2025 Annual cert VA Northport_ Redacted.pdf

Healthcare Facility:

Facility contact(s)

Testing Dates:

Systems were tested by: MGPHO Verifier #:

August 13, 2025

Sean Lampart- Engineering

ANNUAL MEDICAL GAS SYSTEM

INSPECTION ASSESSMENT REPORT

VA Medical Hospital - Northport 79 Middleville Rd Northport, NY 11768

1. Methodology

2. Deficiencies & Findings

3. Outlet Inspection Data

4. Valve Inspection Data

5. Alarm Inspection Data Area Alarm Master Alarm Local Alarm

6. Source Systems Data Storage location Manifolds Medical Air Medical Vacuum

WAGD

Instrument Air Bulk Cryogenic System

Emergency Oxygen low pressure fill connection

7. Analysis Reports Particulate Dew point (air only) Analytical samples (o2, air, N2O, N2)

TABLE OF CONTENTS

Methodology

Statement of testing

Performance testing

Outlets / Inlets:

Zone Valves

Alarms

Deficiencies are based upon the following - NFPA 99 2024 Standard for Health Care Facilities edition as the standard for medical gas systems.

The following medical gas system inspection was tested in accordance with NFPA 99 2024 , and JCAHO Environment of Care 2.05.05 Medical Gas Systems guidelines.

Locations are recorded. Stations locations are numbered using the main door as a reference and moving in a clockwise rotation around the room.

Outlets are tested for pressure, flow (flow rate in the acceptable range are mark as a greater than or equal to 3.0 SCFM for vacuum, greater or equal to 5.0 SCFM for Nitrogen and greater than or equal to 3.5 SCFM for all other normal medical gases @ 50psi. Levels of concentration for all positive medical gases are checked.

Outlets are inspected and tested at the end of all flexible connectors.

Example in an operating room in which ceiling outlet is used with a hose drop. The outlet is tested at the DISS or coupler connection of the hose drop

Zone valves are visual checked for proper signage for areas of control and are not normally closed except for alarm testing where allowable.

Master alarms signals are tested with the actual pressure (where allowable) or tested electically. Area alarms are tested by raising or lowering the actual pressure if allowable. In a hospital setting in most cases the high alarm is not tested because the entire hospital pressure for that gas would have to be raised to activate the high alarm signal. The low alarm is tested by shutting off the zone valve (throttling the valve) and when the pressure drops to 20% below the nominal pressure the low alarm is suppose to activate and the zone valve is turned on prior to any more additional loss in zone pressure. In addition there are circumstances where the testing of the low pressure alarm for an OR would be impractical to test because the alarm senor is monitoring the main piping (not the zone or the patient side of the valve).

Types of gas Stored:

Facility

Medical Gas Cylinder Storage Location Inspection Data

Date August 13, 2025 Location Buiding 92

6VA Medical Hospital - Northport Page STR 1 of STR

Verifier

YE

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A 5.1.3.1 Central Supply System Identification and Labeling.

X

X

X

X

X

X X

X

X

X

X

Continued on pg. 2

5.1.3.1.3 Liquid containers shall have additional product identification visible from all directions with a minimum of 51 mm (2 in.) high letters such as a 360-degree wraparound tape for medical liquid containers.

5.1.3.1.1* Containers, cylinders, and tanks shall be designed, fabricated, tested, and marked (stamped) in accordance with regulations of DOT, Transport Canada (TC) Transportation of Dangerous Goods Regulations, or the ASME Boiler and Pressure Vessel Code, “Rules for the Construction of Unfired Pressure Vessels,”

5.1.3.1.2 Cylinder contents shall be identified by attached labels or stencils naming the contents in accordance with CGA C-7, Guide to the Preparation of Precautionary Labeling and Marking of Compressed Gas Containers.

5.1.3.1.9 Locations containing central supply systems or cylinders containing only oxygen or medical air shall have their door(s) labeled as follows:

5.1.3.2.3 Only gas cylinders, reusable shipping containers, and their accessories shall be permitted to be stored in rooms containing central supply systems or gas cylinders.

5.1.3.2.4 No flammable materials, cylinders containing flammable gases, or containers containing flammable liquids shall be stored in rooms with gas cylinders.

5.1.3.2.5 If cylinders are wrapped when received, the wrappers shall be removed prior to storage.

5.1.3.1.4 Cryogenic liquid containers shall be provided with gas-specific outlet connections in accordance with CGA V-5, Diameter-Index Safety System (Noninterchangeable Low Pressure Connections for Medical Gas Applications), or CGAV-1, Compressed Gas Association Standard for Compressed Gas Cylinder Valve Outlet and Inlet Connections.

5.1.3.1.5 Cylinder and cryogenic liquid container outlet connections shall be affixed in such a manner as to be integral to the valve(s), unremovable with ordinary tools, or so designed as to render the attachment point unusable when removed.

5.1.3.1.6 The contents of cylinders and cryogenic liquid containers shall be verified prior to use.

5.1.3.1.8 Locations containing positive pressure gases other than oxygen and medical air shall have their door(s) labeled as follows:

O2 N2O Air N2 CO2 Specialty Gas

August 13, 2025Date

Facility STR 2 6VA Medical Hospital - Northport Page STRof

Medical Gas Cylinder Storage Location

Location Buiding 92 Verifier

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A

X

X

X

X

X

X

X

X X X X X X X X

Continued on pg. 3

(2) Anesthetizing locations where moderate sedation, deep sedation, or general anesthesia is administered

(7) Kitchens

(6) Engines

(2) Manifolds for gas cylinders with reserve supply

(1) Manifolds for gas cylinders without reserve supply (see 5.1.3.5.10)

(5) Any other compressor, vacuum pump, or electrically powered machinery

(1) Manifolds for gas cylinders without reserve supply (see 5.1.3.5.10)

5.1.3.3.1.1 Any of the following systems shall be permitted to be located together in the same outdoor enclosure:

(2) Manifolds for gas cylinders with reserve supply

(3) Manifolds for cryogenic liquid containers (see 5.1.3.5.12)

(4) Bulk cryogenic liquid systems (see 5.1.3.5.13)

5.1.3.3.1.2 Any of the following systems shall be permitted to be located together in the same indoor enclosure:

5.1.3.2.9 Cylinders containing compressed gases and containers for volatile liquids shall be kept away from radiators, steam piping, and like sources of heat.

