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1 |
Ordering of Hearing: 1A |
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2 |
Notice of Designation of Chairman of Board of Inquiry: 1B |
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Adobe PDF file |
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3 |
Designation of Hearing Officer: 1C |
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Adobe PDF file |
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4 |
Designation of Parties to the Hearing: 1D |
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5 |
Notice of Hearing: 1E |
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Adobe PDF file |
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6 |
Operations 2 -Exhibit No. 2A - Group Chairman Factual Report - Operational Factors/Human Performance |
11 |
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Adobe PDF file |
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7 |
Operations 2 - Attachment 1 - Log of Aircraft N927DA Movement |
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Adobe PDF file |
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8 |
Operations 2 - Attachment 2 - Copy of Pilot's Trip Sequence |
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Adobe PDF file |
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9 |
Operations 2 - Attachment 3 - Copies of DL 1288 Flight Papers and Weight & Balance |
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Adobe PDF file |
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10 |
Operations 2 - Attachment 4 - Aircraft Emergency Equipment and Seat Location |
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Adobe PDF file |
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11 |
Operations 2 - Attachment 5 - Copy of ACARS Log |
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12 |
Operations 2 - Attachment 6 - Copy of Engine Instruments and Operating Parameters |
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13 |
Operations 2 - Attachment 7 - Copy of Normal Takeoff Procedures |
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14 |
Operations 2 - Attachment 8 - Copy of Pilot's Rejected Takeoff Procedures |
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15 |
Operations 2 - Attachment 9 - Copy of Pilot's Passenger Evacuation Procedures |
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16 |
Operations 2 - Attachment 10- Emergency Lights, Emergency Exits Location and Operation |
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17 |
Operations 2 - Attachment 11- Throttle and Fuel Control Lever Location |
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18 |
Operations 2 - Attachment 12- Engine Fire Handle Location |
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19 |
Operations 2 - Attachment 13- Airport Information |
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20 |
Operations 2 - Attachment 14-Air Traffic Control Voice Transcripts |
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21 |
Survival Factors 6 - Group Chairman Factual Report |
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22 |
Survival Factors 6 - Attachment A - Crew and Passenger Seats, Restraint Systems, and Safety Appliances |
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23 |
Survival Factors 6 - Attachment B - Airplane Cabin Diagram |
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24 |
Survival Factors 6 - Attachment C - Photographic Supplement |
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25 |
Survival Factors 6 - Attachment D - Flight Attendant Interviews |
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26 |
Survival Factors 6 - Attachment E - Passenger and Other Witness Interviews |
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27 |
Survival Factors 6 - Attachment F - Flight Attendant Training Records |
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28 |
Survival Factors 6 - Attachment G - Passenger Safety Briefing Card |
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29 |
Structures 7 - Exhibit No. 7A - Group Chairman Factual Report - Structures/Systems |
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30 |
Photo 1. N927DA on runway 17 after coming to a stop. The oil streak is visible left of the runway centerline. |
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31 |
Photo 2. Aerial view showing damage to left fuselage and left engine. |
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32 |
Photo 3. Left fuselage penetration damage. |
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33 |
Photo 4. Left fuselage and engine damage, including fire damage to nacelle. |
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34 |
Photo 5. Right fuselage exit damage. |
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35 |
Photo 6. Fragment damage to left wingtip. |
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36 |
