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. .,,�'�,��OX�nG • /dedi[cl Cases • Madical Ga:Llne Verifications •Analgesia fquipmen� <br /> ' �, Verification Report <br /> �_ rnspector of�ecord <br /> xnx � o�� r ;�-ca i <br /> From:13. Bvan McAllistcr <br /> To: �Q�-----'�"_ '�Q* <br /> Of: �. n4�� �: � , ') <br /> 3 // � _,X- ',<; . <br /> Fax. lf 1�5� � '�.:} <br /> F� �3 �5'i �,- �,,�- <br /> Date:�_�`-T a� <br /> This fax is to conCirm testing has been performed at the <br /> following facility: <br /> Facility: � �-" u ��T ,�� <br /> Address : � l� C1 ��r �� "�'— <br /> City, State ' ---' <br /> 1 �pspital Denta�C> Level 1 2 Q ci±cle one <br /> Test Date � LC� � --' <br /> � Medicul Gases: Oxygen� ,Niuous oxide G�Me�� �r--� �luogeq_, <br /> '�acuum�� Dental Air�.Dental Vacuum . Other��-- <br /> Tcst completcd_�� _._— <br /> ' Interim Report or Completcd �pessed Per NFPA' <br /> � Ready for Patient Us��_xes N� <br /> i <br /> � If completed�nal r t to follow in seven to ten working days. <br /> � <br /> � , <br /> � -�. <br /> I <br /> �, B. ' cAllister, CRTT, CMCxV <br /> � �esi ent <br /> i <br /> Aomcrtempreport <br /> i <br /> 2706 164th Street S.W., Lynnwood,WA. 98037 <br /> ' (425) 741•8807 • I-800•736•7047 • Fax: (a25) 7a1•2500 <br />