5.1.3.2.10 When cylinder valve protection caps are supplied, they shall be secured tightly in place unless the cylinder is connected for use.

(4) Instrument air compressor sources (see 5.1.3.9)

(3) Waste anesthetic gas disposal (WAGD) sources (see 5.1.3.8)

(2) Medical–surgical vacuum sources (see 5.1.3.7)

(1) Medical air compressor supply sources (see 5.1.3.6.3)

5.1.3.3.1.3 Any of the following systems shall be permitted to be located together in the same room:

(5) Instrument air standby headers (see 5.1.3.9.5)

(4) In-building emergency reserves (see 5.1.3.5.14)

(3) Manifolds for cryogenic liquid containers (see 5.1.3.5.12)

5.1.3.3.1.5 Locations shall be chosen to allow access by delivery vehicles and management of cylinders (e.g., proximity to loading docks, access to elevators, and passage of cylinders through public areas).

5.1.3.3.1.6 Indoor locations for oxygen, nitrous oxide, and mixtures of these gases shall not communicate with the following:

5.1.3.3.1.4 Any system listed under 5.1.3.3.1.3 shall not be located in the same room with any system listed under 5.1.3.3.1.1 or 5.1.3.3.1.2, except instrument air reserve headers complying with 5.1.3.3.1.7 and

5.1.3.9.5 shall be permitted to be in the same room as an instrument air compressor.

(5) Storage tanks for flammable or combustible liquids

(4) Rooms containing open electrical contacts or transformers

(3) Locations storing flammables

(1) Areas involved in critical patient care

(8) Areas with open flames

- -Page STR 3 of

Location Buiding 92 Verifier

Medical Gas Cylinder Storage Location

STR 6Facility VA Medical Hospital - Northport Date August 13, 2025

YE

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X

X

X

X

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X X

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X X

X X

X Continued on pg. 4

(5)*They shall be compliant with NFPA 70, National Electrical Code, for ordinary locations (Electrical devices should be physically protected)

5.1.3.3.1.8 Central supply systems for nitrous oxide and carbon dioxide using cylinders or portable containers shall be prevented from reaching temperatures lower than the recommendations of the central supply system’s manufacturer, but shall never be lower than −29°C (−20°F) or greater than 51.6°C (125°F).

(3) If outdoors, they shall be provided with an enclosure (wall or fencing) constructed of noncombustible

5.1.3.3.1.10 Central supply systems for nitrous oxide with a total capacity connected and in storage of 1451 kg (3200 lb) or more shall comply with CGA G-8.1, Standard for Nitrous Oxide Systems at Consumer Sites.

5.1.3.3.1.7 Cylinders in use and in storage shall be prevented from reaching temperatures in excess of 54°C (130°F).

(7) They shall be provided with racks, chains, or other fastenings to secure all cylinders from falling, whether connected, unconnected, full, or empty.

(9) They shall have racks, shelves, and supports, where provided, constructed of noncombustible materials or limited-combustible materials.

(10) They shall protect electrical devices from physical damage.

(8)*They shall be supplied with electrical power compliant with the requirements for essential electrical systems

(6) They shall be heated by indirect means (e.g., steam, hot water) if heat is required.

(2) They shall be secured with lockable doors or gates or otherwise secured.

5.1.3.3.2* Design and Construction. Locations for central supply systems and the storage of positive-pressure gases shall

(1) They shall be constructed with access to move cylinders, equipment, and so forth, in and out of the location on hand trucks complying with 11.4.3.1.1.

(4) If indoors, they shall be constructed and use interior finishes of noncombustible or limited-combustible materials such that all walls, floors, ceilings, and doors are of a minimum 1-hour fire resistance rating.

5.1.3.3.1.9 Central supply systems for oxygen with a total capacity (6) Engines connected and in storage of 566,335 L (20,000 ft3) or more outside of the facility at standard temperature and pressure (STP) shall comply with NFPA 55, Compressed Gases and Cryogenic Fluids Code.

5.1.3.3.1.11 Central supply systems for carbon dioxide using permanently installed containers with product capacities greater than 454 kg (1000 lb) shall comply with CGA G-6.1, Standard for Insulated Carbon Dioxide Systems at Consumer Sites.

5.1.3.3.1.12 Central supply systems for carbon dioxide using permanently installed containers with product capacities of 454 kg (1000 lb) or less shall comply with CGA G-6.5, Standard for Small, Stationary, Insulated Carbon Dioxide Supply Systems.

5.1.3.3.1.13* Central supply systems for bulk inert gases systems with a total capacity connected and in storage of 20,000 ft3 or more of compressed gas or cryogenic fluid at standard temperature and pressure, shall comply with CGA P-18, Standard for Bulk Inert Gas Systems at Consumer Sites.

Location Buiding 92 Verifier

Medical Gas Cylinder Storage Location

Facility VA Medical Hospital - Northport Page STR 4 of STR 6 Date August 13, 2025

YE

S

NO N/

A 5.1.3.3.3 Ventilation.

X

X (1) Medical air sources (see 5.1.3.6) X (2) Medical–surgical vacuum sources (see 5.1.3.7) X (3) Waste anesthetic gas disposal (WAGD) sources (see 5.1.3.8.1) X (4) Instrument air sources (see 5.1.3.9)

X

X

5.1.3.3.4 Storage.

X

X

X

X X

X X

X X X X X

Continued on pg. 5

5.1.3.4 Control Equipment. For control equipment, as specifiedin 5.1.3.5.5, 5.1.3.5.6, and 5.1.3.5.7, that is physically remote from the supply system, the control equipment shall be installed within a secure enclosure to prevent unauthorized access in accordance with 5.1.3.3.2(2).

