HC Pacific Branch: 100 10980 Arrow RTE Rancho Cucamonga, us 4375 Bil BOLING DISTRIBUTION SERVICES 3760 W, LOBTH STRERT MIAMI, H1. 33018 us 305-925-2600 HC Pacific 91729-9998 INC. (KI. PACKING LIST Invoice Number 3117545 | iveiee Baie | BOLING DISTRIBUTION SERVICES INC. (KI 3760 W. 108TH DOCK DOOR B MIAMI, F1. 33018, TREET Ordered By: JOSE: MORENO 1366815 Page Lor? ORDER NUMBER Customer 1D: 31751 VO Number [terms Description | Net Due Date | Dise Due Dare | Discount Amount (OOSNV33 Ni:T30 DAYS, 12/4/2022 1374/2022 Order Date | Vick Ticket No Primary Salesrep Name Taker 11/4/2022 13:04:01 | 2131580 Dan. Sandello LUIS.BARCENA, = tem 1d vow Ordered Sipped| —__Remaining| Disp | em Descriovion Ce (Customer Note: ~Scller hereby acknowledges thatthe parts andlor ‘materials being shipped under this oder are intended for se under Boving’s Federal Aviation ‘Administration (VAA)isued Production CContificate 700 and no ats (or constituent parts thereof ) or the accompanying paperwork (ee. packages shippers. ce.) contain any Federal Aviation Administration: Pris Manutaetuer Approval (FAA-PMA) markings Delivery Instructions: FDEXY 633948178 Carrier: Vedex Ground Tracking #2 611829662485, 2300 2500 7 MSZT2SOH106016 TA NASM ROLE 12 PY 180-200 KSI 318-24 to Onder Line Notes: PONA00S706) MAC FAST EAROO-NLR CERI PACK DY REV. 2/ MEG LLOTW9S755/ DEAR 252.225.7009 CLAUSES. AALLISCEALPUNAS.QAP 33.0 (QLY 15330), POM0S706/ MAC FAST CERF PACK REV. 2/ MEG LLODH9S75S / DEAR 252.225.1009 / CLAUSES. AALBCEIPUNA3.QAP 33.0/(Q1Y 980)LIC Pacific Branch: 100 HC Pacific 10950 Arrow RIWA37S Rancho Cucamonga, CA 91729-9998 us PACKING LIST Invoiee Number SIITS45 Invoice Date _| 11/4/2022 15:10:08 | Page 2or2 _ ORDER NUMBER. 166815 Quantities 2 tem 1D vow ‘Orterel| Shine Ding | fem Descrinvion Uni ice Tat Nentbers W097 On 1350 EA Lat Number: $8100 On: 950 FA ta tine 1 Tal Peces: 2500 Tonal Weighs 181.25- 4HCPacific Empowenns vour 5 5596 Ontaio Mis Pokway, Onto, Colfomio, 91764 Phone 909-598-0509, Fax 909-598-1411 - Website: hcpacfic.com CERTIFICATE OF CONFORMANCE Laan Esac.ooa. To; BOEING DISTRIBUTION SERVICES INC. P.0; 00SNV33 Line Item No.: Part No: MS2125H06016 Revision: 2 Manufacturer:MAC FASTENERS Quantity: 2500 PCS Mfg. Lot # 95755 PARTS MEET REQUIREMENTS Remarks: (OF DFARS 252.225-7009 All material is in new condition. The products finished in this shipment are represented by the manufacturer as conforming to applicable drawings and specifications. Per Manufacturer when parts shipped, to the best of our knowledge pars are free of Mercury contamination . As per Requirements which comply with all applicable items within the Customers Purchase Orders; supporting evidence is avallable at HC Pacific or the source of purchase upon request, it may be subjected to a fee. Uniess otherwise noted, country of origin is USA. HC PACIFIC RETURN AND CLAIM POLICY All claims for error, Shortage, or damages must be made within 30 days after our shipment of goods. Our fabilty is limited to replacing the material or refunding the invoice value of the material sold, HC PACIFIC