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Alaska Airlines 737-900 MAX loses a door in-flight out of PDX

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Old 5th Feb 2024, 06:57
  #1601 (permalink)  
 
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remi
"but in what world do you take delivery of unfinished or known defective components from suppliers"

Sorry to inform you, but in aircraft production there are many, they are assigned as DEVIATIONS.
As examples: over countersunk fastener holes in wing skin, substitute carbon cable in place of SS,
panting of skin panels, blind rivets in place of solids.
Engines are also released with test bed performance figures below ideal, example fuel flow slightly high, EGT a few
degrees above the target, to name a few.
Of course these are production standards and not Operational Standards.
The purchasing Co. Rep would be presented with these, almost as a fait accompli.
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Old 5th Feb 2024, 07:38
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Originally Posted by aeromech3
remi
"but in what world do you take delivery of unfinished or known defective components from suppliers"

Sorry to inform you, but in aircraft production there are many, they are assigned as DEVIATIONS.
What defective components are accepted?

What incompletely built components are accepted?

When is manufacturing using unfinished and defective parts in line with production standards?
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Old 5th Feb 2024, 08:27
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Originally Posted by aeromech3
remi
"but in what world do you take delivery of unfinished or known defective components from suppliers"

Sorry to inform you, but in aircraft production there are many, they are assigned as DEVIATIONS.
As examples: over countersunk fastener holes in wing skin, substitute carbon cable in place of SS,
panting of skin panels, blind rivets in place of solids.
Engines are also released with test bed performance figures below ideal, example fuel flow slightly high, EGT a few
degrees above the target, to name a few.
Of course these are production standards and not Operational Standards.
The purchasing Co. Rep would be presented with these, almost as a fait accompli.
To an SLF these sound like issues that don't impact subsequent work. Unlike many of the issues discussed in this thread which require subsequent rectification.
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Old 5th Feb 2024, 10:20
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Originally Posted by remi
Demonstrating renewed commitment to quality and safety, Boeing is considering taking the innovative step of asking (permitting? encouraging?) its assembly line workers to finish their jobs.

https://www.cnn.com/2024/02/04/busin...ntl/index.html

Back on planet Earth, it's been known for years that aircraft move through the Boeing 737 production line with unfinished work from previous stations or steps.

I don't want to express fake outrage, but in what world do you take delivery of unfinished or known defective components from suppliers? If you're building a car, do you want an engine with "just a few missing valves"?
Not just Boeing. "Travellers" are common.
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Old 5th Feb 2024, 10:31
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Another problem

The Independent reporting ‘another problem with 737 jets”, misdrilled holes in fuselages.

https://www.independent.co.uk/news/b...-b2490584.html
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Old 5th Feb 2024, 11:42
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The seat nearest the opening was deformed.
Was the seat frame damaged - mountings ok, - or - seat mountings deformed / damaged - or - floor deformed / damaged ?
When you think about it, the pressure differential across the floor would be greatest at the opening, and it would be an instant pressure 'pulse'.
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Old 5th Feb 2024, 14:57
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Originally Posted by remi
Demonstrating renewed commitment to quality and safety, Boeing is considering taking the innovative step of asking (permitting? encouraging?) its assembly line workers to finish their jobs.

https://www.cnn.com/2024/02/04/busin...ntl/index.html

Back on planet Earth, it's been known for years that aircraft move through the Boeing 737 production line with unfinished work from previous stations or steps.

I don't want to express fake outrage, but in what world do you take delivery of unfinished or known defective components from suppliers? If you're building a car, do you want an engine with "just a few missing valves"?
Suppose you have an aircraft factory and you sub out your fuselages to an outside vendor. Now suppose their delivery for a bunch of units is held up because one of the components, say the full exit version of the mid-cabin exit, is stuck on a freighter that's queued up and won't be able to unload for a month. And it's not just one door, but maybe all of them for 10 units that are sitting on the supplier's floor. It's going to shut down both your lines if they don't ship the fuselages - yours because there won't be any to build on, and theirs because they don't have any more space to park them while they build others. And there's a ton of work that you, the aircraft builder, can do without the correct doors in place to keep things moving. Now you find out there's a load of door plugs at the factory in Malaysia, and your sub gets the bright idea to ship those via air, so they can have them tomorrow. What are you going to do? You're going to have the sub install the plugs and short-ship with paper that notes the deviations and the work to go that their workers at the customer site are going to do to make the swaps, then ship the plugs back to the plant to go into the frames that they belong in. The planes are shipping "unfinished", but in an acceptable state to keep the lines moving and produce perfectly fine aircraft.