Photo 7. Wire gundle located along right longeron 4; 146 of the 154 wires in the wire bundle had been severed. |
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37 |
Photo 8. Interior view of left fuselage penetration damage adjacent to row 37. |
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38 |
Photo 9. Interior view of left fuselage penetration damage adjacent to row 37. |
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39 |
Structures 7 - Exhibit No. 7B - Wreckage Distribution, Hub Piece Locations |
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40 |
Structures 7 - Exhibit No. 7C - Wreckage Photographs (3) |
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41 |
Powerplants 8 - Exhibit No. 8A - Group Chairman Factual Report |
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42 |
Powerplants 8 - Exhibit No. 8B - Figures and Photographs |
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43 |
Powerplants 8 - Exhibit No. 8B-1 - Volva Manufacturing Drawing 0-169282 Sheets 1 and 4 - Volvo Hub Front Drill Process History |
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44 |
Powerplants 8 - Exhibit No. 8C - Powerplants Group Chairman's Factual Report of Investigation NTSB Accident MIA82IA051 March 18, 1982 |
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45 |
Powerplants 8 - Exhibit No. 8D - Pratt & Whitney Research Report 704297-2440 April 5, 1982 |
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46 |
Powerplants 8 - Exhibit No. 8E - Technical Review of Fluorescent Penetrant Process Delta Airlines, Inc.. August 13 & 14, 1996 |
46 |
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47 |
Powerplants 8 - Exhibit No. 8F - ANE-180 Evaluation Report of Pratt & Whitney Quality System - September 30, 1996 |
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48 |
Powerplants 8 - Exhibit No. 8G - Attachment 1 - Phase 1 Report (Pratt & Whitney) |
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49 |
Powerplants 8 - Exhibit No. 8H - Attachment 2 - Phase II Report (Volvo) |
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50 |
Powerplants 8 - Exhibit No. 8I - Pratt & Whitney Chart Process Control/Quality Inspections of a Titanium Part (Undated) |
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51 |
Powerplants 8 - Exhibit No. 8J - JT8D-200 Series Fan Hub Industry Meeting |
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52 |
Powerplants 8 - Exhibit No. 8K - 14 CFR Parts 21 and 33 Selected Papers |
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53 |
Powerplants 8 - Exhibit No. 8L - Volvo Aero Corporation Drill Type |
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54 |
Photo 1. Drill Type |
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55 |
Powerplants 8 - Exhibit No. 8M - Volvo Aero Corporation Drilling with HSS |
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56 |
Photo 1. Drilling with HSS |
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57 |
Powerplants 8 -Exhibit No. 8N - Volvo Aero Corporation Quality System |
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58 |
Photo 1. Volvo Aero Corporation Quality System |
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59 |
Powerplants 8 - Exhibit No. 8O - Volvo Aero Corporation Quality System 1988 |
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60 |
Photo 1. Volvo Aero Corporation Quality System 1988 |
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61 |
Powerplants 8 - Exhibit No. 8P - Volvo Aero Corporation Quality System 1997 |
1 |
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62 |
Photo 1. Volvo Aero Corporation Quaility System 1997 |
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63 |
Powerplants 8 - Exhibit No. 8Q - Volvo Aero Corporation Finished Part |
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64 |
Photo 1. Volvo Aero Corporation Finished Part |
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65 |
Powerplants 8 -Exhibit No. 8R - NTSB Safety Recommendations A-96-74, -75, -76, and -77 July 29, 1996 - with Related Documents |
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66 |
Flight Data Recorder 10 - Group Chairman Factual Report |
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67 |
Flight Data Recorder 10 - Attachment 1--DFDR Parameter Listing |
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68 |
Flight Data Recorder 10 - Attachment 2--Plotted Data |
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69 |
Flight Data Recorder 10 - Attachment 3 - Tabular Data |
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70 |
Maintenance Records 11 - Exhibit No. 11A - Group Chairman Factual Report |
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71 |
Maintenance Records 11 - Exhibit No. 11B - Attachment 1 - Pratt & Whitney Statement July 10, 1996 |
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72 |
