<table style="width:100%;">
<colgroup>
<col style="width: 5%" />
<col style="width: 7%" />
<col style="width: 9%" />
<col style="width: 11%" />
<col style="width: 4%" />
<col style="width: 9%" />
<col style="width: 11%" />
<col style="width: 9%" />
<col style="width: 0%" />
<col style="width: 6%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 2%" />
<col style="width: 3%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="10"></td>
<td colspan="2">b. Page</td>
<td></td>
<td>of</td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="17"></td>
</tr>
<tr class="odd">
<td colspan="8"><strong>NSTS/ISS PAYLOAD SAFETY VERIFICATION TRACKING
LOG</strong></td>
<td colspan="3"><strong>a. FLIGHT</strong></td>
<td></td>
<td colspan="3"><strong>GROUND</strong></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="17"></td>
</tr>
<tr class="odd">
<td colspan="4"><strong>c. PAYLOAD/ELEMENT AND MISSION:</strong></td>
<td colspan="3"></td>
<td colspan="2"><strong>d. DATE:</strong></td>
<td colspan="8"></td>
</tr>
<tr class="even">
<td><p><strong>e. Log</strong></p>
<p><strong>No.</strong></p></td>
<td><p><strong>f. Hazard</strong></p>
<p><strong>Report</strong></p>
<p><strong>Number</strong></p></td>
<td><p><strong>g. Safety Verification</strong></p>
<p><strong>Number</strong></p></td>
<td colspan="2"><p><strong>h. Safety Verif. Method</strong></p>
<p><strong>(Identify Procedures By Number and Title)</strong></p></td>
<td><p><strong>i. Ground Operation(s)</strong></p>
<p><strong>Constrained</strong></p></td>
<td><strong>j. Independent Verification Required Yes/No</strong></td>
<td colspan="2"><p><strong>k. Scheduled</strong></p>
<p><strong>Completion</strong></p>
<p><strong>Date</strong></p></td>
<td colspan="2"><strong>l. Completion Date</strong></td>
<td colspan="6"><strong>m. Method of Closure (Comments)</strong></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="6"></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="6"></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="6"></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="6"></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="6"></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="6"></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="6"></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="6"></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
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<td></td>
<td></td>
<td colspan="2"></td>
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</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
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<td></td>
<td></td>
<td colspan="2"></td>
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</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
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<td></td>
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</tr>
<tr class="even">
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<td></td>
<td></td>
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<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="6"></td>
</tr>
<tr class="odd">
<td colspan="17">JSC Form 764 (Rev April 22, 1999) (MS Word September
1997)</td>
</tr>
</tbody>
</table>

<table>
<colgroup>
<col style="width: 5%" />
<col style="width: 7%" />
<col style="width: 8%" />
<col style="width: 0%" />
<col style="width: 16%" />
<col style="width: 9%" />
<col style="width: 11%" />
<col style="width: 9%" />
<col style="width: 0%" />
<col style="width: 6%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 2%" />
<col style="width: 3%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="10"></td>
<td colspan="2">b. Page</td>
<td></td>
<td>of</td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="17"></td>
</tr>
<tr class="odd">
<td colspan="8"><strong>NSTS/ISS PAYLOAD SAFETY VERIFICATION TRACKING
LOG</strong></td>
<td colspan="3"><strong>a. FLIGHT</strong></td>
<td></td>
<td colspan="3"><strong>GROUND</strong></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="17"></td>
</tr>
<tr class="odd">
<td colspan="3"><strong>c. PAYLOAD/ELEMENT:</strong></td>
<td colspan="4"></td>
<td><strong>d. DATE:</strong></td>
<td colspan="9"></td>
</tr>
<tr class="even">
<td><p><strong>e. Log</strong></p>
<p><strong>No.</strong></p></td>
<td><p><strong>f. Hazard</strong></p>
<p><strong>Report</strong></p>
<p><strong>Number</strong></p></td>
<td colspan="2"><p><strong>g. Safety Verification</strong></p>
<p><strong>Number</strong></p></td>
<td><p><strong>h. Safety Verif. Method</strong></p>
<p><strong>(Identify Procedures By Number and Title)</strong></p></td>
<td><p><strong>i. Ground Operations</strong></p>
<p><strong>Constrained</strong></p></td>
<td><strong>j. Independent Verification Required Yes/No</strong></td>
<td colspan="2"><p><strong>k. Scheduled</strong></p>
<p><strong>Completion</strong></p>
<p><strong>Date</strong></p></td>
<td colspan="2"><strong>l. Completion Date</strong></td>
<td colspan="6"><strong>m. Method of Closure (Comments)</strong></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="6"></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="6"></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="6"></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="6"></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="6"></td>
</tr>
<tr class="even">
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<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
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<td colspan="6"></td>
</tr>
<tr class="odd">
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<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
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</tr>
<tr class="even">
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
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</tr>
<tr class="odd">
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<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
