TGI_38K5244115A01_c0v1.pdf

FOUO

FOUO: Public availability to be determined under 5 USC 552

TASK GROUP INSTRUCTION

AIM REV 20.11.4.0 (OCTOBER 2020)

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

NO.: SA92881K NMT F/O AY A 0 0

SHIP/HULL NO.: SHIP/HULL NAME: SYSTEM: PROJ/WO NO: CASREP CAT:

DDG-114 USS RALPH JOHNSON K52

CU PHASE TITLE:

*(RE) F/O - S/A 92881K, ACCOMPLISH STRL, SHEET METAL, FALSE DECK, AND RGNG WORK

PREPARING ACTIVITY:

PREPARED BY: CODE PHONE DATE

TOMONOBU NAKAMURA 233.2 080-9350-1345 19-NOV-2024

APPROVED BY: CODE PHONE DATE

HIDEYUKI KOSAKA 233.2 080-9350-1454 19-NOV-2024

CONCURRED BY: CODE PHONE DATE

CONCURRED BY: CODE PHONE DATE

CONCURRED BY: CODE PHONE DATE

CONCURRED BY: CODE PHONE DATE

REASON FOR WORK/NEED FOR CHANGE:

CHANGE INSTRUCTIONS:

SPECIAL REQUIREMENTS:

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

WORK CERTIFICATION SIGNATURES

COMPLETION OF WORK REVIEW: BADGE NO.: SHOP/CODE: PHONE: DATE:

ACCEPTANCE OF COMPLETED WORK

PHYSICAL INSPECTION PHYSICAL INSPECTION COMPLETED: BADGE NO.: SHOP/CODE: PHONE: DATE:

REQUIRED:☐YES ☒NO

RECORDS REVIEW: BADGE NO.: SHOP/CODE: PHONE: DATE:

TGI NO.: SA92881K NMT F/O AY A 0

FOUO

SHIP: DDG-114 CHG/VER: 0/1

LIST OF EFFECTIVE PAGES

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

1-5 J1-2 M1-5

1. SCOPE/PURPOSE

1.1 Title: S/A 92881K, Structural, Sheet Metal, False Deck, and Rigging Work for Navy Multiband Terminal Modem Spiral One; accomplish

1.2 Location of Work:

1.2.1 Passage (02-166-5-L)

1.2.2 Passage (01-118-1-L)

1.2.3 Passage (01-158-1-L)

1.2.4 Combat System Equipment Room (CSER) No.2 (2-126-2-C)

1.2.5 Communications Center (2-126-1-C)

1.2.6 Access Trunk (3-158-3-T)

1.2.7 Crew Living Space No. One (2-78-01-L)

1.2.8 Auxiliary Machinery Room No. One (4-126-0-E)

1.3 Identification:

1.3.1 Quantity (One Lot), Electrical/Electronics Equipment for S/A 92881K, Navy Multiband Terminal (NMT) Modem Spiral One

Remarks: See 2.3 for details.

Location: Onboard Ship shown on 1.2.5 to/from Pier Side, Shop, and/or Naval Information Warfare Center

(NIWC) Yokosuka

1.3.2 Quantity (One Lot), Structural, Sheet Metal, and False Deck Work for S/A 92881K, NMT Modem Spiral One

Remarks: See 2.3 through 2.7 for material and detail.

1.3.2.1 Quantity (One Lot), Stud for Cable Way, Bonding, and Miscellaneous Equipment Installation

Size: 1/4-20UNC-2A

5/16-18UNC-2A

3/8-16UNC-2A

Weld Joint Design: PT1S.1 of MIL-STD-22D Fillet Weld Size: 1/8 Inch Material: Steel Remarks: See 5.4.3.

1.3.2.2 Quantity (One Lot), Bracket for Cable Way

Size: One Inch x One Inch x 1/8 Inch Thickness Angle

FOUO

SHIP: DDG-114 CHG/VER: 0/1

Material: Steel Remarks: See 5.4.3.