Nobody is going to deliberately ship "defective" product, but virtually everything of that scale is going to ship with a bunch of minor non-conformances. Things where something doesn't quite meet the drawing - maybe the outside radius on a corner of some non-structural component is off on a couple units because the plant that makes that part found the long tail of their manufacturing tolerances. The only reason that number is on the drawing is because there has to be a number there, but it can have a loose tolerance than someone put in. It gets reviewed at a couple levels and someone signs off to accept it. Is it non-conforming? Yes. Is it defective? No.
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Old 5th Feb 2024, 16:38
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*** my experience

[chrisl137;11590785]Suppose you have an aircraft factory and you sub out your fuselages to an outside vendor.

*** Such parties are Partners or Subcontractors, not Vendors.

Now suppose their delivery for a bunch of units is held up because one of the … factory in Malaysia, and your sub … fine aircraft.

*** Does not work that way in aerospace, not allowed, outright dangerous.
Malaysia is not involved here it appears, so please don’t put it in if it is a phantasy, Spirit Malaysia apparently delivered the original plug, Spirit Wichita and Boeing Renton appears to have made the boo-boo here

Nobody is going to deliberately ship "defective" product,

*** Reading the material of previous and this case. I would ask a lawyer (Willow?) if it is Negligence or Criminal Negligence what happened here. Moving a HQ to Chicago moves higher management further away from understanding what they are doing. May move them legally from one to the other legal tray. But in aerospace safety culture it is considered criminal negligence.
In some cases people appear to have been pushed to ship defective products. Without understanding what the consequence might be, in aerospace safety culture this is considered criminal pure and simple.

but virtually everything of that scale is going to ship with a bunch of minor non-conformances. Things where something doesn't quite meet the drawing - maybe the outside radius on a corner of some non-structural component is off on a couple units because the plant that makes that part found the long tail of their manufacturing tolerances.

*** yes you can have a pile of non conformances (NCR … others say RNC), but these are documented and checked by knowledgeable specialists.

The only reason that number is on the drawing is because there has to be a number there,

*** in aerospace every number has a reason and generally multiple reasons behind it …

but it can have a loose tolerance than someone put in. It gets reviewed at a couple levels and someone signs off to accept it. Is it non-conforming? Yes. Is it defective? No.

*** information that bubbles up in lots of places is that it is signed off but not checked… and whistleblowers pointing out that in multiple cases people did not want to sign but were forced to or removed or both…


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Old 5th Feb 2024, 16:51
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Originally Posted by A0283
[chrisl137;11590785]Suppose you have an aircraft factory and you sub out your fuselages to an outside vendor.

*** Such parties are Partners or Subcontractors, not Vendors.
Subcontractor/vendor whatever. Legally it's all subcontracts, sometimes with standard terms sometimes with negotiated terms.

Now suppose their delivery for a bunch of units is held up because one of the … factory in Malaysia, and your sub … fine aircraft.

*** Does not work that way in aerospace, not allowed, outright dangerous.
Malaysia is not involved here it appears, so please don’t put it in if it is a phantasy, Spirit Malaysia apparently delivered the original plug, Spirit Wichita and Boeing Renton appears to have made the boo-boo here
It was a random made up example for how incomplete hardware ships. The plugs for the fuselages are apparently made overseas so I picked a random example. Wichita won't have a process for shipping a fuselage with an open hole in the side - it's got to be covered by something. Either a plug, or they would have some kind of shipping dummy. It doesn't matter - the point is that it's not part of the final product, and there's something else that should have shipped in that spot but wasn't available.

but virtually everything of that scale is going to ship with a bunch of minor non-conformances. Things where something doesn't quite meet the drawing - maybe the outside radius on a corner of some non-structural component is off on a couple units because the plant that makes that part found the long tail of their manufacturing tolerances.

*** yes you can have a pile of non conformances (NCR … others say RNC), but these are documented and checked by knowledgeable specialists.
Isn't that what I said?

The only reason that number is on the drawing is because there has to be a number there,

*** in aerospace every number has a reason and generally multiple reasons behind it …
I dream of the day that that's true. There are always free parameters floating around in almost any design and you have to pick something. The place you run into trouble is when there are parameters that should have been analyzed and weren't. Which also happens.

