Appendix 3 - Supplier PPAP Check List Form

Rev Date: April 2011

SUPPLIER PPAP Check List

Supplier Name & Location:
P&L Development and Manufacturing
Cooper Part Number:
1032130
Rev Level / Date: #1 27SE11
10/19/2011
YES

(Note - always refer to the Cooper Standard Supplier Portal for the latest PPAP Checklist version)
NO
N/A

2.2.1 Design Record

x
x
x

A. Hard copy of engineering print or CAD/CAM math data is provided?

B. Print indicates approved release number and release date?
C. Print is 100% ballooned and sequential numbered for dimensions, notes and specifications?
D. All Material Specification(s) are provided in the PPAP package?
(Note that hard copy will not be printed out for Cooper interplant PPAP that have access to WIndchilll.)
E. All Engineering Specification(s) are provided in the PPAP package?
(Note that hard copy will not be printed out for Cooper interplant PPAP that have access to WIndchilll.)
F: For Polymeric (plastic) Parts if requested,. 1SO 11469/1043-1 or ISO 11499/1020 specification.
(Note that hard copy will not be printed out for Cooper interplant PPAP that have access to WIndchilll.)
Comments:

x
x
x

YES

YES

YES

YES

NO

NO

NO

NO

N/A

2.2.2 Authorized Engineering Change Documents

A. Are there any changes authorized that are not yet captured by the current print?
Comments:
Customer specific documents will be included as applicable.

N/A

2.2.3 Customer Engineering Approval

x
x

A. Are CS or Customer Engineering Approvals Required? ECR - Engineering Change Request, SREA, Forever Req, etc.
B. Are Approved Customer specific documents included?
Comments: Customer specific documents will be included as applicable. (e.g. Alerts, concerns, notices, SREAs, EWO, TWO, GM3660
[Engineering Source Approval], GM1411 [PPAP Worksheet] DV [Design Verification] and PV [Production Validation] forms)

N/A

2.2.4 Design Failure Mode & Effects Analysis (DFMEA)

x
x
x
x

A. If design responsible, is a Design Failure Mode & Effects Analysis (DFMEA) present and in the latest AIAG format?
B. Is he DFMEA UP-TO-DATE with a current revision?
C. Are SEV 5-8 and OCC 4-10 identified as Key Characteristic? If none, is there evidence of redesign to reduce SEV or OCC?
D. Is the document linked to the Drawing ? Part Number / Revision Level or Process/Part Name.
Comments:
If the DFMEA is Proprietary, include a blank DFMEA with a Proprietary Information Statement.

N/A

2.2.5 Process Flow Diagram

x
x

A. Is a Process Flow Diagram present?

B. Is PFD up to date with a current revision?
C. Is the document linked to the Drawing ?
D. Is document linked to PFMEA and Control plan?
Comments:

x
x

Part Number / Revision Level or Process/Part Name.

Page 1 of 37

Appendix 3 - Supplier PPAP Check List Form

Rev Date: April 2011

SUPPLIER PPAP Check List

Supplier Name & Location:
P&L Development and Manufacturing
Cooper Part Number:
1032130
Rev Level / Date: #1 27SE11
10/19/2011
YES

(Note - always refer to the Cooper Standard Supplier Portal for the latest PPAP Checklist version)
NO
N/A

2.2.6 Process Failure Mode & Effects Analysis (PFMEA).

x
x

A. Is a Process Failure Mode & Effects Analysis (PFMEA) present and in the latest AIAG format?
B. Is PFMEA up-to-date with a current revision?
C. Are SEV 5-8 with and OCC 4-10 identified as PHIC? If none, is there evidence of actions to reduce OCC?
D. Are Sev 9 and 10 identified as CC?
E. Is in agreement with PFD, Control Plan and WI's/SOP's? Key characteristics must be listed at specific operation/sequence.
F. Are SEV Ratings Appropriate per the AIAG guidelines?
G. Are DET Ratings Appropriate per the AIAG guidelines?
H. Is the document linked to the Drawing (i.e. P/N, Release Date, Revision Date)?
I. If no Actions are identified, is None indicated in each row/field?
J. Are failures at one process step identified as the cause of failures at the appropriate subsequent step?
K. Are the RPN's calculated correctly?
Comments: If PFMEA contains proprietary information, a blank PFMEA is to be included in package with a Proprietary Information Sheet.

