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.R <br />-1� � r�l ��� W-- �� � <br />Airgas <br />Airgas Medical Services, Inc. <br />Everett, WA 98201 <br />(425)741-8807fax(425)968-4620 <br />http://www.airg as.com <br />Medical Gas Line Verification <br />Report <br />Date: 29 August 2013 <br />Job Number: 203832 <br />Contractor: Diamond B / P0101430 <br />Date(s) / Time(s) of Testing: 27 August 2013/1400 hrs <br />Facility: Providence Regional Medical Center — Pacific Campus <br />916 Pacific Avenue <br />Everett, WA 98206 <br />Scope of Work: Cut antl cap oxygen, medical air and vacuum lines in old ER area servicing Trauma, Cardiac <br />Resuscitation, Radiology, Observation 2, Exam 2, OB antl Observation 1. Rooms Exam 1 thru 4 <br />remain active on this zone temporarily until project moves forward to phase 2. No medical air outlets <br />located in the remaining active area. <br />Our firm certifies that the verifier named in the report is properly trained and certified to perform the activities <br />required. All test and measurement equipment is properly calibrated and maintained. As a representative of Airgas <br />Medical Services, Inc. the verifier named in this report has conducted testing and verification of inedical gas piping <br />systems and related equipment to certify the following on the above date. <br />General Findings: <br />A. Medical gases and vacuum are in compliance with NFPA 99 (2005ed): Level 1, Hospital <br />B. No crossed lines were found in medical gas or vacuum systems in the tested areas on the day of testing. <br />C. Medical gases meet minimum concentration. <br />D. Medical gases meet minimum flow and is at normal pressure. <br />E. Medical vacuum meets minimum flow and is at normal vacuum pressure. <br />F. Most Medical gas system components in the area tested are in compliance with NFPA 99 (2005ed),. <br />(See Note, Comments and Recommendations) <br />G. Purge Gas: Lot # 347TUA2029-A (AL) <br />H. Static Pressure Test: PASS (150# for 24 hrs) <br />I. Permit Number: P1308-005 / City of Everett <br />Note: Existing Equipment and Systems <br />NFPA 99(2005ed) #5.1.1.4 — An existing system fhat is not in strict compliance with the provrsions of <br />this standard shall be permitted to be continued in use as long as the authority having jurisdiction has <br />determined that such use does not constifute a distinct hazard to life. <br />II. Medical Gases: <br />A. Oxygen: <br />1. Static Line Pressure: 54 psi <br />2. Dynamic Outlet Free Flow: >3.5 scfm <br />3. Oxygen Concentration: >99.0% <br />4. Delta Flow: PASS <br />P R M C P-08.27.13-203832 <br />Pg 1 of 2 <br />