5.1.3.4.1 The enclosure shall provide enough space to perform maintenance and repair.

5.1.3.4.2 The location of the enclosure for control equipment other than for medical air shall not communicate with combustible or flammable materials.

5.1.3.5* Central Supply Systems. Central supply systems shall be permitted to consist of the following:

(3) Bulk cryogenic liquid systems per 5.1.3.5.13

(2) Manifolds for cryogenic liquid containers per 5.1.3.5.12

(1) Cylinder manifolds for gas cylinders per 5.1.3.5.10

(4) Medical air compressor systems per 5.1.3.6

5.1.3.3.3.1 Venting of Relief Valves. Indoor supply systems shall have all relief valves vented per 5.1.3.5.6.1(4) through (9).

5.1.3.3.3.2 Ventilation for Motor-Driven Equipment. The following source locations shall be adequately ventilated to prevent accumulation of heat:

(A) Outdoor locations surrounded by impermeable walls shall have protected ventilation openings located at the base of each wall to allow free circulation of air within the enclosure.

(B) Walls that are shared with other enclosures or with buildings shall be permitted to not have openings.

5.1.3.3.3.3 Ventilation for Outdoor Locations.

5.1.3.3.4.1 Full or empty medical gas cylinders, when not connected, shall be stored in locations complying with 5.1.3.3.2 through 5.1.3.3.3 and shall be permitted to be in the same rooms or enclosures as their respective central supply systems.

(7) Instrument air compressor systems per 5.1.3.9

(6) WAGD producers per 5.1.3.8

(5) Medical–surgical vacuum producers per 5.1.3.7

5.1.3.3.4.2 Cylinders, whether full or empty, shall not be stored in enclosures containing motor-driven machinery, with the exception of cylinders intended for instrument air reserve headers complying with 5.1.3.9.5, which shall be permitted to be placed in the same location containing an instrument air compressor when it is the only motor-driven machinery located within the room. Only cylinders intended for instrument air reserve headers complying with 5.1.3.9.5 shall be permitted to be stored in enclosures containing instrument air compressors.

- -Facility VA Medical Hospital - Northport Page STR 5 of STR 6 Date August 13, 2025

Location Buiding 92 Verifier

Medical Gas Cylinder Storage Location

YE

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NO N/

A

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X

X X

X X X

X

X

X

X X

X

X X X

Continued on pg. 6

9.3.7.5 Indoor storage or manifold areas and storage or manifold buildings for medical gases and cryogenic fluids shall be provided with natural ventilation or mechanical exhaust ventilation in accordance with 9.3.7.5.1

9.3.7.5.2 Natural Ventilation.

9.3.7.5.2.1 Natural ventilation shall consist of two nonclosable louvered openings, each having an aggregate free opening area of at least 155 cm²/35 L (24 in.²/1000 ft³) of the fluid designed to be stored in the space and in no case less than 465 cm2 (72 in.²).

9.3.7.5.2.3 The openings shall be located to ensure cross ventilation.

9.3.7.5.2.2 One opening shall be located within 1 ft of the floor, and one shall be located within 1 ft of the ceiling.

(3) If potentially exposed to cryogenic temperatures, materials shall be designed for low temperature

(4) If intended for outdoor installation, materials shall be installed per the manufacturer’s requirements.

5.1.3.5.3 Support Gases. Central supply systems for support gases shall not be piped to, or used for, any purpose except medical support application.

(1) In those portions of systems intended to handle oxygen at gauge pressures greater than 2413 kPa (350 psi), interconnecting hose shall contain no polymeric materials.

5.1.3.5.4* Materials. Materials used in central supply systems shall meet the following requirements:

(5) Calibration of medical devices intended for (1) through (4)

9.3.7.5.2.4 Natural ventilation openings shall be directly to the outside atmosphere without ductwork.

(2) In those portions of systems intended to handle oxygen or nitrous oxide material, construction shall be compatible with oxygen under the temperatures and pressures to which the components can be exposed in the containment and use of oxygen, nitrous oxide, mixtures of these gases, or mixtures containing more than 23.5 percent oxygen.

5.1.3.5.1 General. Central supply systems shall be obtained from a supplier or manufacturer familiar with their proper constructionand use and installed in accordance with the manufacturer’s instructions.

5.1.3.5.2 Permitted Locations for Medical Gases. Central supply systems and medical gas outlets for oxygen, medical air, nitrous oxide, carbon dioxide, and all other patient medical gases shall be piped only into areas where the gases will be used under the direction of licensed medical professionals for purposes congruent with

(8) Proportioning systems for medical air USP per 5.1.3.6.3.4 5.1.3.5.1 General. Central supply systems shall be obtained from a supplier or manufacturer familiar with their proper construction and use and installed in accordance with the manufacturer’s instructions.

(2) Clinical application of the gas to a patient, such as the useof an insufflator to inject carbon dioxide into patientbody cavities during laparoscopic surgery and carbon dioxide used to purge heart-lung machine blood flow ways

(1) Direct respiration by patients

(3) Medical device applications directly related to respiration

(4) Power for medical devices used directly on patients

- -of

VerifierLocation Buiding 92

Facility VA Medical Hospital - Northport Page STR 6

Medical Gas Cylinder Storage Location

STR 6

Date August 13, 2025

YE

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A 9.3.7.5.2.5 Mechanical ventilation shall be provided if natural ventilation requirements cannot be met.

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X X

(2) Air shall be permitted to be transferred from a corridor under the door up to the greater of 24 L/sec (50 cfm) or 15 percent of the room exhaust in accordance with NFPA 90A, Standard for the Installation of Air-Conditioning and Ventilating Systems.

