPED ROUND, PAD,

TAPPED ROUND,

CENTERED, CONCENTRIC

INTERNAL THREAD THRU

HOLE 3/4" OD,

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

MATL: STEEL, CARBON, AISI-

1020, FINISH: PLAIN,

BIW CATALOG NO. 53204-040

C233 K. UCHIMURA, 080-9350-

ORDERED FOR KTR

9B 5340 LL9306697 NA 4 N 50457603 5/EA

302 M PAD, TAP, 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.

C233 K. UCHIMURA, 080-9350-

ORDERED FOR KTR

9B 5315 LL9307892 NA 4 N 50457478 15/EA

400 M SLV, 2" IPS, SLEEVE, 2"IPS,

CNA 90/10, BUTTWELD,

200PSI.

4730-00-542-3290

9C 4730 LL4462368 NA 4 N 25/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

401 M CPLG, SW, 1-1/4" IPS,

COUPLING, SOCKET WELD, 1-

1/4" IPS, CU-NI 90-10, 400 PSI

9B 4730 014635863 NA 4 N 15/EA

402 M CPLG, SW, 1" IPS, COUPLING,

SOCKET WELD, 1" IPS, CU-NI

90-10, 400 PSI

9B 4730 014635857 NA 4 N 7/EA

403 M BR, 2-1/2" IPS, BACKING RING,

2-1/2" IPS, CU-NI 90-10

9C 4730 LL4558781 NA 4 N 6/EA

404 M BR, 4" IPS, BACKING RING, 4"

IPS, CU-NI 70-30

9C 4730 LL4358122 NA 4 N 4/EA

405 M BR, 2" IPS, BACKING RING, 2"

IPS, CU-NI 70-30

9C 4730 LL4558817 NA 4 N 6/EA

406 M INSL, 4" IPS, INSULATION,

PIPE,

BRAND: K-FLEX ECO,

SPECIFICATION COMPLIANCE:

EB 4013,

FOR SIZE: 4" IPS,

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

FT LG,

UI: EA/6 FT (ONE

CONTINUOUS LENGTH

REQUIRED),

MATL: NON-HALOGEN,

**GSA ADVANTAGE

AVAILABLE**

3EA/BOX. *MUST BE ORDERED

IN MULTIPLES OF 3EA*

*MSM AVAILABLE*

9B 5640 LL9607848 NA 4 N 4/EA

407 M INSL, 2-1/2" IPS, INSULATION,

PIPE,

BRAND: K-FLEX ECO,

SPECIFICATION COMPLIANCE:

EB 4013,

FOR SIZE: 2-1/2" IPS,

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

LG,

UI: EA/6 FT (ONE

CONTINUOUS LENGTH

REQUIRED),

MATL: NON-HALOGEN,

**GSA ADVANTAGE ITEM**

7EA/BOX. *MUST BE ORDERED

IN MULTIPLES OF 7EA*

*MSM AVAILABLE*

9B 5640 LL9607845 NA 4 N 4/EA

408 M ADH FOR PLASTIC TUBE,

ADHESIVE FOR PLASTIC TUBE

9B 8040 008419773 NA 4 Y 2/PT

409 M ADH FOR CLOTH, ADHESIVE

FOR CLOTH

9B 8040 002738708 NA 4 Y 1/GL

410 M CLOTH,PL, L/W GLASS CLOTH

(NATURAL

9B 8305 001487363 NA 4 N 50455369 1/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 S/A72976K CHT TK AIR AY A 0

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

3819P55107 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/A72976K CHT TK AIR AY A 0

COMUSFLTFORCOMINST 4790.3 REV D CHG 3

07 Nov 2023

SHOP TEST RECORD Page 1 of 8

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-ZBV2 KTR N/A New Low Pressure Air Valve (Label Plate No. L1 of 6.A)

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 513-8274301 Rev. B B. DWG 513-8274303 Rev. B

C. TM S9086-RK-STM-010/CH-505

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 5.6.2 A B C

Clean Fresh Water

150 PSIG 3 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

3819P55107A01 ENCLOSURE-01-1 TOTAL 2

SHOP TEST RECORD Page 2 of 8

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-ZBV2 KTR N/A New Low Pressure Air Valve (Label Plate No. L2 of 6.A)

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 513-8274301 Rev. B B. DWG 513-8274303 Rev. B

C. TM S9086-RK-STM-010/CH-505

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 5.6.2 A B C

Clean Fresh Water

150 PSIG 3 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)

SHOP TEST RECORD Page 3 of 8

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-ZBV2 KTR N/A New Low Pressure Air Valve (Label Plate No. L-1 of 6.A)

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 513-8274302 Rev. B B. DWG 513-8274303 Rev. B

C. TM S9086-RK-STM-010/CH-505

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 5.6.2 A B C

Clean Fresh Water

150 PSIG 3 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)

SHOP TEST RECORD Page 4 of 8

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-ZBV2 KTR N/A New Low Pressure Air Valve (Label Plate No. L-2 of 6.A)

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 513-8274302 Rev. B B. DWG 513-8274303 Rev. B

C. TM S9086-RK-STM-010/CH-505

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 5.6.2 A B C

Clean Fresh Water

150 PSIG 3 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)

SHOP TEST RECORD Page 5 of 8

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-ZBV2 KTR N/A New Low Pressure Air Valve (Label Plate No. L1 (Frame 50) of 6.A)

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 513-8472432 Rev. A B. DWG 513-8274303 Rev. B

C. TM S9086-RK-STM-010/CH-505

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 5.6.2 A B C

Clean Fresh Water

150 PSIG 3 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)

SHOP TEST RECORD Page 6 of 8

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-ZBV2 KTR N/A New Low Pressure Air Valve (Label Plate No. L1 (Frame 100) of 6.A)

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 513-8472432 Rev. A B. DWG 513-8274303 Rev. B

C. TM S9086-RK-STM-010/CH-505

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 5.6.2 A B C

Clean Fresh Water

150 PSIG 3 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)

SHOP TEST RECORD Page 7 of 8

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-ZBV2 KTR N/A New Low Pressure Air Valve (Label Plate No. L7 (Frame 51) of 6.A)

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 513-8472432 Rev. A B. DWG 513-8274303 Rev. B

C. TM S9086-RK-STM-010/CH-505

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 5.6.2 A B C

Clean Fresh Water

150 PSIG 3 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)

SHOP TEST RECORD Page 8 of 8

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-ZBV2 KTR N/A New Low Pressure Air Valve (Label Plate No. L7 (Frame 96) of 6.A)

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 513-8472432 Rev. A B. DWG 513-8274303 Rev. B

C. TM S9086-RK-STM-010/CH-505

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 5.6.2 A B C

Clean Fresh Water

150 PSIG 3 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)

SHOP TEST RECORD Page 1 of 4

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-ZBV2 KTR N/A New Low Pressure Air Valve (Label Plate No. L4 of 6.A)

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 513-8274498 Rev. B

B. TM S9086-RK-STM-010/CH-505

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

OP 5.6.3 A

B

Clean Dry Air 13 PSIG N/A N/A

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)

3819P55107A01 ENCLOSURE-01-2 TOTAL 2

SHOP TEST RECORD Page 2 of 4

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-ZBV2 KTR N/A New Low Pressure Air Valve (Label Plate No. L5 of 6.A)

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 513-8274498 Rev. B

B. TM S9086-RK-STM-010/CH-505

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

OP 5.6.3 A

B

Clean Dry Air 13 PSIG N/A N/A

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)

SHOP TEST RECORD Page 3 of 4

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…