36C24725Q0375_1.docx

Modification to a Previous Notice Modification to a Previous Notice

GENERAL INFORMATION

SET-ASIDE

CONTRACTING OFFICE ADDRESS

Department of Veterans Affairs Tuscaloosa VA Medical Center 3701 Loop Road East Tuscaloosa AL 35404-5088

POINT OF CONTACT*

Contracting Officer Terri Hudson terri.hudson@va.gov

****EMAIL ONLY*****

PLACE OF PERFORMANCE

Central Alabama Healthcare Systems

Engineering

2400 Hospital Road

Tuskegee AL

COUNTRY

ADDITIONAL INFORMATION

AGENCY’S URL

URL DESCRIPTION

DESCRIPTION

February 12, 2025

Please see attached Statement of Work for the Medical Gas Delivery System Repair for the Central Alabama Healthcare Systems.

STATEMENT OF WORK

2024 Medical Gas Delivery System Deficiencies Repair(s)

OBJECTIVE:

The objective of this agreement is to establish a contract inclusive of all personnel, management, materials, parts, equipment, tools, supplies, labor, and transportation require to perform recommended repairs on the Medical Gas Delivery System at the Central Alabama Veterans Health Care Systems (CAVHCS).

SITE VISIT:

Bidders shall visit the site to confirm locations, dimensions, associated equipment, and equipment conditions relative to the recommended repair(s) at Tuskegee VA Bldg. 129 Medical Gas Delivery System Deficiencies findings doing the 2024 inspection. The site visit shall be for the purpose of observing/verifying any conditions, concerns, dimensions, etc. relevant to the fulfillment of this contract. No consideration will be given to claims based on a lack of knowledge of the existing conditions, except where contract documents make definite provisions for adjustment in cost or extension due to existing conditions not readily foreseeable. The site addresses are:

V.A. Medical Center - East 2400 Hospital Rd.

Tuskegee, AL 36083 Bldg.129

CONTRACTOR RESPONSIBILTY:

(1) Contractor shall provide all personnel, management, materials, parts, equipment, tools, supplies, labor, and transportation require to perform the recommended repairs findings on the 2024 Annual Inspection on Medical Gas Delivery System in Bldg. 129 Tuskegee. See Annual Medical Gas Testing and PM reports for recommended repair(s) details.

1- Issue #25086 – Replace (1) dew point monitor.

2- Issue #25086 – Replace (2) desiccant medical air dryer(s) w/integrated controller (includes all filters needed) 3- Issue #25085 – Repair medical air high temperature alarm (not working at Master Alarm Panels) 4- Issue #25102 – Install proper label(s) on Med-Air Intake and Med-Vacuum Exhaust piping.

(2) Contractor shall test all alarms, equipment, and associated equipment for normal and proper operating once work has been completed.

(3) Contractor shall ensure area is clean of all debris material before departing site.

BLDG. 129 MEDICAL GAS SYSTEM EQUIPMENT LIST

Bulk Oxygen Tank w/Reserve Tank

· Praxair Medical Air System

· Duplex Compressor(s) – Amico_A-SCD-P-080P-SS-N-075-46063-T

· Duplex Dryer(s) – Trident Pneumatics_Dryspell

· Dew Point Monitor – Amico

· CO Monitor – GFG_ABL-4021 Medical Vacuum System

· Duplex Pump(s) – Patton’s_72-21-033C Mater Alarm Panels

· Amico – Alert-2 Master Areal Alarm Panels

· Amico – Alert-3 LCD

CONTRACTOR QUALIFICATIONS:

(1) Contractor shall preform all work in accordance with VHA Directive 7515(1), the contractor shall be certified in American Society of Sanitary Engineering (ASSE) 6010 for system installations, ASSE 6020 for system inspections, ASSE 6030 for systems verifier, and ASSE 6040 systems maintenance whichever is applicable to the work contracted to perform.

(2) Contractor shall be licensed and certified to provide the testing and inspection services specified in this contract.

(3) Contractor shall provide service tickets, at the time services are rendered, for all services performed. Service tickets shall be signed by the COR in order to confirm services were rendered.

(4) Contractor shall hold a current and valid ASSE Medical Gas Verifier 6030 certification, ensuring all qualifications meet the requirements as stated in the latest version of NFPA 99.

1- Any personnel representing the contractor and performing the actual inspections shall also be qualified to at least the ASSE Medical Gas Verifier 6030 certification level.

2- The Contractor shall provide copies of the certifications upon acceptance of any contract award, or no work shall be performed, nor accepted, until proof of licensing is verified.