(3) Supply air shall be permitted to be provided from any building ventilation system that does not contain flammable or combustible vapors.

9.3.7.6 Discharge from the natural and mechanical ventilation systems shall be sited by a minimum separation distance in accordance with NFPA 55, Compressed Gases and Cryogenic Fluids Code

9.3.7.7 A storage room shall maintain a temperature not greater than 52°C (125°F).

9.3.7.8 A transfer or manifold room shall maintain a temperature not greater than 52°C (125°F) and not less than −7°C (20°F).

(1) Air shall be permitted via noncombustible ductwork to be transferred from adjacent spaces, from outside the building, or from spaces that do not contain combustible or flammable materials via noncombustible ductwork

9.3.7.5.3.1 Mechanical exhaust to maintain a negative pressure in the space shall be provided continuously, unless an alternative design is approved by the authority having jurisdiction.

9.3.7.5.3.2 Mechanical exhaust shall be at a rate of 1 L/sec of airflow for each 300 L (1 cfm per 5 ft³ of fluid) designed to be stored in the space and not less than 24 L/sec (50 cfm) nor more than 235 L/sec (500 cfm).

9.3.7.5.3.3 Mechanical exhaust inlets shall be unobstructed and shall draw air from within 1 ft of the floor and adjacent to the cylinder or containers.

9.3.7.5.3.4 Mechanical exhaust air fans shall be supplied with electrical power from the essential electrical

9.3.7.5.3.5 Dedicated exhaust systems shall not be required, provided that the system does not connect to spaces that contain combustible or flammable materials.

9.3.7.5.3.6 The exhaust duct material shall be noncombustible.

9.3.7.5.3.7 A means of make-up air shall be provided according to one of the following:

Comments:

9.3.7.5.3 Mechanical Ventilation.

Manifold Inspection Check List continued:

2 of M 10 Date August 13, 2025

Manifold Inspection Data

Facility VA Medical Hospital - Northport Page M

Verifier

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X X

X X

X X

X

X X

X

X

X (2) If located indoors, they shall be installed within a room used only for enclosure of such manifolds.

X 5.1.3.5.10.2 The manifold locations for this category shall be constructed in accordance with 5.1.3.3.2.

X 5.1.3.5.10.3 The manifold locations for this category shall be ventilated in accordance with 5.1.3.3.3.

5.1.3.5.10.4 The manifolds in this category shall consist of the following:

X

X

5.1.3.5.10.1 The manifolds in this category shall be located in accordance with 5.1.3.3.1 and shall meet the following:

(1) If located outdoors, they shall be installed in an enclosure used only for this purpose and sited to comply with minimum distance requirements in NFPA 55.

(1) Two equal headers in accordance with 5.1.3.5.9, each with a sufficient number of gas cylinder connections for an average day’s supply, but not fewer than two connections, and with the headers connected to the final line pressure regulator assembly in such a manner that either header can supply the system

5.1.3.5.6.3 Central supply systems for positive pressure gases shall include one or more relief valves, all meeting the following requirements:

(2) They shall have a relief setting that is 50 percent above the normal system operating pressure, as indicated in Table 5.1.11.

5.1.3.5.6.4 When vented outside, relief valve vent lines shall be labeled in accordance with 5.1.11.1 in any manner that will distinguish them from the medical gas pipeline.

(5) They shall have a vent discharge line that is not smaller than the size of the relief valve outlet.

(6) Where two or more relief valves discharge into a common vent line, its internal cross-sectional area shall be not less than the aggregate cross-sectional area of all relief valve vent discharge lines served.

(7) They shall not discharge into locations creating potential hazards.

(9) They shall be designed in accordance with ASME B31.3, Pressure Process Piping.

(2) Vent valves, if fitted on a header, vented outside of the building per 5.1.3.5.6.1(5) through (9) and 5.1.3.5.6.2

(4) They shall be vented to the outside of the building, except that relief valves for compressed air systems having less than 84,950 L (3000 ft3) at STP shall be permitted to be diffused locally by means that will not restrict the flow.

(8) They shall have the discharge terminal turned down and screened to prevent the entry of rain, snow, or vermin.

5.1.3.5.6.2 When vented to outdoors, materials and construction for relief valve discharge lines shall be the same as required for positive pressure gas distribution. (See 5.1.10.1.)

(1) They shall be located between each final line regulator and the source valve.

5.1.3.5.8 Local Signals.

5.1.3.5.10* Manifolds for Gas Cylinders Without Reserve Supply.

August 13, 2025 Verifier

M 10 Date

Facility VA Medical Hospital - Northport Page M 3 of

Manifold Inspection Data

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X X

X

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X

(3) When the primary header is depleted, the secondary header automatically begins to supply the system.

5.1.3.5.10.6 The manifolds in this category shall have a local signal that visibly indicates the operating status of the equipment and shall activate an indicator at all master alarm panels when or at a predetermined set point before the secondary header begins to supply the system, indicating changeover has occurred or is about to occur.

(2) If located indoors, they shall be installed within a room used only for the enclosure of such containers.

5.1.3.5.11.2 The manifolds in this category shall have their primary and secondary headers located in the same enclosure.

5.1.3.5.11.3 The reserve header shall be permitted to be located in the same enclosure as the primary and secondary headers or in another enclosure compliant with 5.1.3.5.11.1.

5.1.3.5.11.4 The manifolds in this category shall consist of the following:

(3) Intermediate relief valve(s), piped to the outside in accordance with 5.1.3.5.6.1(5) through (9), that protects the piping between the header pressure regulator and the line pressure regulator assembly, and protects the line pressure regulators from overpressure in the event of a header regulator failure

5.1.3.5.10.5 The manifolds in this category shall include an automatic means of alternating the two headers to accomplish the following in normal operation:

(2) When the primary header is supplying the system, the secondary header is prevented from supplying the system.

