MIL-DTL-18295F
APPENDIX A
DEFECTIVE PRODUCT REPORT
CONTRACT NO._______________________________
ORIGINATOR AND ADDRESS:
___________________________________________________________________________
DRAWING NO.___________ REVISION_______________ DATE_________________
PART DESCRIPTION________________________________ QTY__________________
SER. NO.__________________________________________
DESCRIPTION OF DEFICIENCY:
DISPOSITION:
SUBMITTING ACTIVITY AUTHORITY SIGNATURE
TITLE
APPROVED
WAIVED
DISAPPROVED
NAVAL FACILITIES ENGINEERING COMMAND SIGNATURE
DATE
NAVFAC FORM No. 101
23
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