Med gas line verification report 11-01-17.pdfMedical Gas Services, LLC
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6355 NE 151s' Street
425-877-9623
Medical Gas Line Verification
Report
Contractor: PSF Mechanical
Date(s) / Time(s) of Testing: November 1, 2017—2045hrs
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7820 216th ST. SW
#140
Edmonds, WA 98026
Scope of Work: Installation of (4) new oxygen outlets and (4) new medical vacuum inlets
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.
I. General Findings:
A. Medical gases and vacuum are in compliance with NFPA 99 (2012ed): Category 1
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.
E. Medical vacuum meets minimum flow and is at normal vacuum pressure.
F. Medical gas system components in the area tested are in compliance with NFPA 99
(2012ed).
G. Medical Gas Line Purity Test: PASS
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i. Permit #:� BLD20171078 — City of Edmonds
J. Attachments: Work sheet
Note: Existing Equipment and Systems
NFPA 99(2012ed) #5.1.1.4 — An existing system that is not in strict compliance
long as the authority having jurisdiction has determined that such use does not
constitute a distinct hazard to life.
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Medical Gas Services, LLC
II. Medical Gases:
A. Oxygen:
1. Static Line Pressure: 50 psi
2. Dynamic Outlet Free Flow: >3.5 scfm
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4. Delta Flow: PASS
III. Vacuum:
A. Medical — Surgical Vacuum
1. Static Line Vacuum: 26" HgV
2. Dynamic Inlet Free Flow: 3.0 scfm
3_ Malta Flnw. PARS
IV. Particulate Test: PASS
V. Odor: None
V_ 1 [lhitlaft / Inlafe- INICAAA
A. Brand: Amico .
B. Quick Connect Style: Chemetron
VII. Zone Valves: (Existing)
A. Brand: Allied
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C. Labeled for Area Controlled: No
Vill. Alarms:
A. Area Alarms: (Existing)
1 Brand: Allied
2. Labeled for Area Monitored: No
EdmondsCOS-11.1.17-VR-Medical Gas Line (2012ed)
6355 NE Wst Street
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425-877.9623
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Medical Gas Services, LLC
6355 NE 151 n Street
425-877-9623 vVV v
IX. Brazier: Micah Synsteby
A. Brazier Number: SYNSTM*913ML
B. Contractor: PSF Mechanical
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XI. Comments:
A. Area alarm and zone valve are not labeled for areas monitored.
XII. Recommendations:
A_ I ahal 7Ana \/91\/a and alarm fnr araac mnni4nrari_
Tested By: David Pomeranz — Medical Gas System Technician
Reviewed By: Harry Pomeranz — ASSE 6030 Verifier
Ed mondsCOS-1 1. 1. 1 7-VR-Medical Gas Line (2012ed) Fp% 03
EdmondsCOS-11.1.17 VR-Medical Gas Line (2012ed)
Medical Gas Services, LLC
Medical Gas Outlet / Inlets Evaluation Worksheet
Facility: Edmonds Center for Outpatient Surgery Job I Date:11/1 /17 - 2045
Area Tested: Pre/Post OP Verifier: DP
Zone Valve - u None u Not Required i__i New iN Existing
Labeled As: Not Labeled I ZV Brand: Allied
Gas 3 Part Valve DL Gauge Ga. PSI Act PSI Comments:
OX ® Yes ❑ No ® Yes ❑ No 52 50
Area Alarm - ❑ None ❑ Not Required ❑ New ® Existing
Labeled As: Not Labefed mna: Amen
Gas
PSI
Set HI
Set LO
Sensor
Comments:
OX
50
60
40
DL
MA
28
60
40
DL
nntlats R Inlate - IS1C Now (-1 FYistinn
Outlet I Inlets Brand: Amico
Area f room I f or Gas
Location: Wall
flow ' Den
SUM Flow
Quick Connect: Chemetron
' C.M. Part. ' Commen
%
1
>10
P
>99
P
#VAC
3
P
--2
>10
P
>99
P
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Lab name: Certified Medical Testing
Client:
Client ID:
Collected:
Analysis date: 10/0912017 15:11:47
Method: Valve injection
Description: FID
Data file: tph24032.CHR ()
Sample: Calibration Run
Operator: Staff
Comments: Total Hydrocarbons as Methane Results
-2.225
Methane, l .1900d PPPA
HaiogertatedHy&oCafWfif 1.17Wippm
i
Component Area External Units
ethane 53.0540 1.1900 PPM
alogenatedHydroCart18.6235 1.1700 ppm
71.6775 2.3600
Lab name: Certified Medical Testing
Client:
Client ID:
Collected:
Analysis date: 1010912017 15:11:47
Method: Valve Injection
Description: DEt..CD
Data file: tce24129.CHR ()
Sample: Calibration Rur.
Operator: Staff
Cornmerrts: Total Hydrocarbons as Metha^e Results
39.063-172.267 1319.075
1
2-
3-
Halo. Hydrocarbons/1.17001PPM
4-
5-
a
Component Area External Units •
Halo. Hydrocarbons 1803,1270 1.1700 PPM
1803,1270 1.1700
Lab name: Certified Medical Testing
Ctierrt: E�drrrorrds OP Surgery
Client lD: MGSS
Collected: 10.5.17
Analysis date: 10/09/2017 15:18:53
Method: Valve Injection
Description: FID
Data file: tph24033.CHR ()
Sample: 02 Line
Operator: Staff
Cornments: Tota! Hydrocarbons as Methane Results
-2.2II25
t Methane/0.1067/PPPY",
1
Component Area External Units
ethane 4.7575 0.1067 PPAII
4.7575 0.1067
Lab name: Certified Medical Testing
Client: Edmonds OP Surgery
Client ID: MGSS
Collected: 10.5 17
Analysis date: 10/091201715:18:53
Method: Valve Injection
Description.: DELCD
Data file: tce24130.CHR ()
Sample: 02 Line
Operator: Staff
Comments: Total Hydrocm bons as Methane Result;
39.063-172.267
1—
i
2-
3-
5-
Component Area External Units
0.0000 0.0000
1319.075