x
x
x
x
x
x
x
x

YES

NO

N/A

2.2.7 Control Plans

x
x

A. Is a Control Plan present?

B. Have all SC and Key Characteristics been identified and are controls adequate? (discuss with CS before submission if not sure)
C. Is the Control Plan up-to-date with a current revision?
D. Is there linkage to DFMEA (as applicable), PFMEA, PFD, and Operator Instruction?
E. Reaction plans are identified and realistic?
F. Is the document linked to the Drawing (i.e. P/N and Release Date)?
G. Are both Process and Product Characteristics controlled?
H. Have all important Pass Through Characteristics (PTC) been identified and are controls adequate? (discuss with CS before submission if not
sure)
Comments:

x
x
x
x
x
x

YES

NO

N/A

2.2.8 Measurement. System Analysis Studies (MSA)

x
x

A. Are MSAs included and usage of the latest AIAG forms?

B. Are there MSA for all gages, measurement and test equipment used to control product?
C. Are the MSAs using the ANOVA method?
D. Raw data is included in PPAP and available in an Excel file?
E. Do the MSAs meet minimum requirements per AIAG (e.g. % Study Variance should be < 10% Good, 11% - 20% Marginal,
21% - 30%
Unacceptable - action plan required, > 30% No Good and may need to use new gage - action plan required).
F. Ford Specific: Does the % Contribution meet minimum requirements (e.g. % Contribution should be <1% is acceptable, 1% to 9% Marginal,
> 9% Unacceptable)?
G. Ford Specific: When using MiniTab, do the distinct categories meet minimum Ford requirements (e.g. > 10 Acceptable, 5 to 9 Marginal, < 5
Unacceptable)?
H. Ford Specific: When using MiniTab for attribute gages, do they meet minimum Ford requirements (e.g. Sample size should be 50 parts or
greater with a >90% Operator Repeatability, and Kappa > 0.70, Ford prefers > 0.90)?
I. Ford Specific: Are Destructive Gage R&R set up as "nested" and utilizing 3 operators, 5 parts (5 different batches each minimum), Multiple
replicates. (Note: you should assume that all parts within a single batch are the identical).
Comments:
Use of a specific brand of calibration software is not required. Software is to be tested with the Ford data set & evidence of passing included.

x
x
x
x
x
x
x

Page 2 of 37

Appendix 3 - Supplier PPAP Check List Form

Rev Date: April 2011

SUPPLIER PPAP Check List

Supplier Name & Location:
P&L Development and Manufacturing
Cooper Part Number:
1032130
Rev Level / Date: #1 27SE11
10/19/2011
YES

(Note - always refer to the Cooper Standard Supplier Portal for the latest PPAP Checklist version)
NO
N/A

2.2.9 Dimensional Results

x
x

A. Variable measurements for every (except reference) dimensions on part print are to recorded?
B. Dimensional results required for every unique manufacturing process?
C. Is the AIAG Dimensional results form used? Part print information to be recorded on dimen. report, including level, date , org name,. part #,
etc.
D. Are there 6 pieces for all cells or production lines. For multiple cavities, molds, patterns and dies, 1 per cavity at least 6 parts to be
measured. Individual data readings and master(s) sample provided?
E. Is tracing included for Optical Comparator required for inspection?
F. If measured by CMM, reports included?
G. Results indicate that dimensional verifications required by print and control plan have been completed and results indicate compliance?
Comments:

x
x
x
x
x

YES

NO

N/A

2.2.10 Material/Performance Test Results

A. Is the AIAG Material and Performance Test Results form are used?
B. Are records of each specified test included?
C. Part print information to be recorded on Material/Performance Reports? Including engr. Level, date, p/n, etc.
D. Any authorized engineering change documents not yet incorporated into the design record, but present in the part?
E. Number, date and change level of specification to which part was tested?
F. Date on which testing took place?
G. Qty. tested if not stated within specification?
H. Actual results?
I. Material supplier's name (req'd) and code (if applicable)?
J. Ford Specific: Is the DVP&R included?
Comments:

x
x
x
x
x
x
x
x
x

YES

NO

N/A

2.2.11 Initial Process Studies

x
x
x
x
x
x
x
x
x
x
x

YES

NO

A. Per AIAG, all Special Characteristics need to show acceptable initial process capability prior to submission based on 125 pcs. Minimum? If
non-normal data set, reason are supplied to support acceptability?
B. Supplier shall obtain concurrence from the customer on which index is to be used? Use PpK (1.67 PpK)
C. Gage R&R is to be performed in order to understand how measurement error impacts the study measurements?
D. Initial studies will be provided in accordance with the Important Characteristics Summary sheet or Engineering designed drawing?
E. Initial process studies are summarized with capability or performance indices?
F. Studies were evaluated using these common techniques? Ie. Xbar Chart, Capability Histogram, R Chart, Normal Prob. Plot, Last 25
Subgroups, Capability Plot. (MiniTab software provides all of theses.)
G. Is the P Value >5%, if not has the study been evaluated for improvements?
H. Raw data is included in PPAP?
I. Electronic data format to be submitted either in Minitab, or the Raw Data provided in an Excel File.
J. If initial process studies are not satisfactory, is control plan modified for 100% inspection and Corrective action plan submitted to become
capable?
Comments:

