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Medical Gas Services, LLC
6355 NE 15181 Street
Kenmore, WA 98028
425.877-9623
Medical Gas Line Verification
Report
Date: December 10, 2017
Contractor: MacDonald Miller Company
Date(s) / Time(s) of Testing: December 8, 2017 / 1115 hrs.
December 10, 2017 / 0400 hrs.
Facility: Swedish Medical Center — Edmonds Campus
21601 — 761h Avenue West
Edmonds, WA 98026
Scope of Work: Cut and Cap Oxygen, Medical Air, and Medical Vacuum in space for future
pharmacy.
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 of Medical Gas Services LLC the verifier named in this report
has conducted testing and verification of medical gas piping systems and related equipment to
certify the following on the above date.
General Findings:
A. Medical gases and vacuum are in compliance with NFPA 99 (2012ed): Category
B. No crossed lines were found in medical gas or vacuum systems in the tested areas on
the day of testing.
C. Medical gases meet minimum concentration.
D. Medical gases meet minimum flow and are at normal pressure.
E. Medical vacuum meets minimum flow and is at normal vacuum pressure.
F. Most Medical gas system components in the area tested are in compliance with NFPA
99 (2012ed).
(See Note, Comments and Recommendations)
G. Purge Gas: Lot #T0919701 (Central)
H. Static Pressure Test: PASS,
I. Permit #BLD-20161212: City of Edmonds
J. Attachments: Work sheets
Note: Existing Equipment and Systems
NFPA 99(2012ed) #5.1.1.4 — An existing system that is not in strict compliance
with the provisions of this standard shall be permitted to be continued in use as
long as the authority having jurisdiction has determineGI that such use does not
constitute a distinct hazard to life.
SwedishMC-Edmonds-12.8.17-Pharmacy-VR-Medical Gas Line (2012ed) Pg. 1 of 3
Medical Gas Services, LLC
6355 NE 1518t Street
Kenmore, WA 98028
425.877-9623
II. Medical Gases:
A. Oxygen:
1. Static Line Pressure: 56 psi
2. Dynamic Outlet Free Flow: >3.5 scfm
3. Dynamic Outlet Free Flow: >6.0 scfm (for 3 seconds in 'Critical Care Area')
4. Oxygen Concentration: >99.0%
5. Delta Flow: PASS
B. Medical Air:
1. Static Line Pressure: 55 psi
2. Dynamic Outlet Free Flow: >3.5 scfm
3. Dynamic Outlet Free Flow: >6.0 scfm (for 3 seconds in 'Critical Care Area')
4. Oxygen Concentration: 20.9%
5. Delta Flow: PASS
C. Nitrous Oxide:
1. Static Line Pressure: 56 psi
2. Dynamic Outlet Free Flow: >3.5 scfm
3. Nitrous Oxide Concentration: >99.0%
4. Delta Flow: PASS
III. Vacuum:
A. Medical —Surgical Vacuum
1. Static Line Vacuum: 22" HgV
2. Dynamic Inlet Free Flow: >3.0 scfm
3. Delta Flow: PASS.
IV. Particulate Test: PASS
V. Odor: None
VI. Outlets / Inlets: (Existing)
A. Brand: Chemetron
B. Quick Connect Style: Chemetron
VII. Zone Valves: (Existing)
A. Brand: Chemetron
B. Down line gauges: Yes
C. Labeled for Area Controlled: Yes
Vill. Alarms:
A. Area Alarms: (Existing)
1 Brand: Chemetron
2. Labeled for Area Monitored: No
SwedishMC-Edmonds-12.8.17-Pharmacy-VR-Medical Gas Line (2012ed) Pg. 2 of 3
Medical Gas Services, LLC
6355 NE 151s► Street
Kenmore, WA 98028
425.877-9623
IX. Brazier: Matt Kachur
A. Brazier Number: KACHUMT980PR
B. Contractor: MacDonald Miller Company
X. Witness: Rex Kirby — Swedish Medical Center
XI. Comments:
A. Some zone valves are not properly labeled.
B. Area alarms are not labeled.
C. Oxygen and nitrous oxide line pressures are high.
D. Slight particulate matter found in oxygen, medical air, and nitrous oxide lines.
XII. Recommendations:
A. Label All zone valves to indicate areas served.
B. Label all area alarm so indicate areas monitored.
C. Adjust medical gas lines to NFPA 99 required 50-55 psi.
D. Periodically purge medical gas lines to prevent build up of particulate matter.
Tested By: Harry Pomeranz — ASSE 6030 Verifier
SwedishMC-Edmonds-12.8.17-Pharmacy-VR-Medical Gas Line (2012ed) Pg. 3 of 3