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FCA CHECKLIST

NOMENCLATURE CI IDENTIFIER DATE SUPPLIER REQUIREMENTS YES NO

1. Waiver/Deviation List Prepared. 2. Verification Test Procedures Submitted. 3. Verification Testing Comp eted. !. Verification Test "esu ts Compi ed and #vai ab e. $. %aci ities for Conducting %C# #vai ab e. &. Verification Test Procedures "evie'ed and #pproved. (. Verification Testing Witnessed. ). Verification Test Data and "esu ts "evie'ed and #pproved.

COMMENTS

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FCA CERTIFICATION PACKAGE (NASA) %*" C+ +D,-T+%+,".s/ C*-T"#CT -*. P"+0, S1PPL+,"2 4444444444444444444444 #PP"*V,D 67 .S1PPL+,"/ SCOPE/PURPOSE SC*P,2 %unctiona Configuration #udit .%C#/ 'as conducted on t9e fo o'ing Configuration +tem2 C+ +dentifier 555555555-omenc ature 5555555555Part -o.5555555555Seria -o. 5555555555555 P1"P*S,2 T9e purpose of t9is %C# 'as to verif: t9at t9e configuration item;s performance comp ied 'it9 t9e Deve opment Specification. ,31+P0,-T 0#-1%#CT1","S2 555555555555555555555555555555 #PP"*V,D 67 .8*V,"-0,-T/

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