5.1.3.5.10.7 If manifolds are located out of doors, they shall be installed per the manufacturer’s requirements.

5.1.3.5.11* Manifolds for Cryogenic Liquid Containers.

5.1.3.5.11.1 Manifolds for cryogenic liquid containers shall be located in accordance with 5.1.3.3.1 and shall meet the following:

(1) If located outdoors, they shall be installed in an enclosure used only for the enclosure of such containers.

(1) Two equal headers per 5.1.3.5.9, each having sufficient number of liquid container connections for an average day’s supply, and with the headers connected to the final line pressure regulator assembly in such a manner that either header can supply the system

(1) One header is the primary and the other is the secondary, with either being capable of either role.

MofFacility VA Medical Hospital - Northport Page M 4

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Date August 13, 2025

Manifold Inspection Data

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X

X

X

X

X

X

X

X

X

X

X

X

5.1.3.5.11.8 The manifolds in this category shall include a means to automatically activate the reserve header if for any reason the primary and secondary headers cannot supply the system.

5.1.3.5.11.9 The manifolds in this category shall have a local signal that visibly indicates the operating status of the equipment and activates an indicator at all master alarms under the following conditions:

(1) When or at a predetermined set point before the secondary header begins to supply the system, indicating changeover

(3) Pressure relief installed downstream of the connection of the reserve header and upstream of the final line pressure regulating assembly and set at 50 percent above the nominal inlet pressure

5.1.3.5.11.5 The manifolds in this category shall include an automatic means of controlling the three headers to accomplish the following during normal operation:

(2) Reserve header per 5.1.3.5.9 having sufficient number of gas cylinder connections for an average day’s supply, but not fewer than three connections, and connected downstream of the primary/secondary headers and upstream of the final line pressure regulators

(2) Where a hybrid arrangement is employed, when or at a predetermined set point before the secondary (cylinder) header contents fall to one day’s average supply, indicating secondary low

(3) When or at a predetermined set point before the reserve header begins to supply the system, indicating reserve is in use

(1) If provided with two liquid container headers, one cryogenic liquid header is the primary and the other is the secondary, with either being capable of either role.

(2) If provided with one liquid container header and one gas cylinder header (a hybrid arrangement), the liquid container header is the primary and the gas cylinder header is the secondary.

(3) When the primary header is supplying the system, the secondary header is prevented from supplying the system.

(4) When the primary header is depleted, the secondary header automatically begins to supply the system.

5.1.3.5.11.6 The manifolds in this category shall be equipped with a means to conserve the gas produced by evaporation of the cryogenic liquid in the secondary header (when so provided). This mechanism shall discharge the conserved gas into the system upstream of the final line regulator assembly.

5.1.3.5.11.7 The manifolds in this category shall include a manual or automatic means to place either header into the role of primary header and the other into the role of secondary header, except where a liquid/gas hybrid manifold is employed.

VA Medical Hospital - Northport 10 Date August 13, 2025 Page M 5 of

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Manifold Inspection Data

Facility

YE

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X

X

X

X

X X

X X Gauge near master alrm pressure switch X Gas Specific demand check on P/S and gauge

Comments:

(4) When or at a predetermined set point before the reserve header contents fall to one day’s average supply, indicating reserve low

Master alarm pressure switch in the proper location

5.1.4.3 Valve Types. New or replacement shutoff valves shall be as follows:

5.1.4.4. The source, main , service valve shall be labeled in accordance with 5.1.11.2. (valve tags)

5.1.4.4.1 The source valve shall be located in the immediate vicinity of the source equipment.

(1) They shall be of the quarter turn, full ported, ball type.

(2) They shall be of brass or bronze construction.

(3) They shall have extensions for brazing.

(4) They shall have a handle indicating open or closed.

(5) They shall consist of three pieces permitting in-line

Manifold Source Valves

5.1.4.2 Accessibility. All valves, except valves in zone valve box assemblies, shall be located in secured areas such as locked piped chases, or be locked or latched in their operating position, and be labeled as to gas supplied and the area(s) controlled.

5.1.4.4 Source Valve. A shutoff valve shall be placed at the immediate connection of each source system to the piped distribution system to allow the entire source, including all accessory devices (e.g., air dryers, final line regulators), to be isolated from the facility.

Facility VA Medical Hospital - Northport Page M 7 of

Manifold Inspection Data

M 10 Date August 13, 2025 Verifier

YE

S

NO N/

A

X

X X

X

X X

X

X X

X

X

X (2) If located indoors, they shall be installed within a room used only for enclosure of such manifolds.

X 5.1.3.5.10.2 The manifold locations for this category shall be constructed in accordance with 5.1.3.3.2.

X 5.1.3.5.10.3 The manifold locations for this category shall be ventilated in accordance with 5.1.3.3.3.

5.1.3.5.10.4 The manifolds in this category shall consist of the following:

X

X

(4) They shall be vented to the outside of the building, except that relief valves for compressed air systems having less than 84,950 L (3000 ft3) at STP shall be permitted to be diffused locally by means that will not restrict the flow.

(5) They shall have a vent discharge line that is not smaller than the size of the relief valve outlet.

(6) Where two or more relief valves discharge into a common vent line, its internal cross-sectional area shall be not less than the aggregate cross-sectional area of all relief valve vent discharge lines served.

(7) They shall not discharge into locations creating potential hazards.

5.1.3.5.6.4 When vented outside, relief valve vent lines shall be labeled in accordance with 5.1.11.1 in any manner that will distinguish them from the medical gas pipeline.

5.1.3.5.8 Local Signals.

5.1.3.5.10* Manifolds for Gas Cylinders Without Reserve Supply.

5.1.3.5.10.1 The manifolds in this category shall be located in accordance with 5.1.3.3.1 and shall meet the following:

(1) If located outdoors, they shall be installed in an enclosure used only for this purpose and sited to comply with minimum distance requirements in NFPA 55.