(5) Contractor shall use testing equipment that is calibrated and adheres to the standards and criteria set forth by the National Institute of Standards and Technology (NIST), as recommended by the ISO-9001 requirements. As proof of current calibration, the Contractor shall provide a Traceable Calibration Certificate to the COR or their designee, presented upon initial contract issuance and each time certificates are updated. Evidence of all required licenses, as well as documentation of the qualifications of personnel, shall be provided to the CO and COR prior to award of the contract.

(6) Contractor personnel, while on VA property, shall adhere to all requirements and regulations that govern the VA Health Care System and its property. Among all other requirements, the VA Health Care System and its property is now entirely smoke-free. No weapons are permitted on the premises. Medical masking in all required areas.

GENERAL REQUIREMENTS:

(1) All work shall be conducted in accordance with National Fire Protection Association (NFPA 99), Compress Gas Association (CGA), Occupational Safety and Health Administration (OSHA), Joint Commission on Accreditation of Healthcare Organizations (JCAHO), ASSE 6000: Professional Qualifications Standard, VA standards, and latest edition or other applicable current recommendations.

(2) The Individuals working/testing/inspecting on Medical Gas Systems must show proof of the following certification. ASSE 6010, ASSE 6020, ASSE 6030, ASSE 6040

(3) All certifications must be up to date. Any Contractors/Vendor not showing proof of Certifications shall be disqualified.

(4) Contractor shall be registered in SAM.GOV with an active Dunn & Bradstreet number.

(5) All shutdowns shall be coordinated with COR. Shutdown might occur at hours outside of traditional 1st shift, on Holidays, or on weekends. Include such implications in quote.

(6) Contractor shall clean-up work sites DAILY. NO debris can be left at work sites.

(7) Contractor shall visit the work sites and verify all existing conditions and include all such implications in the quote.

(8) The work shall include notification to the department point of contact immediately if life threatening condition exist during the inspections, testing and repairs.

INTERRUPTION OF MEDICAL GAS SERVICES

(1) The interruption of medical gas services (i.e., closure of valves, raising and lowering pressures etc.) shall be prohibited without the approval of the contracts point of contact. Interruption of medical gas services shall be considered a medical gas shutdown, and the Facility shutdown procedure shall be followed. Interruption of medical gas service shall be requested using the following procedure.

1- Notification of the contracts point of contact not less than (3) days in advance of the proposed interruption of medical gas services.

2- Do not proceed with interruption of medical gas service without the contracts written permission from the Engineering department.

HOURS OF WORK:

(1) The hours of work shall take place during the normal business hours of 8:00 AM and 4:30 PM, Monday through Friday, Federal Holidays excluded. Request for weekend work must be submitted in writing. “Inspections” will require a prior five-day notification submitted to the Contract Officers Representative (COR) or government representative.

Federal Holidays and National Holidays observed by the VA Hospital are:

New Years’ Day Labor Day Martin Luther King Day Columbus Day President’s Day Veteran’s Day Memorial Day Thanksgiving Day Juneteenth Christmas Day Independence Day

PERIOD OF PERFORMANCE:

(1) The Period of Performance is three months ARO.

DOWNTIME:

(1) All downtime shall be scheduled 72 hours in advance to minimize impact on Hospital thru COR

NOTES:

1- All modifications shall be reviewed and approved prior to execution.

2- Contractor shall specify cost of modifications IAW GSA pricing schedule.

Testing should be during normal hours 8:00am 4:30pm

WARRANTY:

(1) Contractor shall provide warranty on the integrity of services, parts and equipment installed supporting the CAVHCS Medical Gas Delivery System. The warranty period shall be for one (1) year after completion of work.

Copy of Annual Medical Gas Testing and PM Report

RECORDS MANAGEMENT AND CONTRACT SECURITY

A. Contractor shall comply with VA Handbook 6300.1 Records Management Procedures and VA Handbook 6500.6 Contract Security. Both can be found at:

https://www.va.gov/vapubs/search_action.cfm?dType=2 **Note: This link is the complete list of VA Handbooks and are in sequential order.

**Instructions for accessing VA Handbooks at link listed above:

B. Please follow the same instructions listed above for accessing VA Handbook 6500.6.

• All contractor employees working on this requirement are required to complete mandatory annual training entitled, “VA Privacy and Information Security Awareness” and “HIPPA Training” prior to providing service for each year of the contract with copies sent to the COR for each and available for audit as requested. The course numbers are VA10203 and VA 10176. You must select that you are a contractor. Contractor employees are to self-enroll into TMS via the link: https://www.tms.va.gov/learning/user/SelfRegistrationUserSelection.do

• A VA employee will escort the contractor when contractor is required to enter/work in sensitive areas.

