JA NOC Ref. No. Supplier Notice Of Change Form Jamco America – Revision: Type of Change: Requires Customer Acceptance, Type/Class 1 (Prior to implementation of this change) Notification Only, Type/Class 2 (Changes have been implemented concurrent with this notification) Supplier NOC Ref. No. Submittal Date: Requested Response Date: Revision/Issue: Supplier Name: Submitted By: Address: Title: Telephone: Telephone: Email: Cage Code: Signature: Description of Change: (Please list attachments) Approved Part(s): Yes No Approval Type: STC PMA TSO PC Reason for Change: Impact(s) of Change: Other: _______________________________ Please email to: Software Certification Test Plan/Report change_specialist@jamco-america.com Hardware/Materials Documentation (other than test plan/report & ICA) Mechanical Systems Business Process Or, mail to: Electrical Systems Business Ownership Drawing/Design Credit Reporting Agency Change Specialist, Configuration Management Obsolescence Facility Location Jamco America Inc. Substitution Certificate Status (AS, ISO, NADCAP, etc..) 1018 80th Street S.W. Everett, WA 98203 USA ICA (Instructions for continued airworthiness document such as CMM, AMM & IPC sup.) Received By: Telephone: Date: Assigned Priority Emergency Urgent Routine JA Affected Projects: Approved Part(s): Yes No Approval Type: STC PMA TSO PC Jamco Disposition: Accepted Accepted with changes Disapproved Reason for Disapproval or Description of Customer Required Changes and/or Comments: Jamco Representative: Email: Title: Telephone: Signature: Date: Jamco ODA Certification Impact Review or Major/Minor Change Determination: Major (new or revised PSCP required) Minor Jamco ODA Representative Signature: Date:
Supplier Notice Of Change Form – Jamco America JA NOC Ref. No. Revision: Type of Change: Requires Customer Acceptance, Type/Class 1 (Prior to implementation of this change) Notification Only, Type/Class 2 (Changes have been implemented concurrent with this notification) Submittal Date: Requested Response Date: Supplier NOC Ref. No. Revision/Issue: Supplier Name: Submitted By: Address: Title: Telephone: Telephone: Email: Cage Code: Signature: Description of Change: (Please list attachments) Approved Part(s): Yes No Approval Type: STC PMA TSO PC Reason for Change: Impact(s) of Change: Other: _______________________________ Software Certification Test Plan/Report Hardware/Materials Documentation (other than test plan/report & ICA) Mechanical Systems Business Process Electrical Systems Business Ownership Drawing/Design Credit Reporting Agency Obsolescence Facility Location Substitution Certificate Status (AS, ISO, NADCAP, etc..) ICA (Instructions for continued airworthiness document such as CMM, AMM & IPC sup.) Please email to: change_specialist@jamco-america.com Or, mail to: Change Specialist, Configuration Management Jamco America Inc. 1018 80th Street S.W. Everett, WA 98203 USA Received By: Telephone: Date: Assigned Priority Emergency Urgent Routine JA Affected Projects: Approved Part(s): Yes No Approval Type: STC PMA TSO PC Jamco Disposition: Accepted Accepted with changes Disapproved Reason for Disapproval or Description of Customer Required Changes and/or Comments: Jamco Representative: Email: Title: Telephone: Signature: Date: Jamco ODA Certification Impact Review or Major/Minor Change Determination: Major (new or revised PSCP required) Minor Jamco ODA Representative Signature: Date:
Supplier%20Notice%20of%20Change%20Form%20UE-119.docx