N/A

2.2.12 Qualified Laboratory

x
x
x
x

A. Testing performed by external qualified laboratory need to be certified to ISO/IEC 17025 or national equivalent?
B. Scope of laboratory is Defined (whether internal or 3rd party lab)?
C. If tested externally to supplier, results to be submitted on independent lab letterhead or their normal lab report?
D. If tested externally to supplier, Name of lab, date of tests and standards used to run the tests need to be enclosed?
Comments:

Page 3 of 37

Appendix 3 - Supplier PPAP Check List Form

Rev Date: April 2011

SUPPLIER PPAP Check List

Supplier Name & Location:
P&L Development and Manufacturing
Cooper Part Number:
1032130
Rev Level / Date: #1 27SE11
10/19/2011
YES

(Note - always refer to the Cooper Standard Supplier Portal for the latest PPAP Checklist version)
NO
N/A

2.2.13 Appearance Approval Report

x
x

A. For parts having an appearance requirement on design record, a AAR must be completed for each part or series of parts?
B. AAR and representative parts to be submitted to customer for disposition?
C. AAR w/disposition and authorized customer signature to accompany PSW at time of submission?
D. AIAG form CFG-1002.(AAR) to be used for submission?
Comments:

x
x

YES

NO

N/A

2.2.14 Sample Production Parts

x
x

A. Supplier provides sample parts as specified by the Cooper using plant

B. Include a note in the PPAP package indicating # of functional sample submitted to which Cooper plant
Comments:

YES

NO

N/A

2.2.15 Master Sample

x
x

A. Master sample supplied and retained meeting PPAP requirements per AIAG?
B. Master sample is properly identified and stored?
C. Include a note in the PPAP package referencing supplier's internal procedure governing master samples and their storage?
Comments:

YES

NO

N/A

2.2.16 Checking Aids

A. Supplier to certify all aspects of checking aid to agree with dimensional requirements?
B. Supplier to certify all released changes have been incorporated into checking aid?
C. Supplier to provide for Preventive Maintenance on any checking aid for the life of the part?
D. MSA to be conducted in accordance with AIAG and customer requirements?
E. Checking Aids can include fixtures either variable and attribute gages, models, templates, Mylar's, etc. specific to the product being
submitted?
Comments:

x
x
x
x

YES

NO

N/A

2.2.17 Customer Specific

x
x

A. Raw data for part weight (10 random parts) is included?

B. Submit IMDS submission screen-shot provided?
C. PV results data must be less than one year old?
D. Submit Barcode Label form per CS Requirements?
E. Submit Run @ Rate form (Appendix VII) per CS Guidebook?
F. Submit Submission and Approval of the Tooling form (Appendix 21) per CS Guidebook?
G. Submit Packaging form (Appendix 15) per CS Guidebook?
H. Valid TS16949 or ISO9000 certification uploaded in CS supplier portal?
I. Annual CQI-9 Heat Treat / Braze Assessment (Appendix 04) uploaded in CS supplier portal?
J. Annual CQI-11 Plating Assessment (Appendix 18) uploaded in CS supplier portal?
K. Annual CQI-12 Coating Assessment (Appendix 19) uploaded in CS supplier portal?
L. Annual CQI-15 Welding Assessment (Appendix 22) uploaded in CS supplier portal?
M. Annual CQI-17 Soldering Assessment (Appendix 23) uploaded in CS supplier portal?
N. Annual Supplier Profile (Appendix II) uploaded in CS supplier portal?
O. Product with Studs or Fasteners - Does the manufacture of stud/fastener have a PM on thread rolling tools to prevent usage of worn out tools?
P. Product with Studs or Fasteners - Does the print or engineering specifications define a thread lap criteria and how is this controlled each
production run?
Q. Product with Studs or Fasteners that get Heat Treated - Does the supplier/heat treater verify each batch for proper HT specification? Are
checks on parts for hardness and embrittlement adequate?
Comments

x
x
x
x
x
x
x
x
x
x
x
x
x
x
x

Page 4 of 37

Appendix 3 - Supplier PPAP Check List Form

Rev Date: April 2011

SUPPLIER PPAP Check List

Supplier Name & Location:
P&L Development and Manufacturing
Cooper Part Number:
1032130
Rev Level / Date: #1 27SE11
10/19/2011
YES