IDENTIFICATION, SMOKING AND VA REGULATIONS

The Contractor's FSE shall wear visible identification always while on the premises of the Augusta VA Medical Center. Contractor shall contact the Contracting Officer’s Representative (COR) upon contract award, to receive instructions on how to obtain a VA Identification Badge during the performance of this contract. Augusta VA Medical Center is a smoke free campus which includes both tobacco and e-cigarettes; tickets can be issued by Police Services. Possession of weapons is prohibited. Enclosed containers, including tool kits, shall be subject to search. Violations of VA regulations may result in citation answerable in the United States (Federal) District Court, not a local district, state, or municipal court. Photography or Video on medical center premises is strictly prohibited. Additionally, pursuant to 38 CFR 1.218(b) (23) Use of recording devices of any kind to record patients or employees is strictly prohibited.

Modification to a Previous Notice image1.emf

Report_Tuskegee_VA_Medical_Center_Nursing_Home_10_16_2024.pdf

TUSKEGEE VA MEDICAL CENTER NURSING HOME

Location: Tuskegee , ALABAMA

2024 ANNUAL MEDICAL

GAS INSPECTION

Date: 10/16/2024 - 10/18/2024

Medical Gas Survey & Inspection Performed by:

Report ID: DMM24290-1

ENVIRONMENTAL & MEDICAL GAS SERVICES

103 Hunter Industrial Dr. - Villa Rica, GA 30180 Ph: (770)459-5920 • Fax: (770)459-1812 www.emgsi.com • testing@emgsi.com

Index Title:

Index:

Affidavit:

Credentials:

Inventory:

Summary of Findings:

Detail Report on Findings:

Summary of Corrections Detail Report on Corrections:

Master Alarms Testing:

Area Alarms Testing:

Zone Valves Testing:

Shut Off Valves Testing:

Outlet Testing:

Compressor Testing:

Vacuum Testing:

Bulk Gas Testing:

Page 4 - 7 Page 8 - 9 Page 10 - 11 Page 12 - 13 Page 14 - 16 Page 17 - 18 Page 19 - 22 Page 23 - 29 Page 30 - 36 Page 37 - 38 Page 39 - 52 Page 53 - 58 Page 59 - 63 Page 64 - 69

FINAL FIELD AFFIDAVIT

ANNUAL INSPECTION/TESTING SERVICES

MEDICAL GAS SYSTEMS & EQUIPMENT

10/16/2024 - 10/18/2024

Field Affidavit # DMM24290-1

Zhivorka Yelder Tuskegee VA Medical Center Nursing Home Tuskegee , ALABAMA

Primary Med Gas Authorized Person:

To Whom It May Concern:

In accordance with the terms of the contract documents and NFPA 99 - 2012 edition, I the undersigned, as a duly appointed representative of Environmental & Gas Services Inc. (EMGS), have conducted the following:

Annual Inspection Completed per the requirements of NFPA 99

SEE ATTACHED DATA SHEETS: DATA SHEETS MUST BE ATTACHED

The Contractor verifies that he is responsible for identification of all the equipment to be certified in the system as of this date. Any equipment not listed on the attached worksheets is the responsibility of the Contractor

HOLD HARMLESS CLAUSE:

The above certification applies to the condition of the detailed, itemized list of equipment as of date noted. Environmental & Medical Gas Services, Inc. will be held harmless from any liability caused by any modification of the piping system including but not limited to the gas outlets, alarms, zone valves, manifolds or supply gases at a later date.

Company - CONFIDENTIAL

Repairs were made to the medical gas system(s) at Tuskegee VA Medical Center Nursing Home by a qualified ASSE 6040 Technician (see name above). These repairs occurred during the same time period as the testing so documentation is included as applicable to any repairs made.

Environmental & Medical Gas Services 103 Hunter Industrial Dr.

Villa Rica, GA 30180 Ph: (770)459-5920 Fax: (770)459-1812 www.emgsi.com

Dalton Meeks

Representative

Representative Credentials

Page: 4COMPANY Confidential

Page: 5

Representative Credentials

Page: 6

Page: 7

Inventory Totals

Page: 8COMPANY Confidential

Medical Gas Inventory Totals

Page: 9

Outlets Oxygen - 108 Med Air - 108 Med Vac - 108

Zone Valves Oxygen - 7 Med Air - 7 Med Vac - 7

Shut off Valves Oxygen - 1 Med Air - 1 Med Vac - 1

Area Alarms Oxygen - 6 Med Air - 6 Med Vac - 6

Master Alarms Oxygen - 12 Med Air - 12 Med Vac - 6

324 21 3

18 30

Findings

Page: 10COMPANY Confidential

Deficiency List

DMM24290-1 -- 2024 Annual Medical Gas Inspection

(770)459-5920 (770)459-1812 www.emgsi.com

Item Description DateRecommendationID#

Summary of Findings

25102 Medical Air intake and Vacuum exhaust

Medical air intake is not properly labeled on the outside of the building Medical vacuum exhaust is not properly labeled on the roof.