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Old 5th Feb 2024, 18:57
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Hello A0283

In the context of the Alaska 1282 incident:
In the federal criminal case against Boeing test pilot Mark Forkner, filed and tried to a jury in federal district court in Texas, the charges against him do appear to provide a basis for criminal responsibility to be charged here, but with some important caveats. Recall the unfortunate Mr. Forkner was charged with federal crimes based on allegedly fraudulent statements to the FAA relating to the provision of aircraft parts. The first two counts of the indictment against Mark Forkner alleged fraud involving aircraft parts in interstate commerce, and the remaining counts alleged wire fraud stemming from Boeing invoices to customers. Fortunately (in my view) however, he was acquitted.

The point is, seriously deviating from the required and certified production quality assurance levels - to my non-engineer mind - is a very similar occurrence to the occurrences which served as a basis for the prosecution against Mr. Forkner. I'm referring not to any specific crime(s) which could be charged - I don't practice in the area of federal criminal law - but rather referring to the similarity of the nature or type of underlying problem that occurred. If the MCAS and its terrible deficiencies can be the predicate for a criminal prosecution derived, in a fundamental sense, from its deviation from required and certified safety characteristics, then a door plug not properly assembled and which departs the fuselage in flight also could be such a predicate.

Some other caveats. Though the door plug blowout is quite serious, nobody died and the injuries, such as they are, weren't the stuff of lawyer-televison-advert dreams. So as a criminal case, it would lack the same impact as the crashes (sorry for any unintended dark irony).

The criminal case against Boeing (as many community members already are aware) was settled by a DPA with the United States Department of Justice (Deferred Prosecution Agreement). But the families of the victims of the two MAX crashes challenged dismissal of the charges against Boeing through the DPA, on the basis that their rights - rights as set forth in a FEDERAL STATUTE for gosh's sakes, were not granted to them, to give input to the court on the content of the DPA. So they appealed the dismissal, and it's pending (afaik) in federal appellate court.

Imagine if the Court of Apeals throws out the DPA and a criminal case against Boeing restarts in federal district court in Texas.

As for negligence asserted in a civil case, well, those injured in the Flight 1282 incident already have filed suit (iirc).

My own view is sort of not hot-headed. I posted a little about the trial of Mark Forkner, at the time, and also about the DPA. Consistency may well be the hobgobblin of mediocre lawyers' small minds, but sometimes it may be what fits best. Short of direct and specific evidence showing a knowing dereliction of responsibility under the FARs and any other FAA authority, I don't see that prosecuting another scapegoat over the door plug incident would make any sense. Nor would treating the crisis at the formerly great Boeing as a situation where criminal charges would right the enterprise for going forward. The root cause or causes aren't that individuals broke the law. The system by and through which the enterprise was structured and directed, and managed and supervised, broke down. (Interesting thread on this over at R&N, to be sure).
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Old 5th Feb 2024, 19:39
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I don't see that prosecuting another scapegoat over the door plug incident would make any sense.
I think anyone who was directly responsible for approving MCAS's reliance on a single AoA sensor, combined with its full trim authority, should be (should have been) prosecuted for 346 counts (or a mere 8 counts for the Americans killed) of negligent homicide or involuntary manslaughter, or as close an equivalent as possible. It was predictable with certainty that the design would crash one or more aircraft.

The practice in civil law jurisdictions (as opposed to common law) of prosecuting responsible people in transportation accidents, for simple negligence or error, usually works out to unfair blame shifting. The little people spend time in court and possibly jail, while the management responsible for safety culture go on about their business. We don't do this in common law countries. But MCAS was so egregious ....

As far as the blown out door plug goes, no one got seriously hurt and imo, even with the severity of problems it seems to be uncovering, it doesn't come close to any threshold for criminal prosecution.

However, if senior personnel are found to have lied to regulators, or encouraged/instructed others to do so, in material matters, I'm all in favor of prosecution. The situation with Mark Forkner seems marginal to me, and almost certainly there were people who were more deserving of prosecution.
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Old 5th Feb 2024, 21:16
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Boeing may postponed the delivery of up to 50 MAXes after wrongly drilled holes found

news.sky.com/story/boeing-may-delay-jet-deliveries-after-supplier-finds-glitch-with-fuselages-13064698

Can we expect a new AD/MoM for currently flying aircraft? Have a flight on RYA max in a months time.
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Old 5th Feb 2024, 23:08
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Indonesia’s Komite Nasional Keselamatan Transportasi (KNKT), assisted by NTSB, meticulously followed ICAO rules and published a preliminary report on crash of Lion Air flight 610 30 days after the accident.

