29-RB-S_Q01032

U.S. COAST GUARD COMPUTERIZED MAINTENANCE SYSTEM RB-S-29 Q01032.0 REV'D 12/31/20 ASSET NUMBER OPERATING ACTIVITY MAINTENANCE ACCOMPLISHED MAINTENANCE DUE DATE ASSET HOURS DATE ASSET HOURS MO DAY YEAR MO DAY YEAR ZULU DATE ZULU TIME MO DAY YEAR ITEM 1 DUE CMS CODE ACTION DESCRIPTION CEINUM Q01032 INSP/CHK STOWABLE SLING SEAT RB-B000-001 SCHEDULED UNSCHEDULED DISCREPANCIES FOUND: NO_____ YES_____ MAN HOURS: MK___.___DC___.___EM___.___ET___.___IT___.___GM___.___ BM___.___ FN___.___SN___.___ME___.___OTHER___.___ IF DISCREPANCIES ARE FOUND REMARKS ARE REQUIRED TECHNICIAN'S SIGNATURE TECHNICIAN'S ID * ASTERISK INDICATES QA REQUIRED QA REFERENCES: NONE REVIEWED BY LOG YN DATA ENTRY COMPLETED Distribution Statement D: Distribution authorized to the DHS/CG/DoD and their contractors Administrative/Operational use, 12/11/20. Other requests shall be referred to the appropriate asset product line. WARNING: This document contains technical data whose export is restricted by the Arms Export-Control Act (Title 22, U.S.C., Sec 2751, et. seq.) or the Export Administration Act of 1979, as amended, Title 50, U.S.C. App 2401 et. seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25. DESTRUCTION NOTICE: For classified documents, follow the procedures in DoD 5200.22-M, National Industrial Security Program Operating Manual, Section 5-705 or DoD 5200.1-R, Information Security Program Regulation, Chapter VI, Section 7. For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document. PRIVACY ACT STATEMENT Authority: 44 U.S.C. 3101; 44 U.S.C. 3534; 5 U.S.C. §552a (e)(3); and Executive Order 9397. Purpose: To account for scheduled and unscheduled maintenance performed on CG aircraft and surface assets. Routine Uses: Authorized CG personnel will use this information to document scheduled and unscheduled maintenance, man-hours expended, and the technician respon- sible for tasks performed on CG aircraft and surface assets. Any external disclosures of data within this record will be made in accordance with DHS/ALL-004, General Information Technology Access Account Records, 77 Federal Register 70792, November 27, 2012. Disclosure: Furnishing your Tech ID is voluntary; however, the inability to collect this information could result in untimely or incomplete Asset Computerized Maintenance System reports or the inability for the CG to make informed decisions regarding manpower analysis. Page 1 of 6

U.S. COAST GUARD COMPUTERIZED MAINTENANCE SYSTEM RB-S-29 Q01032.0 REV'D 12/31/20 MK BM NAME: ____________________________TECH ID/TH: _______/_____ NAME: ____________________________TECH ID/TH: _______/_____ NAME: ____________________________TECH ID/TH: _______/_____ NAME: ____________________________TECH ID/TH: _______/_____ NAME: ____________________________TECH ID/TH: _______/_____ NAME: ____________________________TECH ID/TH: _______/_____ DC IT NAME: ____________________________TECH ID/TH: _______/_____ NAME: ____________________________TECH ID/TH: _______/_____ NAME: ____________________________TECH ID/TH: _______/_____ NAME: ____________________________TECH ID/TH: _______/_____ NAME: ____________________________TECH ID/TH: _______/_____ NAME: ____________________________TECH ID/TH: _______/_____ EM FN NAME: ____________________________TECH ID/TH: _______/_____ NAME: ____________________________TECH ID/TH: _______/_____ NAME: ____________________________TECH ID/TH: _______/_____ NAME: ____________________________TECH ID/TH: _______/_____ NAME: ____________________________TECH ID/TH: _______/_____ NAME: ____________________________TECH ID/TH: _______/_____ ET SN NAME: ____________________________TECH ID/TH: _______/_____ NAME: ____________________________TECH ID/TH: _______/_____ NAME: ____________________________TECH ID/TH: _______/_____ NAME: ____________________________TECH ID/TH: _______/_____ NAME: ____________________________TECH ID/TH: _______/_____ NAME: ____________________________TECH ID/TH: _______/_____ GM OTHER NAME: ____________________________TECH ID/TH: _______/_____ NAME: ____________________________TECH ID/TH: _______/_____ NAME: ____________________________TECH ID/TH: _______/_____ NAME: ____________________________TECH ID/TH: _______/_____ NAME: ____________________________TECH ID/TH: _______/_____ NAME: ____________________________TECH ID/TH: _______/_____ PRIVACY ACT STATEMENT Authority: 44 U.S.C. 3101; 44 U.S.C. 3534; 5 U.S.C. §552a (e)(3); and Executive Order 9397. Purpose: To account for scheduled and unscheduled maintenance performed on CG aircraft and surface assets. Routine Uses: Authorized CG personnel will use this information to document scheduled and unscheduled maintenance, man-hours expended, and the technician respon- sible for tasks performed on CG aircraft and surface assets. Any external disclosures of data within this record will be made in accordance with DHS/ALL-004, General Information Technology Access Account Records, 77 Federal Register 70792, November 27, 2012. Disclosure: Furnishing your Tech ID is voluntary; however, the inability to collect this information could result in untimely or incomplete Asset Computerized Maintenance System reports or the inability for the CG to make informed decisions regarding manpower analysis. Page 2 of 6