Sheet 1 of 7

First Article Inspection Report

Form 1: Part Number Accountability
1. Part Number 2. Part Name 3. Serial/Lot Number 4. FAI Report Number
2084115-01 STEM B" 3/QC ME1/E1AIE1C_x000D_
300/9001! -F/2 & 3 MILS PLATING_x000D_
5. Part Revision Level 6. Drawing Number 7. Drawing revision 8. Additional Changes
level
KG264776
9. Manufacturing Process Reference (WO#) 10. Organization Name 11. Supplier Code 12. P.O. Number

13. Detail FAI 14. Full FAI Baseline Part Number including revision level

Partial FAI

Assembly FAI Reason for Partial FAI:

a)if above part number is a detail part only, go to Field 19

b)if above part number is an assembly, go to the INDEX section below.

INDEX of part numbers or sub-assembly numbers required to make the assembly noted above.
15. Part Number 16. Part Name 17. Part Serial Number 18. FAI Report
Number
No Results Found No Results Found No Results Found No Results Found

1) Signature indicates that all characteristics are accounted for; meet drawing requirements or are properly documented for disposition.

2) Also indicate if the FAI is complete per Section 5.4: FAI complete FAI not Complete

19. Report Completed By: 20. Date

21. Report Reviewed by (Quality Representative): 22. Date

23. Customer Approval and Stamp (if applicable): 24. Date

FAI
FAI Status: FAI Pending FAI Rejected
Acceptable

Form QF1439 Rev -

FAI
Acceptable
FAI Pending FAI Rejected Sheet 2 of 7

Form QF1439 Rev -

 Sheet 3 of 7
First Article Inspection Report
Form 2: Product Accountability - Raw Material, Specifications & Special Process(es) and Functional Testing
1. Part Number 2 Part Name 3. Serial / Lot Number 4. FAI Report Number
2084115-01 STEM B" 3/QC ME1/E1AIE1C_x000D_
300/9001! -F/2 & 3 MILS PLATING_x000D_
5. Material or Process 6. Specification Number & Revision No. 7. Code 8. Special Process 9. Customer 10. Certificate of
Name Supplier Code Approval Conformance
Verification number

(Yes/No/NA)
No Results Found No Results Found No Results Found No Results Found No Results No Results Found
Found

11. Functional Test 12. Acceptance report number, if applicable

Procedure Number

13. Comments
14. Prepared By 15. Date

Form QF1439 Rev -

 Sheet 4 of 7
First Article Inspection Report
Form 3: Characteristic Accountability, Verification and Compatibility Evaluation
1. Part Number 2. Part Name
2084115-01 STEM B" 3/QC ME1/E1AIE1C_x000D_
300/9001! -F/2 & 3 MILS PLATING_x000D_
POW-R-SEAL GATE VALVE

Characteristic Accountability Inspection / Test Results

5. Char 6. Reference Location 7. Characteristic 8. Requirement 8a. 8b. Upper 8c. Lower 9. Results 10. Designed 11. Non-
No. Designator UoM Limit Limit Tooling Conformance
Number

1 KG264776.pdf pg.1 Linear Dimension 36.19 in 36.25 36.13

2 KG264776.pdf pg.1 Diameter in 1.871 1.868
3 KG264776.pdf pg.1 Diameter in 1.901 1.898
4 KG264776.pdf pg.1 Linear Dimension 19.06 in 19.09 19.06
5 KG264776.pdf pg.1 Linear Dimension 18.94 in 19.00 18.88
6 KG264776.pdf pg.1 Linear Dimension 18.56 in 18.62 18.50
7 KG264776.pdf pg.1 Diameter in 1.750 1.700
8 KG264776.pdf pg.1 Angle Dimension 30 deg 30.5 29.5
9 KG264776.pdf pg.1 Radius .12 in 0.14 0.10
10 KG264776.pdf pg.1 Linear Dimension 1.56 in 1.62 1.50
11 KG264776.pdf pg.1 Linear Dimension .75 in 0.78 0.72
12 KG264776.pdf pg.1 Angle Dimension 2.00 deg 2.03 1.97
13 KG264776.pdf pg.1 Radius .12 in 0.14 0.10
14 KG264776.pdf pg.1 Linear Dimension 3.25 in 3.28 3.22
15 KG264776.pdf pg.1 Radius .12 in 0.14 0.10
16 KG264776.pdf pg.1 SEE PRINT
17 KG264776.pdf pg.1 Depth in 0.438 0.422
18 KG264776.pdf pg.1 Angle Dimension .75 deg 0.78 0.72
19 KG264776.pdf pg.1 Note 1/4 -18 NPT

Form QF1439 Rev -

 Sheet 5 of 7
Form 3: Characteristic Accountability, Verification and Compatibility Evaluation
1. Part Number 2. Part Name
2084115-01 STEM B" 3/QC ME1/E1AIE1C_x000D_
300/9001! -F/2 & 3 MILS PLATING_x000D_
POW-R-SEAL GATE VALVE

Characteristic Accountability Inspection / Test Results

5. Char 6. Reference Location 7. Characteristic 8. Requirement 8a. 8b. Upper 8c. Lower 9. Results 10. Designed 11. Non-
No. Designator UoM Limit Limit Tooling Conformance
Number

20 KG264776.pdf pg.1 Angle Dimension .090 deg 0.100 0.080

21 KG264776.pdf pg.1 Angle Dimension 29 deg 29.02 28.98
22 KG264776.pdf pg.1 Diameter in 1.474 1.442
23 KG264776.pdf pg.1 Angle Dimension deg 1.480 1.446
24 KG264776.pdf pg.1 Diameter 1.744 / 1.734 in 1.744 1.734
25 KG264776.pdf pg.1 Diameter in 1.750 1.738
26 KG264776.pdf pg.1 SEE PRINT FOR GTOL
27 KG264776.pdf pg.1 SEE PRINT FOR GTOL
28 KG264776.pdf pg.1 Surface SEE PRINT microin
Roughness
29 KG264776.pdf pg.1 Linear Dimension 15 in 15.5

The signature indicates that all characteristics are accounted for; meet drawing requirements or are properly documented for disposition.

12. Prepared By

Form QF1439 Rev -

 Sheet 6 of 7
Article Inspection Report
untability, Verification and Compatibility Evaluation
3. Serial/Lot Number 4. FAI Report

Other Fields
14. Notes

Form QF1439 Rev -

 Sheet 7 of 7
untability, Verification and Compatibility Evaluation
3. Serial/Lot Number 4. FAI Report

Other Fields
14. Notes

ments or are properly documented for disposition.

13. Date

Form QF1439 Rev -