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Medical Gas Services, LLC <br /> 6355 N E 151st Street <br /> Kenmore,WA 98028 <br /> 425-877-9623 <br /> Dental Air and Vacuum Verification <br /> Report <br /> Date: May 30, 2018 <br /> Contractor: Woodwright Designs <br /> Date(s) /Time(s) of Testing: May 30, 2018—0830hrs <br /> Facility: George Orthodontics <br /> 4727 Evergreen Way#B <br /> Everett, WA 98203 <br /> Scope of Work: New dental air and dental vacuum systems. <br /> Our firm certifies that the verifier(s) named in this report are properly trained and certified to <br /> perform the activities required. All test and measurement equipment is properly calibrated and <br /> maintained. As representatives of Medical Gas Services, LLC the verifier(s) named in this report <br /> have conducted testing and verification of medical gaspiping systems and related equipment to <br /> certify the following on the above date. <br /> I. General Findings: <br /> A. Dental air and vacuum are in compliance with NFPA 99(2012ed): Category 3 Dental. <br /> B. No crossed line were found in dental air and vacuum in the area tested on the day of <br /> testing. <br /> C. Dental air meets oxygen concentration, <br /> D. Dental air meets pressure requirements. <br /> E. Dental vacuum meets vacuum level requirements. <br /> F. Dental air and vacuum system components in area tested are in compliance with <br /> NFPA 99(2012ed): Category 3 Dental. <br /> G. Initial Line Pressure Test: PASS <br /> H. Permit#:P1708-003/City of Everett <br /> Note: Existing Equipment and Systems <br /> NFPA 99(2005ed)#5.3.1.4—An existing Level 3 System that is not in strict <br /> compliance with the provisions of this standard shall be permitted to be continued <br /> in use as long as the authority having jurisdiction has determined that such use <br /> does not constitute a distinct hazard to life. <br /> George Orthodontics-5.30.18-VR-Dental Air&Vac <br />