1.4 Security Classification:

1.4.1 Spaces - 1.2.4 and 1.2.5

1.5 Initial Condition: None.

1.6 Contractor work start date:

1.7 Contractor work completion date:

2. REFERENCES:

REF.

NO.

DOCUMENT

/DRAWING

NUMBER

DOCUMENT/DRAWING TITLE REV CHG

NO.

COPY

REQ’D

(Y/N)

SOURCE

DOC

(Y/N)

PARA SEC PG CHP

1 NSI FY-25 NAVSEA Standard Items - 1 N 2 LI FY-25 Local Standard Items - ORG N

3 DWG 441-

8978729

NMT MODEM SPIRAL 1

CONSOLIDATED ELEC MODS &

ML

A Y AL

L

4 DWG 180-

8978728

NMT Modem Spiral 1 FDN and FLS DK MODS and ML

A Y AL

L

5 PDD 441-

ELM-250064

Supplemental Info for S/A 92881 in Communications Ctr (2-126-1-C)

- Y AL

L

6 DWG 512-

8978731

NMT Modem Spiral 1 HVAC MODS and ML

A Y AL

L

7 LAR

92881/DDG9

7/1224212

Delete Volumetric Test Requirement

- Y AL

L

8 DWG 100-

7060386

UNIT STRL ARR DWG ASSY UNIT

E Y 3-

9 DWG 100-

7060387

UNIT STRUCTURAL ARR DWG

ASSY UNIT 2140

D Y SE

E N

OT

E

10 MIL MIL-

STD-1310

Shipboard Bonding, Grounding, and Other Techniques for EMP Mitigation and Safety

H N

11 DWG OD

32382

Grounding and Bonding, Equipment Enclosures, Chassis and Cases, Design and Insta

F 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:

Masato.Endo.ja Typewritten Text

14 JUL 2025

Masato.Endo.ja Typewritten Text

26 NOV 2025

Masato.Endo.ja Cross-Out

Masato.Endo.ja Typewritten Text

2/14/2025 C-1209 M. ENDO 11030028

FOUO

SHIP: DDG-114 CHG/VER: 0/1

5.1 Provide rigging service for removal and installation of each existing and new equipment listed in 1.3.1 to support SRF-JRMC production onboard work, using 2.3 for guidance.

5.2 Accomplish the structural, sheet metal, and false deck work listed in 1.3.2 in accordance with 2.3 through 2.7, using 2.8 and 2.9 for guidance. See 5.4.3.

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

5.2.2 Clean bonding surfaces of the foundation in accordance with Special Note S6 of 2.3, Paragraph 5.1.3.1 b.(1) of 2.10, and 2.11.

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

5.4 Notes:

5.4.1 Planner: Code 233.2 T. Nakamura, 080-9350-1345

Planner: Code 233.1 H. Sasano, 080-9350-1453 Planner: Code 231A K. Yasuo, 243-1108 Planner: Code 234 K. Furukawa, 243-2242

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

5.4.3 SRF-JRMC Shops X67O and X51EO will direct exact location for removal and installation of existing/new stud and bracket for cableway which is not designated in referenced drawings.

5.4.4 Removal and installation of electrical/electronics equipment and cable will be covered by TGI No(s).

38K5244115U01, 38K5244115U02, 38K5244115R01 and 38K5244115R02 (SRF-JRMC TGI).

5.4.5 Naval Information Warfare Center (NIWC) Yokosuka, Japan will provide one person on-site to resolve any technical issues that may arise.

5.4.6 NIWC Yokosuka, Japan Technical Representative:

Point of Contact: Shawn Coursen, 243-7818 E-mail Address: shawn.w.coursen.civ@us.navy.mil

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

5.4.8 WPC will copy the following pages in reference.

REF. 2.9: Pages 3-12, 5-6, and 6-12.

5.4.9 JCN EXSA-ZBN7 is related to this TGI.

5.5 Government Furnished Material (GFM):

5.5.1 All GFM listed in each S/A drawing will be provided by NIWC Yokosuka.

5.5.2 SRF-JRMC will provide materials listed in Appendix “M” including IAF material in each S/A drawing.

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SHIP: DDG-114 CHG/VER: 0/1

5.6 SRF-JRMC will provide the following service work: (TGI No.38K5244115S02)

5.6.1 [C740] Crane and crane rigging service.

