<p> NON-CONFORMANCE REPORT PBS Number PA or TA Number Report Number DBS Number Section 1 To be completed by the Contractor 1 - Contract number and Item Number(s): 2 - Contract title: 3 - Contractor: 4 - Item identification: 5 - Requirement: </p><p>6 - Description of the non-conformance: </p><p>7 - Proposed remedial action: use as is rework repair reject alt. use</p><p>8 - List of attachments: </p><p>9 - Proposed non-conformance category: MINOR non-conformance (Report to be sent to US ITER for information and remedial action implemented) MAJOR non-conformance (Remedial action to be implemented only after US ITER written acceptance) Contractor’s Responsible Officer Contractor’s Quality Officer</p><p>Name Date Signature Nam Date Signature e Section 2 To be completed by US ITER Technical Responsible Officer QA Responsible Officer Decision: Comment:</p><p>Name Date Signature Name Date Signature Chief Engineer: (Reviewer) Division Director (Reviewer) Initials Initials </p><p>Technical Project Officer (Reviewer) Procurement Manager (Reviewer) Initials Initials </p><p>WBS Task Leader (Reviewer) QA ES&H Manager (Approver) Initials Initials Section 3 To be completed by ITER IO IO Technical Responsible Officer IO QA Responsible Officer Decision: Comments:</p><p>Name Date Signature Name Date Signature</p><p>Page 1 of 1 US ITER-7 R5 (9-2012)</p>