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Medical Gas Services, LL <br /> Emergency Shutoff/Zone Valve ® NONE <br /> Valve:❑ New ❑ Existing ® None—Not Required Brand: <br /> 3 Part Valve: ❑Yes ❑ No With Down Line Gauges: ❑Yes ❑ No Sensor Location:❑ UL ❑ DL <br /> Labeled: <br /> Dental Equipment ❑ Not Tested <br /> Dental Air System:❑ New ® Existing ❑NONE Dental Vacuum System: ❑ New ® Existing ❑ NONE <br /> Brand:Air Techniques Brand: Midmark <br /> Model M AS40M Model#: CV6R <br /> Serial M 531036 Serial#: V118657 <br /> Conf:❑ Simplex ® Duplex ❑Triplex ❑ Quad Conf: ❑ Simplex ®Duplex ❑ Triplex ❑ Quad <br /> Compressor Type: Oil less Pump Type: Liquid Ring <br /> Compressor On: 90 psi Compressor Off: 118 psi Vac Level: 10"HgV Horse Power: 1.25 hp. <br /> Line Pressure: 118 psi Particulate: ® Pass❑ Fail Drain: ®Sealed ❑ Open ® Floor ❑Wall <br /> Concentration:21% Horse Power: 1.5 hp. Flexible Connectors: ®Yes ❑No <br /> Receiver: ®Yes ❑ No Drain: ® Manual ❑Auto Air/Water Separator: ®Yes [] No <br /> Moisture Indicator: ®Yes ❑ No Exhausted to Outside: ®Yes ❑ No <br /> Dryer:®Yes ❑No Type: Membrane Location of Discharge: Roof <br /> Intake:❑ Outside ❑ Inside(other) ® Inside(same) Piping: ❑ Hard Copper ®Schedule 40 PVC <br /> Amalgam Separator <br /> ❑ New ® Existing ❑ Not Required ❑None Brand: Solmetex <br /> Model#: HG5 Serial M HG5-K-43948 <br /> Comments: <br /> Cylinder storage room door not labeled. <br /> KANG-11.20.14-Chklst-Level 3 Verification(2005ed) <br />