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PvIedical Gas Setvices, LLC <br /> Medical Gas Services,LLC <br /> 6355 NE 151St Street <br /> Kenmore,WA 98028 <br /> 425-877-9623 <br /> Dental Gas Line Verification <br /> Report <br /> Date: November 25, 2014 <br /> Job Number: 798678 <br /> Contractor: AM Ruyle, LLC <br /> Date(s) and Time(s) of Testing: November 20, 2014 10900 hrs. <br /> November 21, 2014 / 1330 hrs. <br /> Facility: Dr. Alex Kang <br /> 3822 Colby Avenue <br /> Everett, WA 98201 <br /> Scope of Work: New Medical Gases, Dental Air and Vacuum. <br /> Our firm certifies that the verifier(s) named in the report are properly trained and certified to <br /> perform the activities required. All test and measurement equipment is properly calibrated and <br /> maintained. As a representative of Airgas Medical Services NW the verifier(s) named in this <br /> report have conducted testing and verification of Medical Gas piping systems and related <br /> equipment to certify the following on the above date. <br /> I. General Findings: <br /> A. Medical Gases are in compliance with NFPA 99(2005ed): Level 3, Dental <br /> "NOT FOR ANESTHESIA" <br /> B. No crossed lines were found in Medical Gases in the tested areas on the day of <br /> testing. <br /> C. Medical Gases meet minimum concentrations. <br /> D. Medical Gases are at normal pressure. <br /> E. Medical Gases and Dental Air are at normal pressure. <br /> F. Dental Vacuum is at normal level. <br /> G. Medical Gas and Dental system components in area tested are in compliance with <br /> NFPA 99 (2005ed). Level 3, Dental. <br /> H. Medical Gas Line Purity: PASS # 219TUA4029-A (Air Liquide) <br /> I. Initial Line Pressure Test: PASS <br /> City of Everett: Permit# P1409-010 <br /> J. Attachments: Work sheets. <br /> Kang-11.20.14-AG.VR-Dental Gas Line(2005ed) <br />