Recommend adding labels to identify the medical air intake and medical vacuum exhaust

10/17/2024

25085 Medical Air Master Alarms The medical air system has a high temperature alarm that is not working at either master alarm panels

Recommend tying the high temperature alarm in with the lag compressor alarm

10/16/2024

25086 Medical Air System Medical Air dew point monitor is no longer communicating with the systems dryer. The dryers are also not keeping the dew point below the NFPA 99 requirement which is below positive 35 degrees Fahrenheit.

Recommend replacing dryers and dew point monitor to fix this issue. 10/16/2024

Deficiency List for Tuskegee VA Medical Center Nursing Home10/18/2024 Page: 11

Item Deficiency Description Priority DateRecommended SolutionID#

Detail Report on Findings

General Medical Gas Issues

Medical Air intake and Vacuum exhaust

Medical air intake is not properly labeled on the outside of the building Medical vacuum exhaust is not properly labeled on the roof.

Medium 10/17/2024Recommend adding labels to identify the medical air intake and medical vacuum exhaust25102

Page: 12

Item Deficiency Description Priority DateRecommended SolutionID#

Detail Report on Findings

Medical Air Master Alarms The medical air system has a high temperature alarm that is not working at either master alarm panels

Medium 10/16/2024Recommend tying the high temperature alarm in with the lag compressor alarm

25085

Medical Air System Medical Air dew point monitor is no longer communicating with the systems dryer. The dryers are also not keeping the dew point below the NFPA 99 requirement which is below positive 35 degrees Fahrenheit.

Medium 10/16/2024Recommend replacing dryers and dew point monitor to fix this issue.

25086

Page: 13

Corrections

Page: 14COMPANY Confidential

Corrections List

Item Description DateCorrective ActionID#

25070 Floor 1 Area Served: Patient

(MGZV01-03)

Room Number: 1B-130 Gas Type: Med Vac Outlet Number: 1 Outlet Model: O-QDWAL

Bent U-Clip Outlet repaired with repair kit Date found:

Date repaired:

25074 Ground

(MGZVG-01)

Room Number: GB-105 Gas Type: Med Air Outlet Number: 2 Outlet Model: Series B

Bent U-Clip Outlet repaired with repair kit Date found:

25073 Ground

(MGZVG-01)

Room Number: GB-105 Gas Type: Oxygen

Leaking from back body Outlet repaired with repair kit Date found:

25072 Ground

(MGZVG-01)

Room Number: GB-111 Gas Type: Oxygen

Leaking from back body Outlet repaired with repair kit Date found:

25080 Ground

(MGZVG-03)

Room Number: GB-143 Gas Type: Med Air

Leaking from front body Outlet repaired with repair kit Date found:

Correction List for Tuskegee VA Medical Center Nursing Home10/18/2024 Page: 15

Corrections List

Item Description DateCorrective ActionID#

25081 Ground

(MGZVG-03)

Room Number: GB-143 Gas Type: Med Air

Leaking from front body Outlet repaired with repair kit Date found:

Correction List for Tuskegee VA Medical Center Nursing Home10/18/2024 Page: 16

Closed / Resolved Issue List

Item Description Resolution Date

Completed

Detail Report on Corrections

ID#

Bent U-Clip Outlet repaired with repair kit 10/16/2024Floor 1 Area Served: Patient (MGZV01-03) Room Number: 1B-130 Gas Type: Med Vac

Outlet Model: O-QDWAL

25070

Bent U-Clip Outlet repaired with repair kit 10/16/2024Ground Area Served: Patient (MGZVG-01) Room Number: GB-105 Gas Type: Med Air

25074

Leaking from back body Outlet repaired with repair kit 10/16/2024Ground

Room Number: GB-105 Gas Type: Oxygen

25073

Leaking from back body Outlet repaired with repair kit 10/16/2024Ground

Room Number: GB-111 Gas Type: Oxygen

25072

Page: 17

Closed / Resolved Issue List

Item Description Resolution Date

Completed

Detail Report on Corrections

ID#

Leaking from front body Outlet repaired with repair kit 10/16/2024Ground Area Served: Patient (MGZVG-03) Room Number: GB-143 Gas Type: Med Air

25080

Leaking from front body Outlet repaired with repair kit 10/16/2024Ground Area Served: Patient (MGZVG-03) Room Number: GB-143 Gas Type: Med Air

25081

Page: 18

Master Alarms

Page: 19COMPANY Confidential

Phone: (770)459-5920

Fax: (770)459-1812

Master Alarm Report Tuskegee VA Medical Center Nursing HomeFacility 10/18/2024Date Zhivorka YelderJob Contact Dalton MeeksInspector