So why is NTSB’s preliminary report on January 5 MAX9 accident overdue? Could it be due to technical assistance from Boeing’s team of lawyers, accountants and media flacks?
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Old 6th Feb 2024, 00:47
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Originally Posted by ozaub
Indonesia’s Komite Nasional Keselamatan Transportasi (KNKT), assisted by NTSB, meticulously followed ICAO rules and published a preliminary report on crash of Lion Air flight 610 30 days after the accident.

So why is NTSB’s preliminary report on January 5 MAX9 accident overdue? Could it be due to technical assistance from Boeing’s team of lawyers, accountants and media flacks?
One would not need a full suite of cynicism to hold such suspicion, correct?

But with the media spotlight, the Congressional inquiries (on both sides of Capitol Hill), the FAA's inquiries and declining to approve increased production, such "technical assistance" - by which you mean interference - could only be attempted by utter fools. And I'm not even giving the current NTSB Chair any extraordinary credit for toughness of bureaucratic mind (though if I had to guess, I would say trying to provide such "technical assistance" would be a very predictable way to destroy the professional reputation and standing of anyone who tried it).

I'd like to think the Board has always been highly resistant to such interference, but so much of the mythology of the aviation safety ecosystem has been exposed as illusory or corrupt, that I'm not leaning against that particular door (plug).
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Old 6th Feb 2024, 05:37
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Originally Posted by WillowRun 6-3
Though the door plug blowout is quite serious, nobody died and the injuries, such as they are, weren't the stuff of lawyer-televison-advert dreams. So as a criminal case, it would lack the same impact as the crashes (sorry for any unintended dark irony)
I agree. As SLF, I am keen to see ongoing evidence that Boeing consider this occurrence to be very serious. Only its timing prevented a much worse outcome.

I think it's fair to say that the aircraft in question was delivered in an unsafe condition.
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Old 6th Feb 2024, 07:29
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There are some interesting photos here, and a description of the maintenance checks being carried out on AA's MAX planes.

https://news.alaskaair.com/alaska-ai...tions/as-1282/

If you download the media kit they are in high resolution.

Last edited by MarineEngineer; 6th Feb 2024 at 07:43.
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Old 6th Feb 2024, 09:56
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Originally Posted by MarineEngineer
There are some interesting photos here, and a description of the maintenance checks being carried out on AA's MAX planes.

https://news.alaskaair.com/alaska-ai...tions/as-1282/

If you download the media kit they are in high resolution.
Some good photos in there. Extracting parts of some of them for no other reason than they were discussed earlier in the thread:


This appears to show two washers under the nut. One could be a lock/spring washer?


And the upper roller bearing.
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Old 6th Feb 2024, 10:03
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Did you notice that the door seal was deformed slightly?

You can't mix a lock washer with a plain washer. It is probably a spring washer fitted to stop the bolt rattling, or to make aligning the cotter pin easier while keeping the nut 'snug'.
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Old 6th Feb 2024, 10:11
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Originally Posted by MarineEngineer
Did you notice that the door seal was deformed slightly?

You can't mix a lock washer with a plain washer. It is probably a spring washer fitted to stop the bolt rattling, or to make aligning the cotter pin easier while keeping the nut 'snug'.
It is hard for me to judge. I am sure those seals are very flexible. In the photo of the roller bearing it looks like there is a bit of swarf or other rubbish that is caught in the seal. One other image to post, perhaps Alaska were making fun:


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Old 6th Feb 2024, 11:03
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Originally Posted by DTA
Some good photos in there. Extracting parts of some of them for no other reason than they were discussed earlier in the thread:


This appears to show two washers under the nut. One could be a lock/spring washer?


And the upper roller bearing.
The Washers are simply there to ensure the castellated Nut is far enough up the bolt when its nipped up that the split pin inserted through the drilled bolt will actually end up going through slots in the nut.
(and/or for the nut to not bottom out on a plain shank)

P.S. Every time I look at those Rollers I think you really couldn't make them any shorter. But then again there are 4 bolts keeping the door plug in place (or rather there should be )

Last edited by 639; 6th Feb 2024 at 11:13.
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