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</tr>
<tr class="even">
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
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<td colspan="6"></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
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</tr>
<tr class="even">
<td></td>
<td></td>
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<td></td>
<td></td>
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<td colspan="6"></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
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</tr>
<tr class="even">
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="6"></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
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</tr>
<tr class="even">
<td></td>
<td></td>
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</tr>
<tr class="odd">
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
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<td colspan="6"></td>
</tr>
<tr class="even">
<td></td>
<td></td>
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<td></td>
<td></td>
<td></td>
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<td colspan="6"></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="6"></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="6"></td>
</tr>
<tr class="odd">
<td colspan="17">JSC Form 764 (Rev April 22, 1999) (MS Word September
1997)</td>
</tr>
</tbody>
</table>

+-----------------------------------------------------------------------+
| Instructions for completing JSC Form 764.                             |
|                                                                       |
| **a. TITLE**: Indicate by checking the appropriate box whether the    |
| tracking log is applicable for flight or ground safety verifications. |
|                                                                       |
| **b. PAGE**: Indicate the specific page number followed by the total  |
| number of pages.                                                      |
|                                                                       |
| **c. PAYLOAD/ELEMENT**: Insert the name of the payload, followed by   |
| the specific element or experiment, and the mission in which the      |
| payload element is manifested.                                        |
|                                                                       |
| **d. DATE**: Insert the date that the form is completed or updated.   |
|                                                                       |
| **e. LOG NO.**: Use a unique identifier to track each verification    |
| item. The payload organization assigns these designations and         |
| includes them on the verification log included in the phase III       |
| safety data package.                                                  |
|                                                                       |
| **f. HAZARD REPORT NUMBER**: Indicate the number of the hazard report |
| containing the verification item.                                     |
|                                                                       |
| **g. SAFETY VERIFICATION NUMBER**: List the verification number from  |
| the Safety Verification Method block of the applicable hazard report. |
|                                                                       |
| **h. SAFETY VERIFICATION METHOD**: Transfer verbatim from the hazard  |
| report the safety verification method. Identify procedures by number  |
| and title from the hazard report.                                     |
|                                                                       |
| i.  **GROUND OPERATIONS CONSTRAINED**:                                |
|                                                                       |
| > **For Flight SVTLs:**                                               |
| >                                                                     |
| > Indicate "yes" or "no" as to whether this safety verification       |
| > constrains any ground operations. If "yes", provide an attachment   |
| > that identifies which ground operation is constrained. Notification |
| > to the Ground Safety Review Panel of the constraint shall be        |
| > provided by the PO.                                                 |
| >                                                                     |
| > **For Ground SVTLs:**                                               |
| >                                                                     |
| > Indicate which ground operation is constrained by this              |
| > verification. Indication may be specific (e.g. a step in a          |
| > procedure) or general (e.g. arrival or first use).                  |
|                                                                       |
| **j. INDEPENDENT VERIFICATION REQUIRED (YES/NO)**: Indicate the need  |
| for independent verification of the specific item per NSTS/ISS 18798, |
| Interpretation of NSTS/ISS Payload Safety Requirements, current       |
| version, letter TA-94-018.                                            |
|                                                                       |
| **k. SCHEDULED DATE**: Indicate the date planned for completion of    |
| the verification.                                                     |
|                                                                       |
| **l. COMPLETION DATE**: Indicate the actual date of completion.       |
|                                                                       |
| **m. METHOD OF CLOSURE/COMMENTS**: Indicate by title and serial       |
| number the tests, inspections, analyses, etc. by which this           |
| verification will be formally closed and include any additional       |
| information or remarks.                                               |
+-----------------------------------------------------------------------+