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• <br /> Medical Gas Services, LLC <br /> 6355 NE 151st Street <br /> Kenmore,WA 98028 <br /> 425-877-9623 <br /> Dental Air and Vacuum Verification <br /> Report <br /> Date: September 22, 2018 <br /> Job Number: 1533 <br /> Contractor. MVM Development&Construction, Inc. <br /> Date(s)I Time(s) of Testing: September 21, 201811300 hrs. <br /> Facility: Silverlake Orthodontics <br /> 10627 19th Avenue SE <br /> Everett,WA 89208 <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 gas piping systems and related equipment to <br /> certify the following on the above date. <br /> L 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): Level 3 Dental (See Note, Comments and Recommendations) <br /> G. Initial Line Pressure Test PASS <br /> H. Permit#: P1806-013, City of Everett <br /> SiIverlake0rtho-9.21.18-VR-Dental Air&Vac(2012ed) Vta <br />