(Note - always refer to the Cooper Standard Supplier Portal for the latest PPAP Checklist version)
NO
N/A

2.2.18 PPAP Submission Warrant Status

A. Supplier shall submit the required AIAG's Forth Edition PSW form?
B. Is the PPAP ready for submission?
C. Has the warrant been signed by an authorized supplier representative?
D. Does the part name exactly match the print included in the Design Record?
E. Do the part numbers exactly match the print included in the Design Record?
F. Is there a unique customer part number?
G. Does Change Level and Date exactly match the print included in the Design Record?
H. Note any Additional Engineering changes not included in the released level?
I. Is supplier IMDS included?
J. Is supplier P.O. included?
K. Is the correct supplier and site code included?
L. Is the correct Buyer and Buyer code included (as available)?
M. Is the weight identified in Kg to 4 decimal places?
N. Is the Customer and the Division appropriately identified?
O. Is the correct submission level identified?
P. Is the production rate per hour included?
Q. Does the data to support the Production Rate exist in customer specifics?
R. Has the mold/cavity/processes been included?
S. All fields have been completed. N/A has been inserted if any field is non-applicable?
Comments:

x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x

ACC

REJ

DISPOSITION (for Cooper Standard to complete)

If the PPAP submission meets all Cooper-Standard requirements, checked the ACC box.
If the PPAP submission does not meet all Cooper-Standard requirements, checked the REJ box and note the reason for the rejection in the
specific comment sections above.
Comments:

Supplier:

CS Plant:

Reviewed By:

Christina Raynak

07/17/12

Supplier Quality Engineer / Manager

Reviewed By:

Date

'

Cooper BU Engineer / Quality Engineer

Date

At a minimum, the Supplier PPAP should be reviewed and dispositioned by the CS Supplier Quality Engineer or the CS Business Unit Engineer

Page 5 of 37

ENGINEERING CHANGE DOCUMENTS

Not Applicable

CUSTOMER ENGINEERING APPROVAL

SEE SUPPLIER PPPAP

DFMEA

NOT APPLICABLE

PROCESS FLOW DIAGRAM

OPERATION
DESCRIPTION

Receiving Inspection
of 1032131 Valve

Move Valves to
Machining Area

Maching Op

Move Valves to
Washing Area

Wash Valves to
remove any
Deburring
Contamination

Move Valves to BlowOff station

PRODUCT AND
PROCESS
CHARACTERISTICS

6/21/2012
#1
Christina Raynak

ITEM #

DATE:
ECL:
PREPARED BY:

ITEM #

STORE

MOVE

INSPECT

STEP

FABRICATION

PART NUMBER:
1032130
PART DESCRIPTION:
Machined Valve, Ball 3 port

CONTROL
METHODS

Correct Valve in
Package

Visual

Machine Radius on
Valve
(1.7345 +/- .005)

1032130 Machine
Cutting Program,
Operator Instructions,
First Piece Approval,
Inprocess Audit every
5 pcs.

No residue on Valves

Operator Instruction,
Dish Washer Cycle

Compressed Air
Blow-Off
Move Valves to
Packaging & Shipping
Area

Remove any Chips

from Valves

Operator Instruction

Labeling & Packaging

Final Audit

Parts to be packed
and labeled per
Operator Instruction

Operator Instruction,
Verification Form

10

Ship Product

No damage when
loaded

Visual

Page 11 of 37

POTENTIAL
FAILURE MODE AND EFFECTS ANALYSIS
(PROCESS FMEA)
Item:

1032130

Model Year(s)/Program(s)

2013 DS/DJ

FMEA Date (Rev.)

