SMCE Reroute SI testing report/Medical Gas Services
918 S Horton St Suite 917
Seattle, WA 98134
medgasservices.io
(425) 894 5918
Medical Gas Line Verification Report
Date: January 27, 2023
Job Number: 4178
Contractor: MacDonald -Miller Facilities Service
Date(s) / Time(s) of Testing: January 24, 2023 — 0800hrs
Facility: Swedish Medical Center— Edmonds Campus
21601 76th AVE W
Edmonds, WA 98026
Scope of Work: Re -rout of medical oxygen and medical vacuum distribution.
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 oxygen and vacuum are in compliance with NFPA 99 (2012ed): Category 1
B. No crossed lines were found in medical oxygen or vacuum systems in the tested areas on the
day of testing.
C. Medical oxygen meets minimum concentration.
D. Medical oxygen meets minimum flow and is 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. Medical Gas Line Purity Test: PASS
H. Purge Gas: Lot # T1027201 (Central)
I. Attachments: Worksheet
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 determined
that such use does not constitute a distinct hazard to life.
VR-Medical Gas Line Pg 1 of 2
/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: 52.9 psi
2. Dynamic Outlet Free Flow: >8 scfm
3. Oxygen Concentration: 99.65
4. Delta Flow: PASS
III. Vacuum:
A. Medical —Surgical Vacuum
1. Static Line Vacuum: 4.5" 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: BeaconMedaes
B. Quick Connect Style: Chemetron
VII. Brazier: Micah Synsteby
A. Brazier Number: SYNSTM*913ML
B. Contractor: MacDonald Miller Facilities Solution
Vill. Comments:
A. None
Tested By: David Pomeranz — ASSE 6030 Verifier
VR-Medical Gas Line Pg 2 of 2
Medical Gas Services
918 S Horton St, Suite 917
Seattle, WA 98134
medsasservices.io
(425) 894 5918
Medical Gas Outlet / Inlets Evaluation Worksheet
Facility: Swedish Edmonds Job #: 4178 Date: 1.24.23
Area Tested: Imaging Verifier: DP
Zone valve - n None n Not Required n New M Existing
Labeled As: X-Ray 1,2,3 & Ultrasound 1 & 2
ZV Brand: BeaconMedaes
Gas
3 Part Valve
DL Gauge
Ga. PSI
Act PSI
Comments:
OX
® Yes ❑ No
® Yes ❑ No
54
52.9
VAC
® Yes ❑ No
® Yes ❑ No
21
20.43
Area Alarm - n None n Not Required n New M Existing
Labeled As: X-Ray 1,2,3 & Ultrasound 1 & 2
Brand: BeaconMedaes
Gas
PSI
Set HI
Set LO
Sensor
Comments:
OX
52
60
40
DL
VAC
20
--
12
DL
Outlets & Inlets - n New nX Existing
Outlet / Inlets Brand: BeaconMedaes
Location: Wall
Quick Connect: Chemetron
Area / Room / Door
Gas
Flow
SCFM
Delta
Flow
Conc.
Part.
Comments:
X-RAY 3 01104.013A
02
>8
<5
99.65
.000
Dip — 41.08 // HHC
VAC
4.5
>12
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