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•� V <br /> ��•''n R <br /> — � ":`a'����117G • hledical Cases • Madical Gas Line Verrficatlonr •Analgesia Equipment <br /> *� Veri�icatkon Report <br /> .,,_ rnspector of 12ecoT•d <br /> �a.x �' i;, `� l,� �'�� � <br /> From:B. Evan McAlllster <br /> Of� �Q � ' °�pw <br /> ��— -7 /`�/ �Q�� • j ^�l <br /> Fax� �f?�5,� ���`7 `� j� � <br /> ,�1 ` <br /> Date: � �{ �f� � (� — ��� <br /> .��� <br /> This fax is to cnnfirm testing has been per£orr�ned at the <br /> following facility: <br /> Faciliry: KI �-. � (,{ ,�o�,—�� /�,p•S <br /> Address :� ,�n ?.��— l�Q� v� ^� <br /> City, State ,� <br /> Test Date "" ospitat^,,Denlal�C , Level 1 2 Q circle one <br /> ' Medical Gases: Oxygen,� ,Nitrous oxide G�,Medical air__, Nitrogen_, <br /> Vacuum�, Dental Air� ,Dental Vacuum . Other <br /> '�cst completed •� . <br /> Tnterim Report V or Compleced S��C passed per NFPA. <br /> Ready for Patient CJse�_Yes No <br /> If completed S`ina! r t to follow in sever.to ten tivorking days. <br /> B. ' cAllister, CRTI', CMGV <br /> resi ent <br /> Anincrtempreport <br /> 2706 164th Strcet S.W., Lynnwood, WA. 9R037 <br /> (425) �41•8807 • I-BOOa36•7047 • Fax: (425) 7ai•2500 <br />