0721_001(Medical Gas Services
918 S Horton St, Suite 917
Seattle, WA 98134
medgasservices.io
(425) 894 5918
URN=
S301AH38 1N311JdOBA30
au i? z 933
C13AI3338
Medical Gas Line Verification Report
Date: February 121h, 2021
Job Number: 2896
Contractor: University Mechanical Contractors, Inc.
Date(s) / Time(s) of Testing: February 121h, 2021-1300 hrs.
Facility: Swedish Edmonds Campus
21601761h Ave W
Edmonds, WA 98026
Scope of Work: Installation of new medical gas inlets/outlets to existing distribution system
Our firm certifies that the verifier named in the report is properly trained and certified to
perform the activities required. All testing and measurement equipment are 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 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.
D. Medical gases meet minimum flow and are at normal pressure.
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. Permit #: BLD2021-0029 / City of Edmonds
H. Attachments: Worksheets
Note: Existing Equipment and Systems
NFPA 99(2012ed) &51.14 - 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 havingiurisdiction has determined that such use does
not constitute a distinct hazard to life.
2896-2.12.21-VR Pg 1 of 3
Medical Gas Services
918 S Horton St, Suite 917
Seattle, WA 98134
medgasservices.io
(425) 894 5918
II. Medical Gases:
A. Oxygen:
1. Static Line Pressure: 54.9 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: 97.4
5. Delta Flow: PASS
B. Medical Air:
1. Static Line Pressure: 51.2 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: 20.3 %
5. Delta Flow: PASS
6. Carbon Monoxide: Non -Detectable
7. Carbon Dioxide: 382 ppm
B. Dew Point: -17' F
III. Vacuum:
A. Medical - Surgical Vacuum
1. Static Line Vacuum: 21.82" HgV
2. Dynamic Inlet Free Flow: >3.0 scfm
3. Delta Flow: PASS
IV. Particulate Test: PASS
V. Odor: None
VI. Outlets / Inlets:
A. Brand: Multiple
B. Quick Connect Style: Chemetron
VII. Zone Valves:
A. Brand: Chemetron
B. Down line gauges: Yes
C. Labeled for Area Controlled: Yes
VIII. Alarms:
A. Area Alarms:
1. Brand: Chemetron
2. Labeled for Area Monitored: Yes
2896-2.12.21-VR Pg 2 of 3
Medical Gas Services
918 S Horton St, Suite 917
Seattle. WA 98134
medgasservices.io
(425) 894 5918
IX. Brazier: Gregory Lincoln
A. Brazier Number: LINCOGJ918CP
B. Contractor: University Mechanical Contractors, Inc.
X. Comments:
A. None
XI. Recommendations:
A. None
Tested By: Alexander Christensen - Medical Gas Technician
Reviewed By: Matthew Wachsmuth - ASSE 6030 Verifier
2896-2.12.21-VR PS 3 of 3
Medical Gas Services
918 S Horton St, Suite 917
Seattle. WA 98134
medgasservices.io
(425) 894 5918
Medical Gas Outlet / Inlets Evaluation Worksheet
Facility: Swedish Edmonds Campus Job #: 2896 Date: 2.12.21
Area Tested: Family Childbirth Center Verifier: AC
lone VeVve - r-I None M Not Required M New 5a Existing
Labeled As: Patient Rooms 704 thru 707
1 ZV Brand: Chemetron
Gas
3 Part Valve
DL Gauge
Go. PSI
Act PSI
Comments:
OX
0 Yes ❑ No
® Yes ❑ No
54
54.9
MA
0 Yes ❑ No
0 Yes ❑ No
50
51.2
VAC
0 Yes ❑ No
0 Yes ❑ No
23
21.82
Area AVarm - I—i None Fl Not Required r-I New IRI Existing
Labeled As: Patient Rooms 704 thru 707
Brand: Chemetron
Gas
PSI
Set HI
Set LO
Sensor
Comments:
OX
55.4
60
40
DL
MA
50.7
60
40
DL
VAC
22.0
--
12
DL
vuriers tr inners - M New m txistinQ
Outlet / Inlets Brand: Chemetron/BM
Location: Wall
I Quick Connect: Chemetron
Area Room Door
Gas
Flow
SCFM
Delta
Flow
Conc.
Part.Comments:
706
OX
>8
.8
97.4
.000
Mother - New
VAC
4.5
>12
--
--
OX
>8
.8
97.4
.000
Baby - Existing
VAC
4.5
>12
--
--
707
OX
>8
.8
97.4
.000
Mother - New
VAC
4.5
>12
--
--
OX
>8
.8
97.4
.000
Baby - New
VAC
4.5
>12
--
--
MA
>8
1.0
20.3
.000
DP:-17°F CO2:382ppm CO:Oppm
2896-2.12.21 Page 1 of 1
CMtdical Gas Services
8 S Horton St, Suite 917
Seattle. WA 98134
medgasservices.io
(425) 894 5918
Medical Gas Outlet / Inlets Evaluation Worksheet
Facility: Swedish Edmonds Campus Job #: 2896 1 Date: 2.12.21
Area Tested: Family Childbirth Center Verifier: AC
Zone Valve - --1 None Fl Not Reauired F-1 New 15ZI Existina
Labeled As: Patient Rooms 708-713
1 ZV Brand: Chemetron
Gas
3 Part Valve
DL Gauge
Ga. PSI
Act PSI
Comments:
OX
® Yes ❑ No
® Yes ❑ No
55
54.9
MA
® Yes ❑ No
® Yes ❑ No
51
51.2
VAC
® Yes ❑ No
® Yes ❑ No
26
21.82
AreaA/arm- F-1 None Fl Not Reauired FI New IRI Fxistino
Labeled As: Patient Rooms 708-713 6 715 (Air)
Brand: Chemetron
Gas
PSI
Set HI
Set LO
Sensor
Comments:
OX
54
60
40
DL
MA
52
60
40
DL
VAC
22.1
--
12
DL
UUtletS & Inlets - ixl New I I Existing
Outlet / Inlets Brand: BeaconMedaes
Location: Wall
I Quick Connect: Chemetron
Area oom oor
Gas
Flow
SCFM
Delta
Flow
Conc.
Part.Comments:
708
MA
>8
1.0
20.3
.000
VAC
4.5
>12
--
--
OX
>8
.8
97.4
.000
VAC
4.5
>12
--
--
OX
>8
.8
97.4
.000
713
OX
>8
.8
97.4
.000
VAC
4.5
>12
--
--
MA
>8
1.0
20.3
.000
OX
>8
.8
97.4
.000
VAC
4.5
>12
--
--
2896-2.12.21 Page 1 of 1