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� <br />r <br />Airgas <br />Airgas Medical Services, Inc. <br />Everett, WA 98201 <br />(425)741-8807fax(425)968-4620 <br />http://www. airgas.com <br />III. Vacuum: <br />A. Medical — Surgical Vacuum <br />1. Static Line Vacuum: 17" HgV <br />2. Dynamic Inlet Free Flow: >3.0 scfm <br />3. Delta Flow: PASS <br />IV. Particulate Test: PASS <br />V. Odor: None <br />VI. Outlets 1 Inlets: (Existing) <br />A. Brantl: Hill-Rom <br />B. Quick Connect Style: Ohmeda <br />VII. Zone Valves: (Existing) <br />A. Brand:Ohmeda <br />B. Down line gauges: Yes <br />C. Labeled for Area Controlled: Yes <br />VIII. Alarms: <br />A. Area Alarms: (Existing) None <br />IX. Brazier: Jeff Hurlbert <br />A. Brazier Number: HURLBJL005LT <br />B. Contractor: Diamond B <br />X. Witness: Jeff Hurlbert—Diamond B <br />XI. Comments: <br />A. No vacuum zone valve. (Existing) <br />B. No area alarm was found monitoring this area. Since this area is no longer designated as a critical care <br />area an area alarm is not required. (Existing) <br />C. Some light particulate material present in oxygen line. Following a purge of the outlet a second sample <br />was taken, particulates in this sample were significantly less than the previous sample. <br />XII. Recommendations: <br />A. Add vacuum zone valve. <br />B. Perform periodic purge of inedical gas systems to retluce or eliminate the accumulation of particulate <br />material as a means of preventative maintenance. <br />Tested By: <br />%'�' <br />,� <br />,.�� ,��;`,% <br />t� <br />Matthew R. Shyne, ASSE 6030 Verifier <br />Airgas Metlical Services, Inc. <br />matt.shyne(�a,airqas.com <br />Cell 425-248-7152 / Fax 425-968-4620 <br />P R M C P-08.27.13-203832 <br />Pg2of2 <br />