0216_001(Medical Gas Services
918 S Horton St, Suite 917
)L0 z0z't—C 5- T
Seattle, WA 98134
medgasservices.io
(425) 894 5918
Medical Gas Line Verification Report
Date: September 23, 2020
Job Number: 2675
Contractor: Ritter Plumbing and Mechanical
Date(s) and Time(s) of Testing: September 23, 2020-1200hrs
Facility: Bridge Animal Referral Center
8401 Main St
Edmonds, WA 98026
Scope of Work: Installation of five new medical oxygen outlets.
Our firm certifies that the verifiers) named in the report are 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(s)
named in this report have 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 are in compliance with NFPA 99(2012ed): Level 3, Dental
"NOT FOR ANESTHESIA"
B. No crossed lines were found in the medical oxygen in the tested areas on the day
of testing.
C. Medical oxygen meets minimum concentrations.
D. Medical oxygen is below normal pressure.
E. Purge Gas: Lot#W2458221GC01 (Airgas)
F. City of Edmonds: Permit # BLD2020-0537
G. Attachments: Worksheet
Note: Existing Equipment and Systems
NFPA 99(2012ed) #53.1.4 - An existing Level 3 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 havingjurisdiction has determined
that such use does not constitute a distinct hazard to life.
2675-9.23.20-VR Pg.1 of 2
(Mtdical Gas Services
8 S Horton St. Suite 917
Seattle. WA 98134
medgasservices.io
(425) 894 5918
II. Medical Gases
A. Oxygen:
1. Static line pressure: psig.
2. Oxygen concentration at outlet: >99.0%
3. Dynamic outlet free flow at outlet: >3.5 scfm
Ill. Particulate Line Test: PASS
IV. Odor: PASS
V. Outlet:
A. Outlet Style: DISS
X. Brazier: Chris Fitzgerald
A. Brazier Number: FITZGCM988PZ
B. Plumbing Contractor: Ritter Plumbing and Mechanical
XI. Witness: Mark Westbrook - Ritter Plumbing and Mechanical
XII. Comments:
A. Oxygen pressure was low on the day of testing.
XIII. Recommendations:
A. Set oxygen delivery pressure between 50-55psi per nfpa 99.
Tested By: David Pomeranz - ASSE 6030 Verifier
. )A9taa4j2-
2675-9.23.20-VR Pg. 2 of 2
CMtdical Gas Services
8 S Horton St, Suite 917
Seattle. WA 98134
medgasservices.io
(425) 894 5918
Medical Gas Outlet / Inlets Evaluation Worksheet
Facility: Bainbridge Animal Referral Center Job #: 2675 I Date: 9.23.20
Area Tested: Care Facility I Verifier: DP
Outlets & Inlets - ® New p Existinq
•utlet / Inlets
Quick Connect:
1M. MOM
2675-9.2.20 Page 1 of 1