Dave Weber
6/21/2012

1ST PIECE
CHECK AT SETUP

INPROCESS
CHECKS

84

None

3 WRONG RADIUS TOOL

SET IN TURNING
CENTER

VERIFY
CORRECT TOOL
SET IN MACHINE
AT START UP

1ST PIECE
APPROVAL,
INPROCESS
CHECKS

96

None

3 WRONG TOOL OFF-SET

COMPENSATION IN
PROGRAM

VERIFY
PROGRAM TOOL
COMPENSATION
IN PROGRAM AT
SET-UP

1ST PIECE
APPROVAL,
INPROCESS
CHECKS

96

None

VERIFY
CORRECT
PROGRAM AT
SET-UP

1ST PIECE
APPROVAL,
INPROCESS
CHECKS

96

None

CHANGE RADIUS INPROCESS

CUTTING TOOL
CHECKS
EVERY 600 PCS

96

None

SUPPLIER SHIPPED
PARTS OUT OF
SPECIFICATION

WRONG PROGRAM
BEING USED

3 EXCESSIVE WEAR ON
TOOL

Prevention

Detection

Recommended
Action

5 / WASH
VALVES

CONTAMINATION
FROM DEBURRING
PROCESS ON
VALVE

MAY CAUSE ASSY

TO NOT FUNCTION

OPERATOR FAILED TO
COMPLETE THE WASH
PROCESS

OPERATOR
TRAINING,
VERIFICATION
FORM, ROUTER

VISUAL

128 None

7/
COMPRESSED
AIR BLOW-OFF

CHIPS FROM
MACHINING
PROCESS ON
PARTS

MAY CAUSE ASSY

TO NOT FUNCTION

OPERATOR FAILED TO
COMPLETE BLOW-OFF
OPERATION

OPERATOR
TRAINING,
VERIFICATION
FORM, ROUTER

PARTS ARE
PLACED IN A
GREEN BIN
AFTER BLOWOFF OPERATION

128 None

Page 12 of 37

Actions Taken
& Effective Date

RPN

ASSY WILL NOT

FUNCTION
PROPERLY

Action Results
Responsibility
& Target
Completion
Date

Detection

RADIUS NOT
MACHINED TO
PRINT

Current
Process
Controls

Occurrence

Potential
Causes(s)
of Failure

Severity

DIFFICULTY IN
PROCESSING

Current
Process
Controls

RPN

3 / MACHINING
RADIUS ON
VALVE

7/1/2012

Detection

Severity

PARTS OUT OF
SPECIFICATION

Occurrence

Potential
Effect(s)
of Failure

Potential
Failure
Mode

Requirements
1 / RECEIVING

FMEA Date (Orig.)

1032130

Quality, Manufacturing, Engineering

Process Step
/ Function

Prepared by:

P&L DEVELOPMENT

Key Date

Classification

Core Team:

Process Responsibility

FMEA Number:

POTENTIAL
FAILURE MODE AND EFFECTS ANALYSIS
(PROCESS FMEA)
Item:

1032130

Model Year(s)/Program(s)

2013 DS/DJ

Prepared by:

P&L DEVELOPMENT

FMEA Date (Orig.)

7/1/2012

FMEA Date (Rev.)

Key Date

Dave Weber
6/21/2012

MISLABELED, OLD
TAGS NOT REMOVED

OPERATOR
INSTRUCTION,
VERIFICATION
FORM

SHIPPING
PERSONNEL TO
VERIFY
PRODUCT PRIOR
TO SHIPPING

80

None

10 / SHIPPING

PRODUCT
DAMAGED WHILE
HANDLING

SCRAP/REWORK/
SORTING OF
PRODUCT

SHIPPER FAILED TO
FOLLOW PROCEDURES

OPERATOR
INSTRUCTION

SHIPPING
PERSONNEL TO
VERIFY
PRODUCT PRIOR
TO SHIPPING

64

None

Prevention

Page 13 of 37

Detection

Recommended
Action

Responsibility
& Target
Completion
Date

Actions Taken
& Effective Date

RPN

Requirements

Potential
Causes(s)
of Failure

Detection

INCORRECT PART
NUMBER RECEIVED
AT CUSTOMER

Severity

INCORRECT
LABELING OF
CONTAINER

Potential
Effect(s)
of Failure

Occurrence

Action Results

9 / LABELING &
PACKAGING
FINAL AUDIT

Potential
Failure
Mode

Severity

Current
Process
Controls

RPN

Current
Process
Controls

Detection

Occurrence

Process Step
/ Function

1032130

Quality, Manufacturing, Engineering

Classification

Core Team:

Process Responsibility

FMEA Number:

CONTROL PLAN
Prototype
Control Plan Number

Pre-Launch

Production
Key Contact/Phone

Date (Orig.)

Dave Langley / 989-820-5699

Part Number/Latest Change Level

Core Team

1032130 / #1

Quality, Manufacturing, Engineering

Part Name/Description

Supplier/Plant Approval/Date

Machined Valve, Ball 3 Port

Supplier/Plant

P & L Development
PART/
PROCESS NAME/
PROCESS
OPERATION
NUMBER
DESCRIPTION

Customer Engineering Approval/Date (If Req'd.)

Customer Quality Approval/Date (If Req'd.)