Alarm Visual Test

1st Floor FoyerPanel Location Alert-2 MasterModel AmicoManufacturer MGMA01-01Label

Master Alarm Panel Verification Audible TestSensor Location

PASSPASSMechanical Room

Oxygen High Line Pressure

Oxygen Low Line

PASSPASSASEOxygen Main Tank Liquid Level Low

PASSPASSASEOxygen Reserve Tank Liquid Level Low

PASSPASSASEOxygen Reserve Supply in Use

PASSPASSASEOxygen Reserve Low

Med Air High Line

Med Air Low Line

PASSPASSASEMed Air Carbon Monoxide High

PASSPASSASEMed Air Dew Point High PASSPASSASEMed Air Lag Compressor

PASSPASSASEMed Vac Lag Pump in

Use PASSPASSASEMed Vac Low Vacuum PASSPASSASEMed Vac Pump High

Temp

COMPANY Confidential Page: 20

1st Floor FoyerPanel Location Alert-2 MasterModel AmicoManufacturer MGMA01-01Label

Inspection Items The following items were inspected as part of the verification in accordance with NFPA 99:

PASSItem 1: Functional test passed with no failures detected Item 2: All low voltage wiring is supervised Item 3: Means to test for visual or audible alarm failure (i.e. test switch) Item 4: Provision for automatic restart in the event of a power outage Item 5: Visual and audible indication that wiring to an alarm initiating device is disconnected Item 6: Alarm panel is powered from the Life Safety Branch of the Emergency Power Circuit

PASS

PASS

COMPANY Confidential Page: 21

Ground Floor FoyerPanel Location Alert-2 MasterModel AmicoManufacturer MGMAG-01Label

Oxygen High Line

Oxygen Low Line

PASSPASSASEOxygen Main Tank Liquid Level Low

PASSPASSASEOxygen Reserve Tank Liquid Level Low

PASSPASSASEOxygen Reserve Supply

PASSPASSASEOxygen Reserve Low

Med Air High Line

Med Air Low Line

PASSPASSASEMed Air Carbon Monoxide High

PASSPASSASEMed Air Dew Point High PASSPASSASEMed Air Lag Compressor

PASSPASSASEMed Vac Lag Pump in

Use PASSPASSASEMed Vac Low Vacuum PASSPASSASEMed Vac Pump High

Temp Inspection Items

The following items were inspected as part of the verification in accordance with NFPA 99:

PASSItem 1: Functional test passed with no failures detected

Item 2: All low voltage wiring is supervised Item 3: Means to test for visual or audible alarm failure (i.e. test switch) Item 4: Provision for automatic restart in the event of a power outage Item 5: Visual and audible indication that wiring to an alarm initiating device is disconnected Item 6: Alarm panel is powered from the Life Safety Branch of the Emergency Power Circuit

PASS

COMPANY Confidential Page: 22

Area Alarms

Page: 23COMPANY Confidential

Area Alarm Report - Amico - Alert-3 LCD

Zhivorka YelderJob Contact Dalton MeeksInspector Floor 1Floor MGA01-02Label 1B-103-1B-112Room Numbers

Local (in Alarm Box)Sen Loc to

ZVB

Downstream of ZVBSensor Type

Phone: (770)459-5920 | Fax: (770)459-1812

PASSPASSPASSPatient PASS PASS Area(s) Served

Ability for automatic restart

Area Alarm Verification

VIS and AUD indication wiring disc

Means to test failure

Alarm panel powered from emerg pwr Test Switch

Alarm Type Low Alarm High Alarm Visual Test Audible Test

Oxygen 40 PSI 60 PSI PASS PASS Med Air 40 PSI 60 PSI PASS PASS Med Vac 12” Hg N/A PASS PASS

COMPANY Confidential Page: 24

Zhivorka YelderJob Contact Dalton MeeksInspector Floor 1Floor MGA01-03Label 1B-120-1B-130Room Numbers

Remote (Other)Sen Loc to

COMPANY Confidential Page: 25

Zhivorka YelderJob Contact Dalton MeeksInspector Floor 1Floor MGA01-01Label 1B-135, 1B-137-1B-146Room Numbers

COMPANY Confidential Page: 26

Zhivorka YelderJob Contact Dalton MeeksInspector GroundFloor MGAG-01Label GB-103-GB-112Room Numbers

COMPANY Confidential Page: 27

Zhivorka YelderJob Contact Dalton MeeksInspector GroundFloor MGAG-02Label GB-120-GB-130Room Numbers

COMPANY Confidential Page: 28

Zhivorka YelderJob Contact Dalton MeeksInspector GroundFloor MGAG-03Label GB-135-GB146Room Numbers