(1) Two equal headers in accordance with 5.1.3.5.9, each with a sufficient number of gas cylinder connections for an average day’s supply, but not fewer than two connections, and with the headers connected to the final line pressure regulator assembly in such a manner that either header can supply the system

(8) They shall have the discharge terminal turned down and screened to prevent the entry of rain, snow, or vermin.

(9) They shall be designed in accordance with ASME B31.3, Pressure Process Piping.

5.1.3.5.6.2 When vented to outdoors, materials and construction for relief valve discharge lines shall be the same as required for positive pressure gas distribution. (See 5.1.10.1.)

5.1.3.5.6.3 Central supply systems for positive pressure gases shall include one or more relief valves, all meeting the following requirements:

(1) They shall be located between each final line regulator and the source valve.

(2) They shall have a relief setting that is 50 percent above the normal system operating pressure, as indicated in Table 5.1.11.

(2) Vent valves, if fitted on a header, vented outside of the building per 5.1.3.5.6.1(5) through (9) and 5.1.3.5.6.2

Date August 13, 2025 Verifier

Facility VA Medical Hospital - Northport Page M 8 of M 10

Manifold Inspection Data

YE

S

NO N/

A

X

X X

X

X

X

X

X

X

X

X

(3) When the primary header is depleted, the secondary header automatically begins to supply the system.

5.1.3.5.10.6 The manifolds in this category shall have a local signal that visibly indicates the operating status of the equipment and shall activate an indicator at all master alarm panels when or at a predetermined set point before the secondary header begins to supply the system, indicating changeover has occurred or is about to occur.

5.1.3.5.10.7 If manifolds are located out of doors, they shall be installed per the manufacturer’s requirements.

5.1.3.5.11* Manifolds for Cryogenic Liquid Containers.

5.1.3.5.11.1 Manifolds for cryogenic liquid containers shall be located in accordance with 5.1.3.3.1 and shall meet the following:

(1) If located outdoors, they shall be installed in an enclosure used only for the enclosure of such containers.

(3) Intermediate relief valve(s), piped to the outside in accordance with 5.1.3.5.6.1(5) through (9), that protects the piping between the header pressure regulator and the line pressure regulator assembly, and protects the line pressure regulators from overpressure in the event of a header regulator failure

5.1.3.5.10.5 The manifolds in this category shall include an automatic means of alternating the two headers to accomplish the following in normal operation:

(1) One header is the primary and the other is the secondary, with either being capable of either role.

(2) When the primary header is supplying the system, the secondary header is prevented from supplying the system.

(2) If located indoors, they shall be installed within a room used only for the enclosure of such containers.

5.1.3.5.11.2 The manifolds in this category shall have their primary and secondary headers located in the same enclosure.

5.1.3.5.11.3 The reserve header shall be permitted to be located in the same enclosure as the primary and secondary headers or in another enclosure compliant with 5.1.3.5.11.1.

5.1.3.5.11.4 The manifolds in this category shall consist of the following:

(1) Two equal headers per 5.1.3.5.9, each having sufficient number of liquid container connections for an average day’s supply, and with the headers connected to the final line pressure regulator assembly in such a manner that either header can supply the system

Facility VA Medical Hospital - Northport Page M 9

Verifier

Manifold Inspection Data of M 10 Date August 13, 2025

YE

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A

X

X

X

X

X

X

X

X

X

X

X

X

(2) Reserve header per 5.1.3.5.9 having sufficient number of gas cylinder connections for an average day’s supply, but not fewer than three connections, and connected downstream of the primary/secondary headers and upstream of the final line pressure regulators

5.1.3.5.11.6 The manifolds in this category shall be equipped with a means to conserve the gas produced by evaporation of the cryogenic liquid in the secondary header (when so provided). This mechanism shall discharge the conserved gas into the system upstream of the final line regulator assembly.

5.1.3.5.11.7 The manifolds in this category shall include a manual or automatic means to place either header into the role of primary header and the other into the role of secondary header, except where a liquid/gas hybrid manifold is employed.

5.1.3.5.11.8 The manifolds in this category shall include a means to automatically activate the reserve header if for any reason the primary and secondary headers cannot supply the system.

5.1.3.5.11.9 The manifolds in this category shall have a local signal that visibly indicates the operating status of the equipment and activates an indicator at all master alarms under the following conditions:

(1) When or at a predetermined set point before the secondary header begins to supply the system, indicating changeover

(2) Where a hybrid arrangement is employed, when or at a predetermined set point before the secondary (cylinder) header contents fall to one day’s average supply, indicating secondary low

(3) Pressure relief installed downstream of the connection of the reserve header and upstream of the final line pressure regulating assembly and set at 50 percent above the nominal inlet pressure

5.1.3.5.11.5 The manifolds in this category shall include an automatic means of controlling the three headers to accomplish the following during normal operation:

(1) If provided with two liquid container headers, one cryogenic liquid header is the primary and the other is the secondary, with either being capable of either role.

(2) If provided with one liquid container header and one gas cylinder header (a hybrid arrangement), the liquid container header is the primary and the gas cylinder header is the secondary.

(3) When the primary header is supplying the system, the secondary header is prevented from supplying the system.

(4) When the primary header is depleted, the secondary header automatically begins to supply the system.

(3) When or at a predetermined set point before the reserve header begins to supply the system, indicating reserve is in use

Facility VA Medical Hospital - Northport Page M 10 of M 10

Manifold Inspection Data

Date August 13, 2025 Verifier

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X

X

X

X

X X

X X Gauge near master alrm pressure switch X Gas Specific demand check on P/S and gauge

Comments:

(4) When or at a predetermined set point before the reserve header contents fall to one day’s average supply, indicating reserve low Manifold Source Valves

5.1.4.2 Accessibility. All valves, except valves in zone valve box assemblies, shall be located in secured areas such as locked piped chases, or be locked or latched in their operating position, and be labeled as to gas supplied and the area(s) controlled.

