Part II: Results of Surveillance Test.

SB 740-95-10

(o) Block 15. Record the manufacturer or

of the applicable defective column sample number when

deficiencies have been noted in block 10 and evaluation is

reconditioning agency and the date of manufacture.

based on defectives. Enter the total number of defects

When more than one manufacturer is represented

observed for each sample in the appropriate columns

because of the nature of the lot enter N.A.

(p) Block 16. Self-explanatory.

when the evaluation is based on defects.

(h) Block 13. State whether the lot passed or

(q) Block 17. Self-explanatory.

failed the test requirements established in the applicable

(r) Block 18. Record the condition of the

appendix. Enter any additional information that might

preservation, packing, packaging, and marking.

have had an affect on test results.

Enter any

(s) Block 19. State whether the lot passed or

recommendations on lot disposal, e.g., screen or

failed the visual inspection requirements of this bulletin.

renovate.

Record all observed defects or defectives, as applicable,

(i) Block 14. Self-explanatory.

by category, quality defect code, and number of defects

(j) Block 15. Not applicable. (2) Data sheet for

or defectives. Use the category and quality defect codes

Grand Lots, Miscellaneous Lots, or Depot Lots, (DA

given in appendix A and paragraph 2-6a.

Form 985, 1 July 1953). This form shall be used by

(t) Block 20. Note any observation relevant to

the depot or storage activity to record the formation

the condition of an item or to the actual inspection in this

of these lots.

block. Examples of such observations are: different

FORM INSTRUCTIONS

storage conditions of lot segments, unlisted defects,

(a) Block 1. Enter the complete standard

inspection equipment not available or calibration interval

nomenclature and model number of the item. Enter the

exceeded, and severity of defects listed in block 19.

National Stock Number (NSN).

Include a brief lot history when possible.

(u) Block 21a. Self-explanatory.

(b) Block 2. Enter the depot or storage activity

(v) Block 21b. Based on the results of visual

where the items composing the lot are stored.

examination (Part 1, Block 19) enter the condition code

(d) Block 4. State the previous serviceability of

(see para 2-7b).

(w) Block 21c. Based on the test results (Part

each lot composing the grand lot, miscellaneous lot, or

depot lot.

II, Block 13) enter the condition code (see para 2-

(e) Block 5. Enter the method of packing and

7b).

preservation,

(x) Block 22. Self-explanatory.

(f) Block 6. Not applicable.

Part II: Results of Surveillance Test.

(g) Column a. Enter the manufacturer or

(a) Block 1. Self-explanatory.

manufacturers of the individual lots forming the grand lot,

(b) Blocks 2, 2a, and 2b. Enter bulletin

miscellaneous lot, or depot lot.

number, revision, or change, and the date of supply

(h) Column b. Enter the manufacturer's lot

bulletin, revision, or change. When applicable, enter the

number for each of the individual lots.

letter of authority or directive for any performed special

(i) Column c. Enter the date of manufacture of

surveillance not in accord with this bulletin.

each lot.

Enter the

(j) Column d. Enter the lot size for the

meteorological conditions at the test area if they are

individual lots listed in column b. Total the column

relevant to the test. Otherwise enter N.A.

values and enter the sum in the total block at the foot of

(d) Blocks 7 and 8. Consecutively number the

the column.

outer packages from which the samples were selected,

(k) Column e. Record the number of samples

and the individual samples, starting with "1". Record

selected for test from each lot listed in column b. Total

these numbers in blocks 7 and 8.

the column values and enter the sum in the total block at

(e) Blocks 9a and 9b. Enter the type and

the foot of the column.

model of the component or item in the header of each

(l) Column f. Record the number of samples

column and enter the lot number of each sample on the

selected for visual examination from each lot listed in

appropriate line.

column b. Total the column values and enter the sum in

(f) Block 10. In the heading of each column,

the total block at the foot of the column.

describe the test characteristic to be tabulated. Indicate

(m) Columns g, h, and i. Not applicable.

attribute deficiencies with "x" at the intersection of the

(n) Remarks. Enter any pertinent information

individual sample number and the test characteristic, or

regarding formation of the lot or sampling procedure.

enter the actual test result.

(o)

Supplementing

serviceability

report

(g) Blocks 11 and 12. In the space above

number.

The report number entered here shall

blocks 11 and 12 indicate whether the evaluation is based

correspond with the entered on DA Form 984.

on "defects" or "defectives" by crossing out the one that

(p) Other blocks. Self-explanatory.

does not apply.

Enter an "x" at the intersection

(3) Quality Deficiency Report (QDR) (SF 368).

Submit this form when initial receipt inspection re-

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