5.6.2 [X99E] Utility service, electrical.

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

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

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

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

FOUO

J-1

SHIP: DDG-114 CHG/VER: 0/1

APPENDIX "J"

TGI JOB SUMMARY INFORMATION SHEET

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

VERSION:

CASREP

CAT:

SA92881K NMT F/O AY A 0 1

CU PHASE TITLE:

*(RE) F/O - S/A 92881K, ACCOMPLISH STRL, SHEET METAL, FALSE DECK, AND RGNG WORK

PRIMARY COMPONENT:

COMPONENT UNIT LIST (FOR ASSEMBLIES):

VNT RS 01-169-1 DT MT-7481/U SATCOM ER CMPT 2-126-1-C MS

ATTACHMENT LIST:

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

KOIKE ,HIROHIKO

JO: KO: TOTAL MAN HRS: PLANNING ACCEPTANCE:

38K5244115 A01

TOTAL MAT’L COST TOTAL DURATION:

CU PHASE DESCRIPTION:

The purpose of this TGI is to accomplish structural, sheet metal, false deck, and rigging work for S/A 92881K, Navy Multiband Terminal (NMT) modem spiral one.

Location of Work:

Passage (02-166-5-L) Passage (01-118-1-L) Passage (01-158-1-L) Combat System Equipment Room (CSER) No.2 (2-126-2-C) Communications Center (2-126-1-C) Access Trunk (3-158-3-T) Crew Living Space No. One (2-78-01-L) Auxiliary Machinery Room No. One (4-126-0-E)

TASK NAME

SHOP TSD/WC TS CREW# MHRS

HIGH RAD

HOURS

RC

GRID#

FOUO

J-2

SHIP: DDG-114 CHG/VER: 0/1

TASK NAME

SHOP TSD/WC TS CREW# MHRS

HIGH RAD

HOURS

RC

GRID#

Version-1: admin change. [C233 H. Kosaka 11/19/2024] -/-/N V-01 0 0 0

FOUO

M-1

SHIP: DDG-114 CHG/VER: 0/1

APPENDIX “M”

TGI MATERIAL LIST

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

VERSION:

CASREP

CAT:

SA92881K NMT F/O AY A 0 1

CU PHASE TITLE:

*(RE) F/O - S/A 92881K, ACCOMPLISH STRL, SHEET METAL, FALSE DECK, AND RGNG WORK

MATERIAL REFERENCES

REF

NO.

DOCUMENT/DRAWING

NUMBER

DOCUMENT/DRAWING TITLE REV

1 180-8978728 2 512-8978731

3 ELM

JOB ORDER: KEY OP:

38K5244115 A01

MATERIAL LIST

ITEM

NO.

PC

NO.

REF

NO.

M

C DESCRIPTION

STOCK

NUMBER

GENERIC

MATL

TYPE LVL QA

HAZ

MAT

DOC

NO.

QTY

REQD/

UNIT

QTY

USED/

UNIT

001 115 1 M ANGLE,STRUCTURAL, ORDER

FOR KTR

ORIG: C226 T. KATSUYA, 070-

7787-1996

9B 9520 002777312 NA 4 N 42205001 12/FT

001 115 1 M ANGLE,STRUCTURAL, ORDER

FOR KTR

ORIG: C226 T. KATSUYA, 070-

7787-1996

9B 9520 002777312 NA 4 N 42405455 12/FT

002 117 1 M PLATE,ME, 1 X 1

ORDER FOR KTR

ORIG: C226 T. KATSUYA, 070-

7787-1996

9B 9515 002243089 NA 4 N 42195132 1/SF

003 140 1 M ANGLE,STRUCTURAL, ORDER

FOR KTR

ORIG: C226 T. KATSUYA, 070-

7787-1996

9B 9520 012746197 NA 4 N 42195134 8/FT

004 143 1 M PLATE,ME, 3 X 3

ORDER FOR KTR

ORIG: C226 T. KATSUYA, 070-

7787-1996

9B 9515 002375350 NA 4 N 42195136 9/SF

NOTES:

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M-2

SHIP: DDG-114 CHG/VER: 0/1

MATERIAL LIST

ITEM

NO.

