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Gas Outlet Report.pdfG (- W 6,0 L b rz t~L Medical Gas Services, LLC Medical Gas Outlet / Inlets Evaluation Worksheet Facility: Swedish MC - Edmonds Job #: I Date: 12/8/17 Area Tested: PCU East Tower Verifier: HP 7nna Valva. n Nnna n Nnf Rpnnirarl n Naw n Fxi0ina Labeled As: PCU Room 201 ZV Brand: Chemetron Gas 3 Part Valve DL Gauge Ga. PSI Act PSI Comments: OX ❑ Yes ❑ No ❑ Yes ❑ No MA ❑ Yes ❑ No ❑ Yes ❑ No VAC ❑ Yes ❑ No ❑ Yes ❑ No N20 ® Yes ❑ No ® Yes ❑ No 58 56 Aran Alarm - F— Mnnn I-1 MM Rarmirorl n Maw mC FYictinn Labeled As: No label Brand: Chemetron Gas PSI Set HI Set LO Sensor Comments: OX MA VAC N20 54.5 60 40 UL nidinfe R Inlefe . F-1 Maw r7l Fvictinn Outlet / Inlets Brand: Chemetron Location: Wall Quick Connect: Chemetron Area / Room / Door Gas Flow SCFM Delta Flow Conc. % Part. Comments: 201 N20 >8 P >99 P Slight 204 N20 >8 P >99 P Slight SwedishMC Edmonds-DaySurgery-12.8.17-Cut/Cap-Datasht-Gas Outlet Page 1 of 2 Medical Gas Services, LLC Medical Gas Outlet 1 Inlets Evaluation Worksheet Facility: Swedish MC - Edmonds Job #: I Date: 12/10/17 Area Tested: Day Surgery I Verifier: HP Zone Valve - I-1 None n Not Reauired f-1 New N1 Existina Labeled As: ED West Rooms 17-27 1 ZV Brand: Chemetron Gas 3 Part Valve DL Gauge Ga. PSI Act PSI Comments: OX ❑ Yes ❑ No ❑ Yes ❑ No 54 56 MA ❑ Yes ❑ No ❑ Yes ❑ No 58 55 VAC ❑ Yes ❑ No ❑ Yes ❑ No 20 22 Araa Alarm . I-1 Nnna f-1 Net Reauired I-1 New 1-1 Existina Labeled As: I Brand: Gas PSI Set HI Set LO Sensor Comments: Alarm turned off. OX MA VAC Outlets & Inlets - 1-1 New FRI Existina Outlet 1 Inlets Brand: Chemetron Location: Wall Quick Connect: Chemetron Area I Room 1 Door Gas Flow SCFM Delta Flow Conc. % Part. Comments: 103 OX >8 P >99 P Slight MA >8 P 20.8 P Slight VAC >5 P -- -- SwedishMC Edmonds-DaySurgery-12.8.17-CuVCap-Datasht-Gas Outlet Page 2 of 2