5.1.4.3 Valve Types. New or replacement shutoff valves shall be as follows:

5.1.4.4 Source Valve. A shutoff valve shall be placed at the immediate connection of each source system to the piped distribution system to allow the entire source, including all accessory devices (e.g., air dryers, final line regulators), to be isolated from the facility.

(1) They shall be of the quarter turn, full ported, ball type.

(2) They shall be of brass or bronze construction.

(3) They shall have extensions for brazing.

(4) They shall have a handle indicating open or closed.

(5) They shall consist of three pieces permitting in-line

5.1.4.4. The source, main , service valve shall be labeled in accordance with 5.1.11.2. (valve tags)

5.1.4.4.1 The source valve shall be located in the immediate vicinity of the source equipment.

Master alarm pressure switch in the proper location

Location

Medical Air Compressor Inspection Check List

Serial # (H) 10/23/17-8105651-458

Type Quadruplex HP each Compressor 10 hp Other

AC 7

Date August 13, 2025

Medical Air Compressor Inspection Data

Building 200 Basement Verifier

Facility VA Medical Hospital - Northport Page AC 1 of

Manufacture Powerex

Model # MSQ10854P5

YE

S

NO N/

A 5.1.3.6.3* Medical Air Compressor Sources.

X

X X

X X X

X (4) Intake filter–muffler(s) of the dry type

X (5) Pressure relief valve(s) set at 50 percent above line pressure

X

X

X

5.1.3.6.3.4 Compressors for Medical Air.

X (1) Elimination of oil anywhere in the compressor (e.g., liquid ring and permanently sealed bearing compressors)

X (2) Reciprocating compressors provided with a separation of the oil-containing section from the compression chamber by at least two seals creating an area open to atmosphere that allows the following:

5.1.3.6.3.1 Location. Medical air compressor systems shall be located per 5.1.3.3 as follows:

(1) Indoors in a dedicated mechanical equipment area, adequately ventilated and with any required utilities (e.g.,

(2) In a room ventilated per 5.1.3.3.3.3

(3) For air-cooled equipment, in a room designed to maintain the ambient temperature range as recommended by

5.1.3.6.3.2 Required Components. Medical air compressor systems shall consist of the following:

Continued on pg. 2

(A)* Compressors for medical air shall be designed to prevent the introduction of contaminants or liquid into the pipeline by any of the following methods:

(1) Components complying with 5.1.3.6.3.4 through 5.1.3.6.3.8, arranged per 5.1.3.6.3.9

(2) Automatic means to prevent backflow from all on-cycle compressors through all off-cycle compressors

(3) Manual shutoff valve to isolate each compressor from the centrally piped system and from other compressors for maintenance or repair without loss of pressure in the system

(6) Piping and components between the compressor and the source shutoff valve that do not contribute to contaminant levels

(7) Except as defined in 5.1.3.6.3.2(1) through (6), materials and devices used between the medical air intake and the medical air source valve that are of any design or construction appropriate for the service as

5.1.3.6.3.3 Air Drying Equipment. Medical air compressor systems shall preclude the condensation of water vapor in the piping distribution system by the selection of the air drying equipment.

Medical Air Compressor Inspection Check List continued from page 1

Date August 13, 2025 Building 200 Basement Verifier

Medical Air Compressor Inspection Data

AC 7Facility VA Medical Hospital - Northport Page AC 2 of

YE

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A

X

X

X

X

X X

X

(C) Liquid ring compressors shall comply with the following:

X X X X

X X

X

5.1.3.6.3.5 Aftercoolers.

X X X X

(A) Aftercoolers, where required, shall be provided with individual condensate traps.

(a) Direct and unobstructed visual inspection of the interconnecting shaft through vent and inspection openings no smaller than 1.5 shaft diameters in size

(b) Confirmation by the facility operators of proper seal operation by direct visual inspection through the above-shaft opening, without disassembly of the compressor (e.g., extended head compressors with an atmospheric vent between the compression chamber and the crankcase)

(3) Rotating element compressors provided with a compression chamber free of oil that provide the following:

(1) Service water and seal water of a quality recommended by the compressor manufacturer shall be used.

(2) Reserve medical air standby headers or a backup compressor shall be installed.

(3) When installed, the header shall comply with 5.1.3.5.9.

(4) When installed, the number of attached cylinders shall be sufficient for 1 hour normal operation.

(a) Separation of each oil-containing section from the compression chamber by at least one seal having atmospheric vents on each side with the vent closest to the oil-containing section supplied with a gravity drain to atmosphere

(b) Unobstructed visualization of the atmospheric vent(s), closest to each oil-containing section, that is accessible for inspection without disassembling the compressor

(c) Entry of the rotating shaft into each compression chamber at a point that is above atmospheric pressure

(B) The receiver shall not be used as an aftercooler or aftercooler trap.

(C) Aftercoolers shall be constructed of materials deemed suitable by the manufacturer.

(D) Antivibration mountings shall be installed for aftercoolers as required by equipment dynamics or location and in accordance with the manufacturer’s recommendations.

Continued on pg. 3

(d) Confirmation by the facility operators of proper seal operation by direct visual inspection of the atmospheric

(B) For liquid ring compressors, service water and seal water shall be treated to control waterborne pathogens and chlorine from hyperchlorination from entering the medical air.

(D) Compressors shall be constructed of materials deemed suitable by the manufacturer.

(E) Antivibration mountings shall be installed for compressors as required by equipment dynamics or location and in accordance with the manufacturer’s recommendations.

(F) Flexible connectors shall connect the air compressors with their intake and outlet piping.