ITAR DISCLAIMER “This shipment may contain items that require ITAR export licenses. A notation on the shipper with each shipped part number will designate the item either ITAR Vill, in which case the shipment DOES REQUIRE any international shipper/carrier to apply to The United States Department of State for an export license betore shipment is made, or EAR99-NIR (No License Required} Special handling of ITAR items and information relating to such items is required. Additional restrictions may also apply {0 all intermational shipments for both ITAR and EAR99-NIR items. Please check with The United States Department of State for details. Domestic (U.S.) customers must obtain the required export license for any international shipments made. Violations of the ITAR/EAR regulations and laws can result in severe fines, penalties, imprisonment, and loss of exporting privileges. With acceptance of this material the purchaser agrees to comply with applicable Laws and Regulations of The United States and other international organizations pertaining to the export or handling of these items and/or other Pertinent information relating to these items. . ps Date 11/04/22 (pe LAX, Authorized Quality Represent Form HCQCOIS Effective 10/16/20204005106 [15755 Mac Fasteners ATTriMas Aerospace Company TEST REPORT AND 1110 E. Enterprise PROCESS CERTIFICATION Ottawa, KS 66067 CUSTOMER PO NUMBER PO Date CERT DATE HC PACIFIC 4005706 04/18 02723119 PART WOMBER REV PART TRE MS21250H06016 2 Bolt, Twelve Point [rorne FS GUANTITY PROCUREMENT SPEC 95755 7,000 NASM@831 REVS RAW MATERIAL IDENTIFICATION (Mill Gert Attached) [WATERIAL MATERIAL SPECIFICATION TWILL HEAT NUMBER SUPPLIER 8740_ PER AMS6322 MiMit7104220 JOHNSTOWN MECHANICAL TEST RESULTS - TESTING PER NASM1312 ULTIMATE TENSILE STRENGTH DOUBLE SHEAR STRENGTH POUNDS [PSI POUNDS PS! Jraigue Test Sample 7 — EZ Accent 19,400 19,520 24,660 24,780 ow Load 788 High Load 7060 19,430 19,520 24,740 24,820 ‘Stress Durabiity BE] _Accept 19,500 24,860 External Load Method 19,510 24,960 [H92 4560 Hours 24 aoe amie Tiagnalic Paricle Inepaction par 19,590 24,860 Asti enece 19,610 24,770 fsamote nse 1) 100% nso (2 accept ea aoa Tague Penatrant Tepecton pat lsampto nap [100% ins] CiAccent IN. REQ. 17400 wn. Reo. Ed fragnotic Pormeabinty TMLAS4? Less than 20 [7] Accept METALLURGICAL EXAMINATION eae Discontinuites a CarbiDecarty Recess Torque inlibs [Accept Grain Flow a Microstructure Grain Size a Workmanship Untempered Martensite pcgclen ger sgen Tp Sem ey enemy FINISH PROGESSOR: betray Plating Works IEAT TREAT PROGESSOR: Paulo Products NADGAP ID 4679 Fasnium Piste E] ais-aar-si6e | Typellcass2 | SPECIFICATION: AMS2750 passivate REQUIREMENT: 180-200 KSI FTU HRC 39-43 q fpesucrs: sampte size: 6 42-0 HRE TEST CERTIFICATION \WE CERTIFY THAT THE PART NUMBER, LOT NUMBER, AND SAMPLES REFERENCED [ABOVE HAVE BEEN PROCESSED AND TESTED IN ACCORDANCE WITH THE ‘APPLICABLE SPECIFICATION FOR THE TESTS REPORTED HEREIN. THIS. CERTIFICATION SHALL NOT BE RE-PRODUCED, EXCEPT IN FULL, WITHOUT THE [APPROVAL OF MAC FASTENERS, INC. ge ‘Quality Assurance Representative ROTHORIZEDT IF TIAGOMAC FASTENERS, INC. 1110 ENTERPRISE OTTAWA, KANSAS 66067 CERTIFICATE OF CONFORMANCE AND MANUFACTURER'S AFFIDAVIT CUSTOMER — HCPACIFIC P0:4005706 PART NUMBER: MS21250H06016 REV:2 LOT NUMBER: 95755 MANUFACTURED QUANTITY: 7,000 MILL HEAT NUMBER: MM17104220 COUNTRY OF ORIGIN: UNITED STATES OF AMERICA DFARS 252.225.7009 Compliant MERCURY FREE CERTIFICATION MacFasteners certifies that the parts referenced in the above lot number do not contain Mercury or Mercury compounds, and were manufactured in a Mercury free environment. We certify that the parts furnished against the above referenced purchase order were manufactured by MAC FASTENERS within the United States, and were processed in accordance with all applicable drawings and specifications. Objective evidence of compliance is on file, subject to examination upon request. Mac Fasteners is a DISC QSLM approved Manufacturer - CAGE Code ORFT4 Mac Fasteners is an Airbus approved Supplier - 203399 Q\ QUALITY {SSURANCE REPRESENTATIVE DATE: 2/29/2019 AUTHORIZED: JF 11/6117,Mac Fasteners Inc. A TTriMas Aerospace Company 1110 E. Enterprise Ottawa, KS 66067 HEAT TREAT CERTIFICATION CUSTOMER: HC PACIFIC DATE: 2/23/2018 PO NUMBER: 4005706 MANUFACTURED QUANTITY: 7,000 PROCESSOR: Paulo Products NADCAP ID 4679 LOTNUMBER: 95755 MATERIAL: 8740 PARTNUMBER: — MS21250H08016 REVISION: 2 REQUIRED HARDNESS: 180-200 KSI FTU HRC 39-43 SAMPLE SIZE: 8 HARDNESS: 42-43 HRC HEAT TREAT SPECIFICATION: AMS2759 Notes: The fasteners referenced in this report have been processed, inspected and certified by the He Treat Contractor in accordance with all applicable drawings and specifications. Heat Treatmen has been verified in accordance with procurement specification and part drawing, by metallurgical and mechanical testing as applicable. Evidence of compliance as well as certification from the Heat Treat Contractor is on file and subject to examination upon request. Oly QUALITYASSURANCE REPRESENTATIVESpecialized Electro Plating and Polishing DE TRAY Nickel Passvate Copper Bight Dip . Decorative Chrome trp Copper Plating Works pated a Cadmium 10405 EAST ELEVENTH STREET « INDEPENDENCE, MISSOURI 64052 Phone (616) 252-8411 Fax (616) 252-8527 « E-mail: Info@DeTrayPlating.com February 21, 2019 Mac Fasteners 1110 East Enterprise Street Ottawa, Kansas 66067 Subject: Certification ‘This is to certify that the following parts have been stress relieved for 4 hours at 3754/-25 before cleaning cadmium plate per QQ-P-416/AMS-QQ-P-416/NAS4160/AMS2400, Type Il, Class 2; embrittlement relief within 4 hours of plating at 375+/-25 for 23 hours, Please reference our Invoice#226924 dated 02/21/2019 for: Lotit- 95755 P.N.