PC

NO.

REF

NO.

M

C DESCRIPTION

STOCK

NUMBER

GENERIC

MATL

TYPE LVL QA

HAZ

MAT

DOC

NO.

QTY

REQD/

UNIT

QTY

USED/

UNIT

005 144 1 M PLATE,ME, 1 X 1

ORDER FOR KTR

ORIG: C226 T. KATSUYA, 070-

7787-1996

9B 9515 014160552 NA 4 N 42195138 1/SF

006 118 1 M BAR,METAL, ORDER FOR KTR

ORIG: C226 T. KATSUYA, 070-

7787-1996

9B 9510 001891562 NA 4 N 42195139 12/FT

007 130 1 M ANGLE,STRUCTURAL, ORDER

FOR KTR

ORIG: C226 T. KATSUYA, 070-

7787-1996

9B 9520 010239272 NA 4 N 42205026 6/FT

008 902 1 M ANGLE,STRUCTURAL, ANGLE,

STRUCTURAL, 2-1/2" X 2" X

1/4" THK, ALUMINUM ALLOY

5456 H111, ASTM B221 (SAE-

AMS-QQ-A-200/7). BIW CAT#:

56107-282

ORDER FOR KTR

ORIG: C226, T. KATSUYA, 070-

7787-1996

9B FY25 LL4573214 NA 4 N 4/FT

009 903 1 M ANGLE,STRUCTURAL, ORDER

FOR KTR

ORIG: C226 T. KATSUYA, 070-

7787-1996

9B 9540 008922352 NA 4 N 42195140 4/FT

010 904 1 M BAR,BIMETALLIC, BAR,

BIMETALLIC TRANSITION

JOINT, ALUMINUM / STEEL,

3"W X 3/4"THK, CONSISTS OF

1/8" ALUMINUM 5456 H117 OR

5086 H32 BONDED TO 1/4"

ALUMINUM 1100 BONDED TO

3/8" STEEL ASTM A516 GR-55.

BIW CAT: 57001-046.

ORDER FOR KTR

ORIG: C226, T. KATSUYA, 070-

7787-1996

9B FY25 LL9309320 NA 4 N 11/FT

011 907 1 M TAPE, 4", TAPE, CORROSION

PROTECTION, ALL WEATHER,

SCOTCHRAP 51, 4" X

100FT(102 MM X 30.5M) X 20

MIL THK, PRINTED WITH

PRODUCT NAME AND

THICKNESS, HIGH TACK

ADHESIVE, BACKING MATL:

POLYVINYL CHLORIDE,

COLOR: BLACK, 1CS=4RO,

UPC#: 054007428046, 3M ID:

7000043017, GSA ADVANTAGE

ITEM

9D 8305 LL4820191 NA 4 N 42207427 2/RO

012 909 1 M SCREW,MACHINE, SCREW,

MACHINE, FLAT HEAD,

SLOTTED, COUNTERSUNK 82

DEG, NYLON, 1/4"-20UNC-2A X

1"LG, MOLDED NYLON, 6/6,

MIL-C-20693, TY 1, COMP A,

COLOR: MANUFACTURE'S

STANDARD.

ORDER FOR KTR

ORIG: C226, T. KATSUYA, 070-

7787-1996

9B 5305 LL9006424 NA 4 N 42207429

100/EA

FOUO

M-3

SHIP: DDG-114 CHG/VER: 0/1

MATERIAL LIST

ITEM

NO.

PC

NO.

REF

NO.

M

C DESCRIPTION

STOCK

NUMBER

GENERIC

MATL

TYPE LVL QA

HAZ

MAT

DOC

NO.