Medical Air Compressor Inspection Check List continued from page 2

Date August 13, 2025

Building 200 Basement Verifier

ACFacility VA Medical Hospital - Northport Page AC 3 of

Medical Air Compressor Inspection Data

YE

S

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A 5.1.3.6.3.6 Medical Air Receivers. Receivers for medical air shall meet the following requirements:

X X X

X

X

X X X

X X X

X X

X

X

X

X

(2) They shall be located upstream (source side) of the final line regulators.

(1) They shall be appropriate for the intake air conditions.

(C) When aftercoolers are provided, they shall be arranged to meet either one of the following:

Continued on pg. 4

(3) They shall be constructed of materials deemed suitable by the manufacturer.

(4) They shall be provided with antivibration mountings installed as required by equipment dynamics or location and in accordance with the manufacturer’s recommendations.

5.1.3.6.3.8 Medical Air Filters. Medical air filters shall meet the following requirements:

(A) Component arrangement shall be as follows:

(1) Components shall be arranged to allow service and a continuous supply of medical air in the event of a single fault failure.

(2) Component arrangement shall be permitted to vary as required by the technology(ies) employed, provided that an equal level of operating redundancy and medical air quality is maintained.

(B) Medical air compressors shall be sufficient to serve the peak calculated demand with the largest single compressor out of service. In no case shall there be fewer than two compressors.

(2) They shall be sized for 100 percent of the system peak calculated demand at design conditions.

(1) They shall be made of corrosion-resistant materials or otherwise be made corrosion resistant.

(2) They shall comply with Section VIII, “Unfired Pressure Vessels,” of the ASME Boiler and Pressure Vessel

(3) They shall be equipped with a pressure relief valve, automatic drain, manual drain, sight glass, and pressure

(1) They shall be designed to provide air at a maximum dew point that is below the frost point [0°C (32°F)] at 50 psi to 55 psi at any level of demand.

(4) They shall be of a capacity sufficient to prevent the compressors from short-cycling.

5.1.3.6.3.7 Medical Air Dryers. Medical air dryers shall meet the following requirements:

5.1.3.6.3.9 Piping Arrangement and Redundancies.

(3) They shall be sized for 100 percent of the system peak calculated demand at design conditions and be rated for a minimum of 98 percent efficiency at 1 micron or greater.

(4) They shall be equipped with a continuous visual indicator showing the status of the filter element life.

(5)They shall be constructed of materials deemed suitable by the manufacturer.

(1) Arranged as a duplex or multiplex set, sized to serve the peak calculated demand with the largest single aftercooler out of service, and provided with valves adequate, to isolate any single aftercooler from the system without shutting down supply of medical air

Medical Air Compressor Inspection Data

Medical Air Compressor Inspection Check List continued from page

7of

Building 200 Basement Verifier Date August 13, 2025

ACFacility VA Medical Hospital - Northport Page AC 4

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X

X

X

X

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X X

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X X

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X X

(H) Under normal operation, only one aftercooler shall be open to airflow with the other aftercooler valved off.

(I) Under normal operation, only one dryer–filter(s)–regulator sequence shall be open to airflow with the other sequence valved off.

(2) They shall be installed upstream (source side) and downstream of components in series so as to create redundant parallel branches of components.

(J) If the relief valve required in 5.1.3.6.3.2(5) and 5.1.3.6.3.6(3) can be isolated from the system by the valve arrangement used to comply with 5.1.3.6.3.10(F), then a redundant relief valve(s) shall be installed in the parallel sequence.

(K) A DN8 (NPS 1⁄4) valved sample port shall be provided downstream of the final line pressure regulators, dew point monitor, and carbon monoxide monitor and upstream of the source shutoff valve to allow for sampling of the medical air.

(L) Medical air source systems shall be provided with a source valve per 5.1.4.4.

(M) Where medical air piping systems at different operating pressures are required, the piping shall separate after the filters but shall be provided with separate line regulators, dew point monitors, relief valves, and source

5.1.3.6.3.10 Electrical Power and Control.

(G) A three-way valve (three-port), indexed to flow, full port shall be permitted to be used to isolate one branch or component for the purposes of 5.1.3.6.3.10(C), 5.1.3.6.3.10(D), 5.1.3.6.3.10(E), and

(2) Arranged one per compressor, sized to handle the output of that compressor, and valved as appropriate to allow repair or replacement with that compressor out of service but without shutting down supply of medical air

(A) Medical air source systems shall be controlled to ensure continuous supply of medical air at pressures consistent with Table 5.1.11 under all conditions of system use as follows:

(1)Automatic activation of compressor(s) as necessary to supply the demand.

(2)Managing the operation to equalize wear on all compressors. Where this equalization is achieved manually, the facility staff shall arrange a schedule for manual alternation.

Continued on pg. 5

(F)* Dryers, filters, and regulators shall be provided with manual valves upstream and manual valves or check valves

(1) They shall be installed for each component, upstream and downstream of each component, allowing each to be individually isolated.

(E) Dryers, filters, and regulators shall be at least duplexed, with each component sized to serve the peak calculated demand with the largest of each component out of service.

(D)* A medical air receiver(s) shall be provided with proper valves to allow the flow of compressed air to enter and exit out of separate receiver ports during normal operation and allow the receiver to be bypassed during service without shutting down the supply of medical air.

AC 5 of AC Date August 13, 2025

Building 200 Basement Verifier

Medical Air Compressor Inspection Data

7Facility VA Medical Hospital - Northport Page

Medical Air Compressor Inspection Check List continued

YE

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A

X

X

X

X

X (D) Medical air compressor system controls shall be provided with electrical systems including, at a minimum:

X

X

X

X

X X

(C) Each compressor motor shall be provided with electrical components including, but not limited to, the following:

(1) Dedicated disconnect switch installed in the electrical circuit ahead of each motor starter

(2) Motor starting device

(3) Overload protection

(1)Built-in disconnect means shall be included to allow appropriate operation of multiple compressor systems and…