Christina Raynak / 6-21-12

Supplier Code

Other Approval/Date (If Req'd.)

Other Approval/Date (If Req'd.)

PLDE01
MACHINE,
DEVICE
JIG, TOOLS
FOR MFG.

CHARACTERISTICS
NO.

PRODUCT

PROCESS

METHODS
SPECIA
L
PRODUCT/PROCESS EVALUATION/
SAMPLE
CHAR.
SPECIFICATION/ MEASUREMENT
CLASS
SIZE
FREQ.
TOLERANCE
TECHNIQUE

RECEIVING
INSPECTION OF
1032131 VALVE

CORRECT VALVE IN
PACKAGING

MACHINING

CNC
TURNING
CENTER

VALVE WASH

COMPRESSED
AIR BLOW-OFF

MACHINE
RADIUS ON
VALVE

1032130
CUTTING
PROGRAM

PART
WASHER

REMOVE
DEBURRING
CONTAMINATION

WASHER
CYCLE

BLOW-OFF
STATION

VISUAL

1.7354 +/- .005

MICROMETER

NO RESIDUE ON
VALVES

VISUAL, PART
ROUTER

REMOVE
CHIPS FROM
PARTS

NO CHIPS ON
PARTS

PROPER
LABEL AND
PACKAGING

PARTS TO BE
PACKED AND
LABELED PER
OPERATOR
INSTRUCTION

Page 14 of 37

CONTROL
METHOD

PER LOT VISUAL

REACTION
PLAN
QUARANTINE
PRODUCT,
CONTACT
SUPPLIER FOR
RESOLUTION

1ST
CUTTING
PIECE,
PROGRAM,
EVERY 5
OPERATOR
PCS
INSTRUCTION,
IN-PROCESS
CHECKS

QUARANTINE
PRODUCT,
CONTACT
SUPERVISOR
FOR
RESOLUTION

100%

PER LOT

VISUAL

QUARANTINE
PRODUCT,
CONTACT
SUPERVISOR
FOR
RESOLUTION

VISUAL, PART
ROUTER

100%

PER LOT

OPERATOR
INSTRUCTION,
IN-PROCESS
CHECKS

QUARANTINE
PRODUCT,
CONTACT
SUPERVISOR
FOR
RESOLUTION

VISUAL

CARTON

OPERATOR
INSTRUCTION
VERIFICATION
FORM

QUARANTINE
PRODUCT,
CONTACT
SUPERVISOR
FOR
RESOLUTION

LABELING &
PACKAGING
FINAL AUDIT

Date (Rev.)

6/21/2012

CONTROL PLAN
Prototype
Control Plan Number

Pre-Launch

Production
Key Contact/Phone

Date (Orig.)

Dave Langley / 989-820-5699

Part Number/Latest Change Level

Core Team

1032130 / #1

Quality, Manufacturing, Engineering

Part Name/Description

Supplier/Plant Approval/Date

Machined Valve, Ball 3 Port

Supplier/Plant

P & L Development
PART/
PROCESS NAME/
PROCESS
OPERATION
NUMBER
DESCRIPTION
SHIPPING

Date (Rev.)

6/21/2012
Customer Engineering Approval/Date (If Req'd.)
Customer Quality Approval/Date (If Req'd.)

Christina Raynak / 6-21-12

Supplier Code

Other Approval/Date (If Req'd.)

Other Approval/Date (If Req'd.)

PLDE01
MACHINE,
DEVICE
JIG, TOOLS
FOR MFG.

CHARACTERISTICS
NO.

PRODUCT
SHIP
PRODUCT

PROCESS

METHODS
SPECIA
L
PRODUCT/PROCESS EVALUATION/
SAMPLE
CHAR.
SPECIFICATION/ MEASUREMENT
CLASS
SIZE
FREQ.
TOLERANCE
TECHNIQUE
NO DAMAGE WHEN
LOADED

10

Page 15 of 37

VISUAL

PER LOT

CONTROL
METHOD
SHIPPER
PROCEDURE

REACTION
PLAN
QUARANTINE
PRODUCT,
CONTACT
SUPERVISOR
FOR
RESOLUTION

Production Part Approval

Dimensional Test Results
P & L Development and Manufacturing
1PLDE01
P & L Development and Manufacturing
INSPECTION FACILITY:

Page 21 of 37 Pages

ORGANIZATION:

PART NUMBER:

1032130

SUPPLIER / VENDOR CODE:

PART NAME:

Machined Valve, Ball 3-Port

DESIGN RECORD CHANGE LEVEL:

#1 27SE11

ENGINEERING CHANGE DOCUMENTS:

ITEM

DIMENSION /
SPECIFICATION

22.04mm (1.7354)

2
3
4
5

Surface Roughness
Make from molded
Break sharp
Significant

SPECIFICATION /
LIMITS

TEST
DATE

QTY.
TESTED

+/- .13 (.005)

5/7/12

5/7/12

ORGANIZATION MEASUREMENT
RESULTS (DATA)

1.7342
1.7345
1.7348
1.7341
1.7342
1.7340
Pass
Noted
Noted
Noted

OK

NOT
OK

x
x
x
x
x
x
x
x
x
x

Blanket statements of conformance are unacceptable for any test results.

