DESIGN VERIFICATION PLAN AND REPORT Copies must be verified for current revision

DVP&R No: Rev: Date:

System Description: Aeration Supplier Name: Environmental Dynamics Internation

Subsystem Description: Diffusers Supplier Code: Affected Program(s): Metro, NZ Team:

Assembly Description: Part Number Rev Design Engineer Supplier Design Engineer (Key Contact)
Supplier
Address:
Name: Name:

City: Zip / Postal Code:

Component Description: Part Number Rev
Title: Title:
Diffuser Membranes
State: Country:
Email: Email:

Test Stage ED = Engineering Development Test, DV = Design Verification Test, PV = Production Verification Test, CCT = Continued Compliance Testing Phone: Phone:
Target Requirements. State required probability and confidence of meeting criteria, e.g. R90, C90 or all must pass.
Sample Level A = Prototype (No tooling), B = Prototype (Soft Tooled), C = Production Tooling (Not Process), D = Production Tooling & Process Cell: Cell:

Planned Product Testing Reporting of Results Planned Test Timing & Sample information Actual Timing & Sample Information
Compliance / Scheduled Timing Actual Timing
Test Results Test Test Location / Verification Sample Size Report or Doc.
Test #

Regulatory / Specification / Test Name Method or Procedure Duration Acceptance Criteria Test Results / Findings Pass / Fail Test Completed by Notes Stage Target Requirement Resp. Source of Requirement Sample Level or Batch # Number Sample Level Sample ID Sample Size Tested
SC/CC/KPC
Start End Start End

Verification Report Authorization Design Engineer Review / Approval

I affirm that the samples used for verification testing are representative of our parts, and I authorize the use of this data.

Authorized Signature Date Authorized Signature Date

Title Time Title Time

Page 1 of 1