Maintenance Records 11 - Exhibit No. 11C - Attachment 2 - Pratt & Whitney Quality Standard Visual Inspection Standard 454 (With Deletions) |
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73 |
Maintenance Records 11 - Exhibit No. 11D - Attachment 3 - Pratt & Whitney Suppliers Report of Nonconformance |
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74 |
Maintenance Records 11 - Exhibit No. 11E - Attachment 4 - English Translation of Volvo's Manufacturing Records on HUB S/N 32971 |
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75 |
Maintenance Records 11 - Attachment 5 - Pratt & Whitney Letter/Statement Addressing Their Involvement with Volvo July 19, 1996 |
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76 |
Maintenance Records 11 - Attachment 6 - Interview Statement and Fax From Pratt & Whitney Representative July 30, 1996 |
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77 |
Maintenance Records 11 - Attachment 7 - Delta Air Lines JT8D-219 Engine Shop Visit Maintenance Program and Related Sign-Off Sheeets |
9 |
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78 |
Maintenance Records 11 - Attachment 8 - Pratt & Whitney JT8D Engine Manual Front Compressor HUB Inspection Section 72-33-31 |
13 |
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79 |
Maintenance Records 11 - Attachment 9 - Delta Air Lines JT8D-219 Engine Maintenance Management Plan (EMMP) Light Maintenance Guidance and Records for Work Done on Engine and HUB |
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80 |
Maintenance Records 11 - Attachment 10 - Delta Air Lines JT8D-219 EMMP Heavy Maintenance Plan |
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81 |
Maintenance Records 11 - Attachment 11 - Delta Air Lines Engine Test Log Engine S/N 726984 Dated December 30, 1995 |
8 |
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82 |
Maintenance Records 11 - Attachment 12 - Delta Air Lines Life Limited Part History and Job Instruction Cards with Sign-Offs Engine S/N 726984 |
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83 |
Maintenance Records 11 - Attachment 13 - Delta Air Lines Oil Consumption Records and Pratt and Whitney's Oil Consumption Valves JT8D-219 |
3 |
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84 |
Maintenance Records 11 - Attachment 14 - Delta Air Lines Maintenance History on Engine S/N 726984 Between 12/21/95 And It's Installation on N927DA |
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85 |
Maintenance Records 11 - Exhibit No. 11F - Attachment 15 - Delta Air Lines Training Records of The Inspectors Who Last Inspected The Accident HUB S/N 32971 |
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86 |
Maintenance Records 11 - Exhibit No. 11G - Attachment 16 - Nondestructive Guidelines For Inspector (Delta) Training By Air Transport Association ATA Specification 105 |
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87 |
Maintenance Records 11 - Exhibit No. 11H - Attachment 17 - Delta Air Lines NDT Inspector's Physical Examination Guide, Excerpt, Eye Exam |
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88 |
Maintenance Records 11 - Exhibit No. 11I - Attachment 18 - Interview Statement With Delta's NDI Inspector |
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89 |
Maintenance Records 11 - Exhibit No. 11J - Attachment 19 - Delta Air Lines Statement Concerning Plastic Bead Blasting Dated August 22, 1996 |
1 |
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90 |
Maintenance Records 11 - Exhibit No. 11K - Attachment 20 - Pratt & Whitney JT8D Engine Manual Process Standard Excerpt Plastic Bead Blasting |
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91 |
Maintenance Records 11 - Exhibit No. 11L - Attachment 21 - Pratt & Whitney JT8D Engine Manual Front Compressor Group 1st Stage HUB Cleaning Spop 19 Plastic Bead |
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92 |
Maintenance Records 11 - Exhibit No. 11M - Attachment 22 - Delta Air Lines Process Standard For Past Preparation and Inspection, No. 900-6-3, Dated October 1, 1995 |
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93 |
Maintenance Records 11 - Exhibit No. 11N - Attachment 23 - Delta Air Lines Process Standard FPI 900-6-3 No. 2 Dated June 15, 1996 |
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94 |
Maintenance Records 11 - Exhibit No. 11O - Attachment 24 - Delta Air Lines Engine Records, HUB N1 Comp Front (JTD-219) |
4 |
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95 |
Maintenance Records 11 - Exhibit No. 11P - Delta Air Lines Internal Memorandum Responding to FAA'S FPI Technical Review |
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96 |
Maintenance Records 11 - Exhibit No. 11Q - Delta Air Lines Copy of Pratt & Whitney's February, 1995 FPI Inspection Report |
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97 |
Maintenance Records 11 - Exhibit No. 11R - Pratt & Whitney JT8D Engine Manual Front Compressor Group Cleaning |
14 |
