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ENGINEERING CHANGE NOTICE<br />

I<br />

1. ECN (use no. from pg. 1)<br />

Page 2 of,5 640845<br />

16. Design 17. Cost Impact 18. Schedule Impact (days)<br />

Verification<br />

Required<br />

ENGINEERING CONSTRUCTION<br />

[] Yes Additional [] $ Additional [] $ Impro vement []<br />

No Savings [] $ Savings [] $ Delay []<br />

19. Change Impact Review: Indicate the related documents (other than the engineering documents identified on Side<br />

1) that will be affected by the change described in Block 13. Enter the affected document'number in Block 20.<br />

SDD/DD [ ] Seismic/Stress Analysis [ ] Tank Calibration Manual [ ]<br />

Functional Design Criteria [ ] Stress/Design Report r 1 Health Physics Procedure [ ]<br />

operating Specification [ ] Interface Control Drawi ng<br />

C ]<br />

Spares multiple Unit Listing [ ]<br />

Criticality Specification [] Calibrati on Procedure [] Test []<br />

Procedures/Specificati on<br />

Conceptual Design Report [ ] Installation Pro ce dure [ ] Component Index [ ]<br />

Equipment Spec. [ ] Maintenance Procedure [ ] ASME Coded Item [ ]<br />

Const. Spec. [ ] Engineering Procedure [ ] Hunan Factor Consideration [ ]<br />

Procurement Spec.<br />

C]<br />

operating Instruction Computer Software [^<br />

Vendor Information [ ] operating Procedure [ ] El ec tric Circuit Schedule [ ]<br />

DM manual [] operati onal Safety Requirement [] ICkS Procedure []<br />

FSAR/SAR [] IEFD Drawi ng [] Process Control Manual/Plan []<br />

Safety Equipment List f l Cell Arrangement Drawing [ ] Process Flow Chart [ ]<br />

Radiation Work Permit [ ] Essential Material r ] Purchase Requisition<br />

Specifi cati on<br />

L<br />

Environental Impact Statement [ ] Fac. Proc. Samp. Schedule [ ] Tickler File []<br />

Environmental Report<br />

'/<br />

[] Insp ec ti on Plan [] []<br />

Environmental Permit .}a^rFr]/ Inventory Adjustment Request [ ] []<br />

AL^<br />

indicate that the signing organization has been notified of other affected documents listed below.<br />

<strong>Document</strong> Number/Revision <strong>Document</strong> Number/Revision <strong>Document</strong> Number Revision<br />

G<br />

i!/) Xe1&4 Aeyoe4 elzo V"" %<br />

21. Approvals<br />

Signaturey Date<br />

Design Authority F1 e.L ^`I Design Agent<br />

Cog. Eng. r^ ShcrC^^+ L^l t'44<br />

Cog. Mgr. J „m om / ^ OAN h<br />

$Pr<br />

EAw4"M<br />

8 13 A X<br />

4 RD?eA11<br />

Other /3reff ^fan^ i, _ r<br />

lI" v w^mcu<br />

o . Ptx„rf<br />

A-7900-013-3 (05/96) GEF096<br />

2- z 9<br />

J e n•wA^4i^1^ z z<br />

`J<br />

PE<br />

Safety N A<br />

Design<br />

Environ. N p<br />

Other<br />

DEPARTMENT OF ENERGY<br />

[ ]<br />

ature<br />

Date<br />

o 00, E `<br />

'w4<br />

0—yp^<br />

Signature or a Control Number that<br />

tracks the Approval Signature<br />

ADDITIONAL<br />

^' ^-`6' `y`I<br />

'

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