REQUEST FOR DEVIATION OR DRAWING CHANGE

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					                             REQUEST FOR DEVIATION OR DRAWING CHANGE
Requested By (Supplier, Supplier Representative):                                                            Date: 11/21/2005


Description of Item Affected: :
Part Number, Revision Level: :
                                                        DEVIATION REQUEST
Describe Deviation Requested:



Quantity of Parts Involved:
Reason for Non-Conformance:




Corrective Action Taken:




                                                  DRAWING CHANGE REQUEST
Describe Drawing Change Requested:




Reason:



Effectivity Date Requested:
                                         REVIEWED BY STERN INDUSTRIES, INC.
Project Coordinator                                                                 Approve/Reject   Date:
Product Engineering:                                                                Approve/Reject   Date:
Mfg. Engineering:                                                                   Approve/Reject   Date:
Quality Assurance:                                                                  Approve/Reject   Date:


                                                    REVIEWED BY CUSTOMER
 Customer:
 Customer
 Representative:                                                                    Approve/Reject   Date:

Comments:




       After Disposition, return forms to: Stern Industries Quality Assurance   1