COMPANY Confidential Page: 29

Zone Valves

Page: 30COMPANY Confidential

Zone Valve Box Report

Floor 1Floor MGZV01-02Label

Room Numbers Puritan BennettManufacturer1B-103-1B-112

Gas Type Valve Size

Area(s) Served Leak Test

Zone Valve Box Verification

Not behind doors or hidden

PASSPatient

Cover plate Accessible

PASS PASS

Intervening wall exist between zone valve and the outlets served

1/2"Oxygen 1/2"Med Air 3/4"Med Vac

COMPANY Confidential Page: 31

Floor 1Floor MGZV01-03Label

Room Numbers Puritan BennettManufacturer1B-120-1B-130

COMPANY Confidential Page: 32

Floor 1Floor MGZV01-01Label

Room Numbers Puritan BennettManufacturer1B-135-1B-146

COMPANY Confidential Page: 33

GroundFloor MGZVG01-01Label

Room Numbers Puritan BennettManufacturerGB-135-GB146

PASSParient

COMPANY Confidential Page: 34

GroundFloor MGZVG-01Label

Room Numbers Puritan BennettManufacturerGB-103-GB-112

COMPANY Confidential Page: 35

GroundFloor MGZVG-02Label

Room Numbers Puritan BennettManufacturerGB-120-GB-130

1/2"Med Air 1/2"Med Air

COMPANY Confidential Page: 36

Shut-off Valves

Page: 37COMPANY Confidential

Shut Off Valve Report Tuskegee VA Medical Center Nursing Home

Facility 10/18/2024Date

GroundFloor

Location

Shut Off Valve Verification

Service Label

Locking Handle

Locked door or above cieling

Locked open secure area

Three piece quarter turn

NFPA 99

Valve Type

OxygenLoading Dock 1-1/4" PASS PASS PASS PASS PASS

Area(s) Served: Entire facility

Source Valve

Med AirMechanical Room 1/2" PASS PASS PASS PASS PASS

Area(s) Served: Entire Facility

Med VacMechanical Room 1-1/4" PASS PASS PASS PASS PASS

Area(s) Served: Entire Facility

COMPANY Confidential Page: 38

Outlets

Page: 39COMPANY Confidential

Outlet Testing Report

Zhivorka YelderJob Contact Dalton MeeksInspector Floor 1Location DMM24290-1Job # PatientArea Served MGZV01-01Zone Box

Room # Outlet # Type Label Cross Connect

Drop

Pressure Flow Rate

O2 % Purge

Phone: (770)459-5920

Fax: (770)459-1812

1B-135 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-135 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-135 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-135 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-135 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-135 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-137 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-137 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-137 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-137 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-137 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-137 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-138 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-138 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-138 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-138 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-138 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-138 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-139 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-139 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS

COMPANY Confidential DMM24290-1Tuskegee VA Medical Center Nursing Home 2024 Annual Medical Gas Inspection Page: 40

1B-139 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-139 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-139 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-139 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-140 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-140 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-140 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-140 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-140 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-140 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-141 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-141 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-141 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-141 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-141 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-141 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-142 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-142 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-142 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-142 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-142 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-142 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-143 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-143 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-143 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-143 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-143 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-143 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-144 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-144 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-144 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS

COMPANY Confidential DMM24290-1Tuskegee VA Medical Center Nursing Home 2024 Annual Medical Gas Inspection Page: 41

1B-144 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-144 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-144 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-145 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-145 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-145 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-146 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-146 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-146 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A

COMPANY Confidential DMM24290-1Tuskegee VA Medical Center Nursing Home 2024 Annual Medical Gas Inspection Page: 42

PatientArea Served MGZV01-02Zone Box

1B-103 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-103 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-103 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-104 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-104 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-104 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-105 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-105 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-105 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-105 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-105 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-105 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-106 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-106 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-106 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-106 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-106 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-106 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-107 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-107 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-107 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-107 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-107 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-107 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-108 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-108 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-108 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-108 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-108 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-108 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-109 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS

COMPANY Confidential DMM24290-1Tuskegee VA Medical Center Nursing Home 2024 Annual Medical Gas Inspection Page: 43

PatientArea Served MGZV01-02Zone Box

1B-109 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-109 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-109 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-109 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-109 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-110 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-110 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-110 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-110 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-110 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-110 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-111 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-111 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-111 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-111 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-111 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-111 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-112 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-112 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-112 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-112 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-112 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-112 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A

COMPANY Confidential DMM24290-1Tuskegee VA Medical Center Nursing Home 2024 Annual Medical Gas Inspection Page: 44