SIGNATURE

C. Raynak

March CFG-1003
2006

TITLE

QA Manager

DATE

5/7/2012

MATERIAL/PERFORMANCE TEST RESULTS

NOT APPLICABLE

QUALIFIED LABORATORY

NOT APPLICABLE

APPEARANCE APPROVAL REPORT

NOT APPLICABLE

SAMPLE PRODUCTION PARTS HAVE BEEN SH

E BEEN SHIPPED PER RELEASES.

MASTER SAMPLES HAVE BEEN RETAINED

AND IDENTIFED.

TAINED

CHECKING AIDS

NOT APPLICABLE

Weight Measurement for 1032130

1) .0157
2) .0158
3) .0156
4) .0157
5) .0157
6) .0158
7) .0158
8) .0156
9) .0157
10) .0157
Sum of 10 = 0.1571/ 10 = .0157

Appendix XV - Packaging Form

Rev - 2

Rev Date - April 2010

Packaging Information Form

05/30/12
05/30/12
PACK EFFECTIVE DATE:
P&L Development and Manufacturing
SUPPLIER NAME:
1PLDE01
SUPPLIER NUMBER:
Christina
Raynak
SUPPLIER CONTACT:
989-739-5203
PHONE #:
989-739-5205
FAX #:
ISSUE DATE:

4025 Arrow St.

Oscoda, MI 48750

SUPPLIER
ADDRESS:

PART INFORMATION

DIMENSIONS

PART NUMBER:
NAME:
REVISION LEVEL:

PACKAGING INFORMATION

CONTAINER

CONTAINER TYPE

IF EXPENDABLE

RETURNABLE

TRIPLE WALL
OTHER

OUTSIDE LENGTH

CONTAINER STYLE
PALLET BIN - SOLID SIDES

DROP DOWN SIDE

PALLET BIN - COLLAPSIBLE SIDES

BREAK AWAY

PALLET BIN - 1 OR MORE DROP DOORS

CARTON

STACKING STRENGTH

OUTSIDE WIDTH

CONTAINER FEATURES
PALLET BOX

x DOUBLE WALL

18"
18"
18"
27
17.75
17.75
17.75

WEIGHT:

IF RETURNABLE

SINGLE WALL

DIMENSIONS (INCHES)

WIDTH:
HEIGHT:

REQUIRED PACKAGING DIGITAL PICTURES ATTACHED:

CORRUGATED CONTRUCTION

x EXPENDABLE

2"
2"
2"
.0157kg

LENGTH:

1032130
Machined Valve, Ball 3 Port
#1

(BURST OR ECT)

SMALL MANUAL TOTE - STRAIGHT SIDES

HAND HOLES

SMALL MANUAL TOTE - NESTABLE

OTHER

SMALL MANUAL TOTE - COLLAPSIBLE

OUTSIDE HEIGHT

OTHER

WEIGHT (POUNDS TARE)

INSIDE LENGTH

CONTAINER STYLE
REGULAR SLOTTED

ADDITIONAL INFORMATION

OWNERSHIP

(SEE REVERSE SIDE)

SUPPLIER PURCHASED - SUPPLIER OWNED

PICTURES ON PAGE 2

CSA PURCHASED - SUPPLIER OWNED

INSIDE WIDTH

x HALF SLOTTED

INSIDE HEIGHT

PALLET BOX

AND MAINTAINED

OTHER

CSA PURCHASED - CSA OWNED

OTHER - DESCRIBE ON BELOW

PALLET
DIMENSIONS (Inches)

LOAD CONFIGURATION

PALLET MATERIAL

PALLET STYLE

NUMBER OF PARTS IN CONTAINER

LENGTH (RUNNER)

HARD WOOD HEIGHT

SINGLE WING

NUMBER OF CONTAINERS ON PALLET

WIDTH (DECK BOARD)

