2 - Submittals_Form_928-R.pdf

[ ] NEW [ ] RESUBMIT

ITEM SPECIFICATION SECJ AP- DISAP- SEE INITIAL

No PARA. NO./DWG. NO. PROVED PROVED REVERSE

TYPE OR PRINT NAME TITLE

TYPE OR PRINT NAME AND GRADE

TYPE OR PRINT NAME AND GRADE

TYPE OR PRINT NAME AND GRADE

TRADOC FORM 928-R, Nov 91

TO:

[ ] Approved [ ] Disapprove as indicated Above and Subject to Any Applicable Comments on the Reverse Side. Request Resubmittal on Disapproved.

items Within _______________ Days of Date Shown Below.

DATE SIGNATURE

TO:

DATE SIGNATURE

Recommend [ ] Approval [ ] Disapproval as indicated Above and Subject to Any Applicable Comments on the Reverse

TO:

FOR GOVERNMENT USE ONLY

For Evaluation and Action

DATE SIGNATURE

MATERIAL APPROVAL SUBMITTAL

TRADOC Reg 715-3

BY COMPLETEING THIS FORM, THE UNDERSIGNED CONTRACTOR CERTIFIES THAT

THE MATERIAL COMPLIES WITH ALL SPECIFICATIONS OF SUBJECT CONTRACT.

DATE

PREVIOUS SUBMISSION NUMBER PROJECT NUMBER

SUBMITTALSUBMISSION NUMBER

DESCRIPTION OF MATERIAL

DATE SIGNATURE

TO: (Contracting Officer) FROM: (Contractor)

TO BE COMPLETED BY CONTRACTOR FOR GOVERNMENT USE ONLY

(Include Type, Model Number, Catalog Number, Mfg., etc.)

CONTRACT NUMBER

(for Digital Signature)