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98 |
Maintenance Records 11 - Exhibit No. 11S - Delta Process Standard 9001-1 No. 18/21 Excerpt on Cleaning |
13 |
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99 |
Maintenance Records 11 - Exhibit No. 11T - GE Product Support Review of the Delta Atlanta TOC Engine Component FPI and Cleaning Process |
14 |
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100 |
Maintenance Records 11 - Exhibit No. 11U - Delta Air Lines Flow Chart On The Post Emulsify Type Penetrant System |
2 |
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101 |
Cockpit Voice Recorder 12 - Group Chairman Factual Report |
39 |
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102 |
Materials Laboratory 15 - Exhibit No. 15A - Metallurgist's Factual Report |
10 |
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103 |
Materials Laboratory 15 - Exhibit No. 15B - Metallurgist's Factual Report Supporting Material |
11 |
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104 |
Materials Laboratory 15 - Evans East---Time-Of-Flight Secondary IOM Mass Spectrometry Analytical Report |
20 |
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105 |
Materials Laboratory 15 - Exhibit No. 15C - Three Pieces of the Hub, As Received In The Materials Laboratory |
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106 |
Materials Laboratory 15 - Photo 1. Photograph Of Exhibit No. 15C |
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107 |
Materials Laboratory 15 - Exhibit No. 15D - Fracture Face On The Hub |
1 |
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108 |
Materials Laboratory 15 - Photo 1. Photograph of Exhibit No. 15D |
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109 |
Materials Laboratory 15 - Exhibit No. 15E - Angled View Of The Facture Face At The Aft End Of The Tierod Hole |
1 |
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110 |
Materials Laboratory 15 - Photo 1. Photograph of Exhibit No. 15E |
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111 |
Materials Laboratory 15 - Exhibit No. 15F - Scanning Electron Microscope View Of The Tierod Hole Surface At Origin "02" |
1 |
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112 |
Materials Laboratory 15 - Photo 1. Photograph of Exhibit No. 15F |
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113 |
Materials Laboratory 15 - Exhibit No. 15G - Microstructure In The Damaged Portion Of The Tierod Hole |
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114 |
Materials Laboratory 15 - Photo 1. Photograph of Exhibit No. 15G |
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115 |
Materials Laboratory 15 - Exhibit No. 15H - Blue Etch Anodize Test on Fracture Sample |
1 |
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116 |
Public Hearing Transcript 3/26/97 - 362 pages |
362 |
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117 |
Public Hearing Transcript 3/27/97 - 312 pages |
312 |
0 |
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118 |
Public Hearing Transcript 3/28/97 - 224 pages |
224 |
0 |
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119 |
Proposal of Corrections in Mr. B. Anderson's Testimony at the Public Hearing in Atlanta, March 26-28, 1997 |
100 |
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120 |
Correspondence from Pratt & Whitney |
1 |
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121 |
Pratt & Whitney Submission to NTSB |
12 |
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122 |
Correspondence from Air Line PIlots Association |
6 |
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123 |
Correspondence from Delta Air Lines Party Coordinator |
1 |
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124 |
Correspondence from Delta Air Lines |
1 |
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125 |
Delta Air Lines Submission to the NTSB |
52 |
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126 |
Metallurgist's Factual Report 97-117 |
6 |
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127 |
Characterization of Mounted Hub Section (Material Characterization) |
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128 |
Photo 1. Mounted Specimen. Mounting material was cut before removal for SIMS analysis. The tierod hole is identified. The boxed region contains the fracture origin and the "hardened layer". |
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129 |
Photo 2. Oxygen and arbon SIMS maps from first region examined. White indicated higher elemental concentrations. Both oxygen and carbon were observed to be concentrated in the "hardened layer" as well as in the cracks (white |
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130 |
Photo 3. Oxygen, carbon, iron, and silicon SIMS maps of the second region examined. Elevated concentrations (more white) of oxygen, carbon, and iron were observed in the "hardened layer". |
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131 |