- MS21250H06016 Chris Pierson, Vice-President ~ tos DE TRAY PLATING WORKS,Johnstown 124 Laucel Ave, TEST REPORT Johnstown, PA 15806 Wire WORK ORDER Lor NuMBER . Phone: 814 532-5756 108424 ‘E-MM17104220 Technologies Fax: 814.532.5684 SALES ORDER / RLS 382225 / 006 CERT IO/ REV 00067078 101 soto 0 bac Fasteners, ne. Best Way Distribution 43209 Arrington Re, Oocks 17-20 Grandview, Mo 030 xa usa Atta: QA Dept esr cusToNER PO. usToneR PART cuwamy ous ONO SuPweNronTe ooaee2st arso.372 esr ues ___¢_oov4s864 sus7e0%7 seecircarion Macrastrsr2 ‘AMS200%; AMS6222; AMS-S-6049A; MIL'S-G049A 8740 DFARS Osfense Federal Acquisition Reguiaion Supplement Silicon Killed Fine Grain. Aeraf Qually/Cotd Heading Qual ‘Drawn From Annealed Rod Spherodize Annealed In Process Heavy Phos & Light Lue Cid Sie. 372 .001 000 : Ciena = 0 ous 260? stk 3 ate 30000 oe on won an net _o0 008 Ae sess “a a ees es Hechaniest———— Tensile Str LbsISain soco sona0 e0co RA er Cont Percent, ot eo so Decarb FED Inches ‘00 ‘00 o.cca Surtace det. depth inches 02 toe oz Rod a Soares Bod Source wait Fource Countey of Origin Watt Ett cuntnon get rte ns stand ec eee ep ne Speciation. Choisy Ia repos by ero ta supose nT AR [ecestaton. Ts es ropa caret bo tepoducad a aaruted cept bout na wien ‘emib sn ol JOnW STOW We TECHNOLOGIES. Te es asus cried Deon ate op (6) 5 Couto Systoms 02 60) Page ot WD auglos. Low xe Panes: T2017NucoR Mill Certification rR: Caan sg NUCOR CORPORATION ee oe ee NUCOR STEEL SOUTH CAROLINA 3} 365-8701 Sold To: JOHNSTOWN wRE TECHNOLOGY To: 04 LOGY ‘erage reomoton ‘Shp Te: Jonnsrown wine TECHNOLOG FRENSTOIA Pa 15005 RSC PA 508 aia sae set Fe Bia) SE s019 Customer P.O] 92590 ‘Sates Order | 2586563 Proavet Group | Ros at wumber| 3200043700000 Grace | 6740 Na S-6049 ASS 6222 Lote | 011780422002 ‘Size | 76" (4375) Wie Red eat | neaut7i04z20 Product | 716" (4375) re Rod Col 674000, Bi Mentor | cr728276 ‘Deserpion| 874000. Toad Number | CrA07715 ‘Customer Spee ‘Gustorer Part # | FXTAOAATIG encanta ner ea noc abo Rd Warr tc dH el er We ae EAE Roll Date: 7312017 _ Moll Date: 9312017 Gly Shipped LBS: 37.219 _ Gly Shipped Pes: 9 Melt Date: sir017 ° e 8 s cu wi co Mo v n sn 040% 0.005% 0.005% 0.25% OTH «OMAK «OSI 024K .aDID% 02TH 0.006% SELLY | HO HY HR YH | ease [| ws [ae [oe Ye a | ROT fafa }o Roll ate: 73172017 Miroexaminaton OK ‘945 2201 Frequency: 0.00 ‘AMS 2001 Soverty 0.00 Mio Tensile 133000931 Max Tense 137000psi ‘average Tense 135000ps1 Redscton of Ares: 51% Grain Sze por ASTM E112 29 Recon Rai 208.001 ASTM cae Sitece: "2 nea Racius: 2 Center 2 ASTM ER Monod, Sass TMS EAS Maning: 1:00 H:00 Siete: T1090 Hi00 Globular TOS HOS 3136.08 WEL REPARG AS NOT PERECRMO ON TH MATERA Foe ee ee eae Perc sm urrrom ave nor ae useo wT enooucrion oF rs {- ote James H lew Ohision Meta Paget of 2Certification mMucoR NUCOR CORPORATION eneizo17 es Sat Mocon SreeL SoU canoLina oo ESET fsdTe pintzoumyneromo.oor bere Jagr yma ren sgeganaye rom moe nares reno Se ow EE ome pe eee Lee SR aaa wa aa or as Pr a Seas eee Ste ES EE ca | oc sur [7 car oe fae Daa Fes US et TOD acer | Ste Save on isin | era 9 Sate rts | RATE ‘ac one eed he a bon mented rer be HAG Id ts ai ee eee Specification Comments: WAS NOT PERFORMED ON TS MATERIAL SOURCE MATERIALS IN ANY FORM HAVE NOT BEEN USED IN THE PRODUCTION oF Mis {ewe James H. Blew Dhvsion Metaturgst age 2 of 2| Qsaceme PC700 Compliance Checklist (Applies to BOEING Routing Code Receiving and ARD/PC700 Outbound) Part #: Ms21250H06016 | bots: 96755 Controt#: | 2022KMR47K Inspector Name: MAYSA SHOUSHA 12/06/2022 f ‘anpete al actos indicated below, Pace Tnopactor samp nth "Com plated secon aa evidence thatthe Wasted Instructions: | reaurement has been vere: when verfieaton ent appicala due fo non Boving pat numbers or bgacy nvenion then vito "MA" inthe “Completed secon SS7ui8 FORM MUST BE SCANNED INTO THE CONTROL IMAGES WHEN COMPLETE! [completed beni ‘sume 1. Confirm the TCR N.2 (Boeing Q31) text is on the supplier's certification and flag the TCR code N.2 (PC700) in the required TCRs list. Check the Supplier's text to the TCR text. (This is not required for | legacy inventory (prior to 5 Sep 2019, nor is it mandatory for non-Boeing part numbers provided all steps 2-9 are compliant) 2. Confirm parts are not PMA marked (physically or on paperwork). If marked FAA-PMA Reject the parts per Clause N.2 and Create a Service NOW request for Part Profile Update so that the PMA part will have its own profile. If discovered at outbound, ensure the certified PN is not marked ARD Y, and PMA is marked Y. Do not identify inventory as PC700 compliant. 3. Check if receiving paperwork contains a TSO statement. Accept the receipt f the supplier has the N.2 | text and a TSO statement. (Always check the FAA TSO website to confirm TSO approval) NOTE: Inventory received prior to 5 Sep 2019 and valid under TSO is not authorized to be marked ARD Y 4. Mark TCR listed on the purchase order that are compliant 5. Identify certified part numbers (FS). If PC-700 pop-up message appears, but TCR N.2 was not on the || Purchase order, complete steps 2-9 on this checklist. N.2 text is not required on certifications but | ‘compliance to PC-700 is required. NOTE - purchase order may have TCR N.3 (PC-700 compliance requirement) applied. 6. Check if vendor is approved using QWI-140 (This applies to both Manufacturer and Distributor). Use “SQIS' file in DocuWare as reference when needed and use http://active, boeing.com/doingbiz/d14426/index.cfm if 01-4426 is needed, 7. Review drawing and specifications for approved source requirements. Validate approved sources on Grawing. If the distributor or manufacturer is not authorized, then Reject. If no sources are listed, then this step is Not Applicable. 8, Perform inspection (dimensional, material, process) per drawing and specifications. During outbound | inspection, confirm the ARD/PC-700 part number received a dimensional inspection. 9. Update Control by responding “Y" to the PC-700 (ARD) Pop-up message. If no message is displayed, proceed with the regular inspection as applicable. If updating a previously received control that has the ARD flag set to U you will need to remove the line, then add the certified part number again, identifying it as ARD Y or N as applicable. Confirm that each certified part number only has only has one FAA type flagged (ARD, TSO, or PMA), Comments: | DOCH Te ‘DOCUMENTTYPE | REVIOATE” | APPVO [UTR | PAGE ‘anF-as2ARD | ARD nventoryinbound inspection Checklst | FORMOREXHIT | 2szoz1 | s.abach | 8 10F 4