20120215101823536.pdfAjngaoMedical Services, Inc.
Everett, ww98201
(425),41-880rfax (4zo)968'4020
Viedical Gas Line Verificatioii
Report I
Date: 24January 2O12
Job Number: 201742
Contractor: PSF Mechanical
Dake/s\/Tinne(n)ofTesting: 23January 2012/072Ohns
Facility: Swedish- Edmonds Medical Center
21001 7O"'Avenue West
Edmonds, VVA98O20
Scope of Work: Added new Oxygen and Vacuum isolation valves in ceiling above control room
in MRI room, also added lea. Oxygen and vacuum outlets.
Our firm certifies that the verifier named in the report is properly trained and certified to perform
the activities required. All test and measurement equipment is properly calibrated and
maintained. As a representative nfAirgas Medical Son/ioeo NW the verifier named in this report
has conducted testing and verification of Medical Gas piping systems and related equipment to
certify the fn||ovvinQ on the above date.
General Findings:
A. Medical Gases and Vacuum are incompliance with NFPA99U9Q9ed\:
Level
B. No crossed lines were found in Medical Gases in tested areas on the day of testing.
C. Medical Gases meet minimum concentration.
U. Medical Gases meet minimum flow and normal pressure.
E. Medical Vacuum meets minimum flow and isotnormal vacuum pressure.
F. Most medical Gas System components in area tested are in compliance with
NFPA 99(1999ed): See (Note), (Comments), (Recommended Corrections) and
(Corrections)
G.Medical Gas line purity: PASS #LH01Y10QA(AG)
H. 15O#for 24hour Line Pressure Test: PASS
City ofEdmonds, Permit #:11'OQ30
1. Attachments: Purity Sheet.
Note: Existing Equipmentand Systems
NFFY\9g/Y0QQedl#4'Y.4—Anexisting system that b/not /nstrict compliancewith
the provisions of this standard shall be permitted to be continued in use as long as
the authority having jurisdiction has determined that such use does no/ constitute a
distinct hazard tolife.
01-AG.VR-Medicm|Gas Line (1S08ad)'Rev11 PQ 1 of 3
Airgas Medical Services, Inc.
Everett, WA 98201
(425)741-8807 fax (425)968-4620
http://www.airgas.com
II. Medical Gases:
A. Oxygen:
1. Static Line Pressure: 59 psig.
2. Dynamic Outlet Free Flow: >3.5 scfm.
3. Oxygen Concentration: >99.0%
4. Delta Flow: PASS
III. Vacuum:
A. Medical / Surgical Vacuum:
1. Static Line Vacuum: 23"HgV.
2. Dynamic Outlet Free Flow: >3.0 scfm.
3. Delta Flow: PASS
IV. Particulate Line Test: PASS
V. Outlets / Inlets Brand: Chemetron
A. Quick Connect Style: Chemetron
VI. Zone Valves: Chemetron- NCG
A. Without down line gauges.
VII. Alarms: None
• :[•TA►[�7►L�
IX. Brazier: Terry D, Barnes
A. Brazier Number: MG01- BARNETD894BM
B. Plumbing Contractor: PSF Mechanical
X. Witness: Tom Goodson- Facilities
XI. Comments:
A. No Vacuum zone valve. ( existing)
B. No down line gauge on oxygen zone valve. ( existing)
C. Oxygen line pressure is 59psig.
XII. Recommended Corrections:
A. Add Vacuum zone valve.
B. Add oxygen zone valve with down line gauge.
C. Lower oxygen line pressure to 55psig.
XIII. Corrections:
A. None
01-AG.VR-Medical Gas Line (1999ed)-Rev1.1 Pg 2 of 3
i
Airgas Medical Services, Inc.
Everett, WA 98201
(425)741-8807 fax (425)968-4620
http://www.airgas.com
Tested By: Eric Burt
Eric N. Burt, ASSE 6020
Inspector
Airgas Medical Services, Inc.
eric.burt(cDairgas.com
Cell 425-754-1097
Signature Block
01-AG.VR-Medical Gas Line (1999ed)-Rev1.1 Pg 3 of 3