Photo 4. Backscatter electron image photomicrograph of polished surface containing "hardened layer" and at least 29 cracks. The red arrows in Regions 1 and 2 identify observed plastic deformation under the "hardened layer". |
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132 |
Photo 5. EDS map of the location labeled "A" in Region 1, Figure 4. An elevated concentration of K-bank iron was found in the patch of high intensity backscatter electrons (arrow). |
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133 |
Photo 6. EDS map of Region 3, Figure 4. Elevated concentrations of K-band oxygen, aluminum, iron, and chromium (arrows) were identified. |
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134 |
Photo 7. EDS map of bulk microstructure (Region 4, Figure 4.) ELevated concentrations of K-bank aluminum were observed to correspond to equiaxed alpha microstructure (arrows). |
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135 |
Photo 8. Backscatter electron image of the tierod hole surface. The red arrows identify patches of high intensity electron return. The yellow arrows identify the directional marring. White arrows outline the changed surface |
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136 |
Photo 9. EDS map of Region 5, Figure 8. Elevated concentrations of K-band iron and chromium were identified in the regions of high intensity backscatter electron return (arrows). |
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137 |
Photo 10. EDS map of the directional marring found in Region 6, Figure 8. K-bank oxygen and silicon were identified in the marred regions. |
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138 |
Photo 11. EDS map of Region 7, Figure 8. K-bank oxygen and silicon (arrows) were observed on the regions of low intensity backscatter electron return. |
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139 |
Photo 12. EDS map of the high intensity backscatter electron return from region 8, Figure 8. An alevated concentration of K-band iron (arrow) was observed. |
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140 |
Photo 13. EDS spectrum taken from gold coated section of mounting compound. The oxygen and silicon peaks are identified. |
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141 |
Characterization of Mounted Hub Section - Attachment 1 |
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142 |
Characterization of Mounted Hub Section - Attachment 2 |
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143 |
Characterization of Mounted Hub Section - Attachment 3 |
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144 |
Characterization of Mounted Hub Section - Attachment 4 |
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145 |
Delta Air Lines Party Coordinator's Submitted Comments on McDonnell Douglas' Submission |
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146 |
Metallurgist's Factual Report 97-136 |
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147 |
Volvo Aero Corporation Submission |
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148 |
Photo 1. Hole #2B. Cutting without coolant with HSS drill to breakdown. Cutting data see report 9634-0101. |
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149 |
Photo 2. Cross section of hole #2B, quite close to the location of the drill breakdown, showing similar microstructure as JT8-hub failure. Hardness impressions on the photo represent 53 HRC, 37 HRC and 31 HRC, almost identic |
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150 |
Photo 3. Cross section of hole #2B quite close to the location of the drill breakdown. Mag. 7-8X. |
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151 |
Photo 4. Cross section of hole #2B quite close to the location of the drill breakdown showing a surface layer with cracks and a appearance similar to the failed JT8-hub. |
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152 |
Photo 5. Cross section of hole #2B quite close to the location of the drill breakdown showing a surface layer with an appearance similar to the failed JT8-hub. Mag. 128X. |
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153 |
Photo 6. Cross section of hole #2B quite close to the location of the drill breakdown showing a surface layer with a apperance similar to the failed JT8-hub. |
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154 |
Photo 6A. Concentration Profile Sample 2B |
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155 |
Photo 7. Hole #2 drilled with standard cutting data with HSS. The arrows show BEA indications consisting of impressions of chips smeared on the hole surface. |
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156 |
Photo 8. Longitudinal section of hole 2 through a BEA indication, arrow A in photo 7. The microstructure showing plastic deformation to a depth of up to 35um (1.38 mills) created by a impression of a chip. Mag. 500X. |
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157 |