QTY

REQD/

UNIT

QTY

USED/

UNIT

013 910 1 M FERRULE, FERRULE, NYLON,

FALSE DECK FASTENER,

7/8"OD X 1/2"OA LG, MOLDED

NYLON, 6/6, 0.250" FLAT HEAD

MACHINE SCREW

ORDER FOR KTR

ORIG: C226, T. KATSUYA, 070-

7787-1996

9B 5320 LL9006423 NA 4 N 42207428

100/EA

014 936 1 M PANEL, FALSE DECK, PANEL,

FALSE DECK, COMPOSITE,

CO-CURED BALSA CORE AND

PHENOLIC COMPOSITE, WITH

LONMAT FLOORING WEAR

SURFACE, SPEC: MIL-PRF-

32664, TYPE I, CLASS 1, FORM

1, GROUP 1, AREAL WEIGHT:

2, SIZE: 48" X 100" X 0.560-

0.575"THK, COLOR: SEMI-

GLOSS BLUE, BIW CAT#:

57204-001, PLASCORE INC

P/N: SM3000-BLU-48X96,

9B FY25 LL9608383 NA 4 N 4/SH

015 938 1 M ADHESIVE,AIRCRAFT, ORDER

FOR KTR

ORIG: C226 T. KATSUYA, 070-

7787-1996

9B 1680 014313607 NA 4 N 42195143 2/EA

016 A00 1A

2 M SHEET,ME, ORDER FOR KTR

ORIG: C226, T. KATSUYA, 070-

7787-1996

9B 9535 002326866 NA 4 N 42195144 2/SH

017 A00 1B

2 M SHEET,ME, ORDER FOR KTR

ORIG: C226 T. KATSUYA, 070-

7787-1996

9B 9535 002326872 NA 4 N 42195158 1/SH

018 A00 1C

2 M SHEET,ME, ORDER FOR KTR

ORIG: C226 T. KATSUYA, 070-

7787-1996

9B 9535 010931648 NA 4 N 42195159 1/SH

019 A00

2 M SHEET,ME, ORDER FOR KTR

ORIG: C226 T. KATSUYA, 070-

7787-1996

9B 9535 002326869 NA 4 N 42195160 1/SH

020 100 2 M DUCT,SPIRAL WOUND, 4,

DUCT SPIRAL WOUND, DWG:

8100-1301-0286, SIZE: 4-

1/2"DIA X 0.025"THK, MATL:

ALUMINUM ALLOY 3003 H14,

NON INSULATED, ASTM B209,

BIW CATALOG NO,03112-012,

ORDER FOR KTR

ORIG: C226, T. KATSUYA, 070-

7787-1996

9B 5680 LL9006728 NA 4 N 42207445 15/FT

021 102 2 M ELBOW 45 DEG, ELBOW 45

DEGREE, 3 SEGMENTED,

DWG: 8100-1301-0286, SIZE: 4-

1/2" DIA X 0.050" THK, MATL:

ALUMINUM ALLOY 3003 H14,

ASTM B209, BIW CATALOG NO,

03174-158, ORDER FOR KTR

ORIG: C226, T. KATSUYA, 070-

7787-1996

9B FY25 LL4605142 NA 4 N 2/EA

022 104 2 M ELBOW 90, DUCT, ELBOW 90

DEGREE, 5 SEGMENTED, 4-

1/2" DIA, 0.050" THK, ASTM

B209 (QQ-A-250/2), ALUMINUM

ALLOY 3003-H14, BIW DWG#:

8100-1301-0286

ORDER FOR KTR

ORIG: C226, T. KATSUYA, 070-

7787-1996

9B FY25 LL9007078 NA 4 N 1/EA

FOUO

M-4

SHIP: DDG-114 CHG/VER: 0/1

MATERIAL LIST

ITEM

NO.

PC

NO.

REF

NO.

M

C DESCRIPTION

STOCK

NUMBER

GENERIC

MATL

TYPE LVL QA

HAZ

MAT

DOC

NO.

