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Oi/1J/200i 1J:52 Fa� 4257412500 KITROS INC f�001 <br />. ". <br />� ��Nitrox,n� <br />� �. <br />• hfedlcal Gasr.s • MrAlcol Cns Line Verifrcarions . Analgesla Equipment <br />�Verification Report <br />_ Inspector of Record <br />rnx � <br />From: II. Evan McAllistcr <br />To: ��� -`C`�N�S��-- -- <br />oc � t� i; �- M�C�_. ��� � <br />r�:._��5�-�L^41� — <br />Date: l 1 �51 ��_ --- - <br />—T.��— <br />This fax is to confirm tcstin� has been performcd at the <br />following facility: <br />facility: c, ��.�'��4� �MP-1 1�IeA �ii� �P.�2� � <br />Address :���i " � � ��� 5'�. '� (,l � <br />City, Scate �� �_�(,� . � <br />Test Date��� Hospital __, DeMal � <br />���� <br />Medical Gascs: Oxygcn ✓, Nitrous oxide �Medical air _, NiVogen_, <br />Vacuum , Dcnlal Air �Dcntal V¢cuwn .�. Other <br />Tcst cumpletcd �� ��r;1 a�a:�C7 f�5j Cf�nl�ilo�� �!�'S7 <br />/ \ <br />Interim Report ___ _ or Complcted r/ Passed per NFPA. <br />Rcady for Paticnt Usc_._�Ycs No <br />If cumpleted final rcport tn follow in se��en tn ten �vorking days. <br />��,����'k���.p.��-4�' �'�'� <br />f3. �Evan McAllistcr, CRi"1', CMGV � <br />President <br />1s�mcrtcmprcport <br />770G I fi4ih Street S.W., I.ynnwood,'NA. 98037 <br />(425) 741-R807 • 1•800-73[•7047 • Fax:(425)741-2500 <br />�;�;� <br />