Photo 9. Longitudinal section of hole 2 through a BEA indication, arrow B in photo 7. A chip with deformed microstructure is smeared into the hole surface. Mag. 500X. |
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158 |
Photo 10. Same as previous. Mag 500X. |
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159 |
Photo 11. Hole #26 drilled with standard cutting data with HSS and fine bored. No indications came up to view a tBEA. |
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160 |
Photo 12. Cross section of hole #26 showing deformed material to a depth of up to 12 um (0.47 mills). Mag 500X. |
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161 |
Photo 13. Hole #25 drilled with standard cutting data with HSS, fine bored and honed. BEA shows no indications. |
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162 |
Photo 14. Cross section of hole #25 showing deformed material to a depth of 5 um (0.20 mills). Mag 500X. |
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Photo 15. Hole adjacent to hole #1A drilled with HSS to failure by increased cutting data and without coolant. BEA has been performed. |
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Photo 16. Hole #1A after opening up and BEA. And elliptic cavity can be seen on the ID. The surrounding area of the cavity indicated alternaterly in grey and blue. |
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Photo 17. Hole #1A. Longitudinal section showing remelt material with cracks and overheated material (above B-transus) with transformed B. The section is located at arrow A in photo 16. Mag 500X. |
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Photo 18. Hole #1A. Longitudinal section of showing overheated material (above B-transus) with transformed B and partially transformed B. The section is located at arrow B in photo 16. Mag 200X |
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Photo 19. Hole adjacent to hole #1B drilled with HSS to failure by increased cutting data and without coolant. BEA has been performed. |
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Photo 20. Hole #1B after deviding and BEA. The ID exhibit an BEA indication consisting of a mostly blue elliptic spot with surrounding area which indicated alternaterly in grey and blue. Compare with photo 16. |
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Photo 21. A close up of the center of the BEA indication in hole #1B. The grey area G is contaminated with iron (Fe) in difference with the blue area B. Notice the crack in the area. |
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Photo 22. Hole #57 drilled with increased cutting data with HM to breakdown. The hole has also been fine bored and honed. BEA shows a white-grey indication in the drill breakdown area. |
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Photo 23. Hole #57 after reetch. The indication appear blue. |
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Photo 24. Cross section of the indication area in hole #57. The microstructure shows deformation to a depth of 0.2 mm (0.0079 inch). Mag. 32X. |
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Photo 25. A close up on the indication area in hole #57 in previous photo. During the drill breakdown particles on tungsten (W) have been pressed into the ID. |
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Photo 26. The indication area in hole #57. Chemical analysis in SEM areas with iron (Fe) and tungsten (W) have been verified which indicate grey in BEA. |
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Photo 27. Hole #52 drilled with increased cutting data with HSS to breakage. The hole has also been fine bored and honed. The hole was blue etched before and after being sectioned into two halfs. |
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Photo 28. Microstructure of hole #52 showing deformed and overheated material. Mag. 32X. |
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Photo 29. A close up of photo 28. Microstructure of hole #52 showing deformed and overheated material to a depth of 0.6 - 0.7 mm (0.024-0.028 inch). Mag 64X. |
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Photo 30. Example of a delta drill used without coolant. A heavy accumulation of chips accured during the testing. |
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Correspondence from Patricia Garcia Concerning Delta #1288, Pensacola Accident July 6, 1996 |
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Pensacola, Florida Safety Recommendation (A-98-9 through -23) |
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Douglas Aircraft Company Submission to the NTSB |
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(FAA) Titanium Rotating Components Review Team Report |
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Correspondence from McDonnell Douglas |
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