SOFT WOOD WEIGHT

DOUBLE WING

NUMBER OF PARTS PER PALLET

HEIGHT

PAPER

FLUSH WING

GROSS WEIGHT PER CONTAINER WITH PARTS

WEIGHT

PLASTIC

BLOCK

PALLETIZED LOAD HEIGHT

METAL

OTHER

(INCLUDING PALLET)

OTHER

HEIGHT PALLETS CAN BE STACKED IN TRANSIT

0.002

COST

PACKAGING COST PER PIECE

TRANSPORTATION INFORMATION

UPS

CARRIER TO BE USED:

FREIGHT CHARGES:

CSA SHIP TO LOCATION:

COLLECT

PREPAID

BI-WEEKLY

MONTHLY

SCHEDULED PICK UP TIME(S):

SCHEDULED PICK UP DAY(S): x MONDAY

x TUESDAY

x WEDNESDAY

x THURSDAY

x FRIDAY

WEEKLY

BI-MONTHLY

(CHECK ALL THAT APPLY)

SUPPLIER TO COMPLETE

Reviewed by

5/30/12

C. Raynak
Signature

Date

Signature

Date

Signature

Date

Signature

Date

CSA USE ONLY

Approved Packaging

Approved Transportation

Approved Purchasing

OTHER:

Part Submission Warrant

Machined Valve, Ball 3 Port

Part Name

1032130

Shown on Drawing Number

Cust. Part Number

1032130

Orig. Part Number

1032130

#1

Engineering Change Level

N/A

Additional Engineering Changes

Safety and/or Government Regulation

Yes

N/A

Checking Aid Number

N/A

Dated
Purchase Order No.

No

C256000038
N/A

Checking Aid Eng. Change Level

ORGANIZATION MANUFACTURING INFORMATION

P & L Development and Manu

27SE11

Dated

0.0157

Weight (kg)

N/A

Dated

CUSTOMER SUBMITTAL INFORMATION

1PLDE01

CSA Leonard Plant

Organization Name & Supplier/Vendor Code

Customer Name/Division

4025 Arrow St.

Patrick Schereden ABH02

Street Address

Buyer/Buyer Code

Oscoda

MI

City

48750

Region

USA

Postal Code

2013 DS/DJ

Country

Application

MATERIALS REPORTING

Yes

Has customer-required Substances of Concern information been reported?

No

n/a

n/a

Supplier IMDS # 251 967 003

Submitted by IMDS or other customer format:

Are polymeric parts identified with appropriate ISO marking codes?

Yes

No

REASON FOR SUBMISSION (Check at least one)

Initial submission

Change to Optional Construction or Material

Engineering Change(s)

Sub-Supplier or Material Source Change

Tooling: Transfer, Replacement, Refurbishment, or additional

Change in Part Processing

Correction of Discrepancy

Parts produced at Additional Location

Tooling Inactive > than 1 year

Other - please specify

REQUESTED SUBMISSION LEVEL (Check one)

Level 1 - Warrant only (and for designated appearance items, an Appearance Approval Report) submitted to customer.
Level 2 - Warrant with product samples and limited supporting data submitted to customer.

Level 3 - Warrant with product samples and complete supporting data submitted to customer.
Level 4 - Warrant and other requirements as defined by customer.
Level 5 - Warrant with product samples and complete supporting data reviewed at organization's manufacturing location.

SUBMISSION RESULTS

dimensional measurements
material and functional tests
appearance criteria
statistical process package
(If "NO" - Explanation Required)
Yes
NO
CNC Machining
Mold / Cavity / Production Process
The results for

These results meet all design record requirements:

DECLARATION
I affirm that the samples represented by this warrant are representative of our parts, which were made by a process that meets all
Production Part Approval Process Manual 4th Edition Requirements. I further affirm that these samples were produced at the production
rate of _300_/_1_ hours. I also certify that documented evidence of such compliance is on file and available for your review. I have noted
any deviation from this declaration below.
EXPLANATION/COMMENTS:

MASTER SAMPLE IDENTIFED WITH GREEN TAG AND RETAINED.

Is each Customer Tool properly tagged and numbered?

Organization Authorized Signature
Print Name
Title

Yes

No

n/a

Christina Raynak

Christina Raynak

Phone No.

Quality Manager

E-mail

Date
989-739-5203

Fax No.

craynak@pl-dev.com

FOR CUSTOMER USE ONLY (IF APPLICABLE)

PPAP Warrant Disposition:

Approved

Rejected

Other

Customer Signature
Print Name

March
2006

CFG-1001

Date
Customer Tracking Number (optional)

7/17/12
989-739-5205