(Do not make additional copies of this waiver without consent of the originator.)
Supplier: Log Number: Date initiated:
Revision:
Attn: Part Number:
Expiration Date: Part Description:
Discrepancy:
Temporary specification allowed:
What is the Corrective Action? Owner Estimated Completion Date
Why should accept this deviation? (Required)
Product Engineer: Product Engineering Manager
Quality Manager: Process Engineering Manager Supply Chain Mgr: Operations Manager Originator: (Do not submit until all other signatures complete) QAF-0089 REVISION "-" PAGE 1