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Medical Gas Services, LLC <br /> 6355 NE 151st Street <br /> Kenmore,WA 98028 <br /> 425-877-9623 <br /> IL Dental Air: <br /> A. Static Line Pressure: 120 psig <br /> B. Concentration of Oxygen: 20.8% <br /> III. Dental Vacuum: <br /> A. Static Line Vacuum: 6" HgV <br /> IV. Particulate Line Testing: PASS <br /> V. Odor: None—PASS <br /> VI. Dental Equipment: <br /> A. Dental Air: (New) <br /> 1. System air components are in compliance with NFPA 99(2012ed) <br /> 2. Brand Name: Air Techniques <br /> 3. Model Number:AS30 <br /> 4. Serial Number: AS300-18030070 <br /> 5. Configuration: Duplex <br /> 6. Horse Power: .75 <br /> 7. Air Intake: Inside different room <br /> 8. Pump: Oil Less <br /> B. Dental Vacuum: (New) <br /> 1. System vacuum components are in compliance with NFPA 99(2012ed) <br /> 2. Brand Name: Air Techniques <br /> 3. Model Number: MT10 <br /> 4. Serial Number: MJ100-18030035 <br /> 5. Configuration: Simplex <br /> 6. Horse Power: 1.5 <br /> 7. Exhaust Vented Outside: Yes <br /> VII. Brazier: <br /> A. Brazier Number: Mark Sutin <br /> B. Plumbing Contractor: SUTINMD016DC <br /> VIII. Witness: Eric Woodwright—Woodwright Designs <br /> IX. Comments: <br /> A. None <br /> X. Recommendations: <br /> A. None <br /> Tested By: David Pomeranz—ASSE 6030 Verifier <br /> a4 e f2A e2_ <br /> George Orthodontics-5.30.18-VR-Dental Air&Vac <br /> r" / <br />