QTY

REQD/

UNIT

QTY

USED/

UNIT

023 3 3 M ANGLE,STRUCTURAL, ORDER

FOR KTR

ORIG: C226 T. KATSUYA, 070-

7787-1996

9B 9520 002774912 NA 4 N 42195161 20/FT

024 M BAR,METAL, ORDER FOR KTR

ORIG: C226 T. KATSUYA, 070-

7787-1996

9B 9510 001891588 NA 4 N 42195162 10/FT

100 M INSULATI, ORDERED FOR KTR

ORG: C231A K.YASUO 243-

9Q 5640 013713263 NA N 5/SH

101 M INSULATI, ORDERED FOR KTR

ORG: C231A K.YASUO 243-

9Q 5640 013713262 NA N 4/SH

102 M SOUND CO, ORDERED FOR

KTR

ORG: C231A K.YASUO 243-

9Q 5640 013715238 NA N 5/SH

103 M INSULATI, ORDERED FOR KTR

ORG: C231A K.YASUO 243-

9Q 5640 LL4823204 NA N 3/SH

104 M INSULATI, ORDERED FOR KTR

ORG: C231A K.YASUO 243-

9Q 5640 LL4941458 NA N 9/SH

105 M INSULATI, ORDERED FOR KTR

ORG: C231A K.YASUO 243-

9Q 5640 LL4808709 NA N 6/SH

106 M TAPE,TEX, ORDERED FOR

KTR

ORG: C231A K.YASUO 243-

9B 8315 002671632 NA N 2/RO

107 M TAPE,TEX, ORDERED FOR

KTR

ORG: C231A K.YASUO 243-

9B 8315 002671633 NA N 2/RO

108 M ADHESIVE, ORDERED FOR

KTR

ORG: C231A K.YASUO 243-

9B 8040 005508835 NA Y 2/GL

109 M RIVET,BL, ORDERED FOR KTR

ORG: C231A K.YASUO 243-

9B 5320 008503270 NA N 3/HD

110 M SCREW,CA, ORDERED FOR

KTR

ORG: C231A K.YASUO 243-

9B 5305 000680508 NA N 2/HD

111 M SCREW,CA, ORDERED FOR

KTR

ORG: C231A K.YASUO 243-

9B 5305 000712505 NA N

200/EA

112 M WASHER,F, ORDERED FOR

KTR

ORG: C231A K.YASUO 243-

9B 5310 001411795 NA N

400/EA

113 M NUT,PLAI, ORDERED FOR KTR

ORG: C231A K.YASUO 243-

9Q 5310 007616882 NA N

200/EA

114 M ANGLE,STRUCTURAL,

ORDERED FOR KTR

ORG: C231A K.YASUO 243-

9B 9520 002774900 NA N 10/FT

115 M ANGLE,STRUCTURAL,

ORDERED FOR KTR

ORG: C231A K.YASUO 243-

9B 9520 002774903 NA N 10/FT

FOUO

M-5

SHIP: DDG-114 CHG/VER: 0/1

MATERIAL LIST

ITEM

NO.

PC

NO.

REF

NO.

M

C DESCRIPTION

STOCK

NUMBER

GENERIC

MATL

TYPE LVL QA

HAZ

MAT

DOC

NO.

QTY

REQD/

UNIT

QTY

USED/

UNIT

116 M STRIP,METAL, ORDERED FOR

KTR

ORG: C231A K.YASUO 243-

9B 9515 002043974 NA N 10/FT

117 M SCREW,CA, ORDERED FOR

KTR

ORG: C231A K.YASUO 243-

9B 5305 002693211 NA N 20/EA

118 M NUT,SELF, ORDERED FOR

KTR

ORG: C231A K.YASUO 243-

9B 5310 004838790 NA N 20/EA

119 M WASHER,FLAT, ORDERED

FOR KTR

ORG: C231A K.YASUO 243-

9B 5310 001670821 NA N 1/HD

120 M RUBBER SHEET,SOLID,,

ORDERED FOR KTR

ORG: C231A K.YASUO 243-

9B 5330 001790052 NA N 2/SY

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:

DDG-114 SA92881K NMT F/O AY A 0

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

38K5244115 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:

DDG-114 SA92881K NMT F/O AY A 0