PatientArea Served MGZV01-03Zone Box

1B-120 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-120 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-120 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-121 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-121 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-121 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-122 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-122 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-122 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-123 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-123 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-123 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-124 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-124 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-124 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-125 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-125 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-125 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-126 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-126 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-126 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-127 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-127 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-127 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-128 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-128 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-128 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-129 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS 1B-129 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-129 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A 1B-130 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS

COMPANY Confidential DMM24290-1Tuskegee VA Medical Center Nursing Home 2024 Annual Medical Gas Inspection Page: 45

PatientArea Served MGZV01-03Zone Box

1B-130 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS 1B-130 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A

COMPANY Confidential DMM24290-1Tuskegee VA Medical Center Nursing Home 2024 Annual Medical Gas Inspection Page: 46

GroundLocation DMM24290-1Job # PatientArea Served MGZVG-01Zone Box

GB-103 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-103 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-103 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-104 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-104 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-104 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-105 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-105 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-105 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-105 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS Bent U-Clip GB-105 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-105 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-106 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-106 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-106 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-106 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-106 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-106 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-107 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-107 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-107 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-107 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-107 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-107 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-108 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-108 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-108 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-108 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-108 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-108 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-109 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS

COMPANY Confidential DMM24290-1Tuskegee VA Medical Center Nursing Home 2024 Annual Medical Gas Inspection Page: 47

PatientArea Served MGZVG-01Zone Box

GB-109 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-109 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-109 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-109 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-109 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-110 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-110 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-110 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-110 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-110 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-110 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-111 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-111 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-111 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-111 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-111 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-111 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A

GB

-112

1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS

2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS

1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS

2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS

1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A

2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A

COMPANY Confidential DMM24290-1Tuskegee VA Medical Center Nursing Home 2024 Annual Medical Gas Inspection Page: 48

PatientArea Served MGZVG-02Zone Box

GB-120 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-120 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-120 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-120 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-120 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-120 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-121 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-121 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-121 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-121 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-121 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-121 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-122 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-122 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-122 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-122 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-122 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-122 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-123 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-123 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-123 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-123 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-123 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-123 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-125 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-125 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-125 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-125 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-125 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-125 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-126 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS

COMPANY Confidential DMM24290-1Tuskegee VA Medical Center Nursing Home 2024 Annual Medical Gas Inspection Page: 49

PatientArea Served MGZVG-02Zone Box

GB-126 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-126 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-126 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-126 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-126 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-127 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-127 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-127 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-127 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-127 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-127 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-128 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-128 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-128 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-128 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-128 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-128 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-129 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-129 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-129 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-129 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-129 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-129 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-130 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-130 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-130 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A

COMPANY Confidential DMM24290-1Tuskegee VA Medical Center Nursing Home 2024 Annual Medical Gas Inspection Page: 50

PatientArea Served MGZVG-03Zone Box

GB-136 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-136 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-136 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-136 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-136 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-136 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-137 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-137 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-137 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-137 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-137 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-137 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-138 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-138 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-138 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-138 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-138 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-138 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-139 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-139 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-139 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-139 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-139 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-139 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-140 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-140 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-140 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-140 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-140 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-140 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-141 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS

COMPANY Confidential DMM24290-1Tuskegee VA Medical Center Nursing Home 2024 Annual Medical Gas Inspection Page: 51

PatientArea Served MGZVG-03Zone Box

GB-141 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-141 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-141 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-141 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-141 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-142 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-142 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-142 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-142 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-142 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-142 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-143 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-143 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-143 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-143 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS Leaking from front body GB-143 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-143 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-144 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-144 2 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-144 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-144 2 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-144 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-144 2 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB-146 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB-146 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB-146 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A GB145 1 Oxygen PASS PASS < 5 PSI 52 > 3.5 SCFM 99% O2 PASS GB145 1 Med Air PASS PASS < 5 PSI 54 > 3.5 SCFM 21% O2 PASS GB145 1 Med Vac PASS PASS > 12” Hg 24 > 3.0 SCFM N/A N/A

COMPANY Confidential DMM24290-1Tuskegee VA Medical Center Nursing Home 2024 Annual Medical Gas Inspection Page: 52

Air Compressors

Page: 53COMPANY Confidential

Medical Air Compressor Report as per NFPA 99

Facility:

Project Contact:

Date:

Verifier:

10/18/2024

System Name Plate Data

Manufacturer: Amico Model: A-SCD-P-080P-SS-N-075

-46063-T Serial: 9232013921101

Equipment Location: Mechanical Room

Compressor Type: Oil-less reciprocating # of Compressors: 2

Compressor HP (ea): 7.5 HP

Area Served: Entire facility

System Voltage: 460/3/60

General Inspection Items

Adequate ventilation: PASS

Area secured with lockable door: PASS Aftercooler Type:

Final Line Regulators

Three valve bypass for simplex: N/A

Individual regulator isolation valves: PASS

Regulator Type: Duplex Regulator gauges installed & calibrated: PASS

Company - CONFIDENTIAL Page: 54

Manufacturer: Trident Pneumatics Model: Dryspell Serial: 2013/04S7189

Medical Air Dryers

Medical Air Treatment System

Dryer Type: Desiccant Dryers keep dew point below 32 F: FAIL

Dryers can be isolated for service: PASS

Moisture separation & drainage: PASS

Dryer sized properly: PASS

Air Treatment Filters

Filter Type:

# of filters in each bank: 2

Filter banks are at least duplex: PASS

Filter bank can be isolated for service: PASS

Visual filter element indicator: PASS

Filters sized properly: PASS

Under normal operation on one air treatment bank is valve on:

Dew Point & CO Monitor

Dew Point Monitor CO Monitor

Manufacturer: Amico Model:

Serial: 75-8821-3.5

Manufacturer: GFG Model: ABL-4021 Serial: A310-1016

35 FAlarm Point:

PASSLocal Alarm:

PASSMaster Alarm:

10 PPMAlarm Point:

PASSLocal Alarm:

PASSMaster Alarm:

High Temp Alarms Lag Alarms Local Alarm:

Master Alarm:

Local Alarm:

Master Alarm:

Company - CONFIDENTIAL Page: 55

Distribution Piping Inspection

Individual compressor check valves: PASS

Main line pressure relief valve: PASS relief valves: PASS

Piping gas type is labeled: PASS

High/Low line pressure switch with demand check: PASS

Interconnecting piping cleaned for O2 service: PASS140 PSI

75 PSI

NFPA 99 compliant source shut off valve installed and labeled: PASS

Receiver Inspection

Automatic receiver drain: PASS

National Board Number: 320863

Receiver pressure gauge: PASS Receiver sight glass: PASS

Receiver safety relief valve: PASS

Receiver three valve bypass installed: PASS

Compressor Intake Inspection

Intake inlet screened and turned down: PASS

Intake located at least 20 ft.

above ground level: PASSIntake Filter: PASS

Intake located at least 10 ft. from any door, window or other opening: PASS

Intake located at least 25 ft. from vacuum exhaust and other noxious fumes: PASS

Flex connectors installed on inlet and outlet piping: PASS

Intake Location: PASS

Located: Outdoors

Company - CONFIDENTIAL Page: 56

Verification Inspection Data

Sample collection valve (SCV) installed: PASS

Dew point level at SCV: 43.09

CO level at SCV: DNT Total Hydrocarbon level at SCV: DNT

Halogenated Hydrocarbon

Carbon Dioxide

Functional individual pump disconnect switches: PASS

Correct rotation: PASS

System alternation: Automatic Reserve units activated automatically on demand: PASS

System powered by the equipment branch of the essential electrical system:

See facility

Emergency power verified by: See facility

Air Compressor Run Hours

Unit 1: 1296

Unit 2: 2614

Unit 1:

Unit 2:

Lead / Lag Switch Settings On Off On Off

Company - CONFIDENTIAL Page: 57

Medical Air Intake

Medical air intake location pictured below:

Company - CONFIDENTIAL Page: 58

Vacuum Pumps

Page: 59COMPANY Confidential

Medical Vacuum Pump Report as per NFPA 99 - Existing Facility Requirements

Manufacturer: Patton's Model: 72-21-033C Serial: 72-58928

Equipment Location: Mechanical Room

Pump Type: Oil-Sealed Rotary Vane # of Pumps: 2

Pump HP (ea): 3 HP

Area Served: Entire facility

Pump Voltage: 460/3/60

General Inspection Points

Adequate ventilation: PASS

Company - CONFIDENTIAL Page: 60

Receiver Inspection

Receiver manual drain present: PASS

National Board Number: 781247 Receiver properly sized with vacuum gauge: PASS

Exhaust located at a different level from air intake: PASSExhaust Located Properly: PASS

Exhaust turned down and screened: PASS

Vacuum Exhaust Inspection

Vacuum Distribution Piping Inspection

Vacuum pump sized properly: PASSIndividual pump

Pump can be isolated for maintenance: PASS Source shut-off valve installed and properly labled: PASS

Located: Outdoors

Company - CONFIDENTIAL Page: 61

Operational Checks

Pump Run Hours

Unit 1: 3316

Unit 2: 3639

Lead / Lag Switch Settings On Off On Off

Correct Rotation: Emergency power verified by: See facility

System alternation: Automatic

Lag pump alarm:

Powered by the emergency power circuit: PASS

Reserve units activated automatically: PASS

Functional individual pump disconnect switches: PASS

Local visual:

Local audible:

HEPA Filters

Only One Bank is in Use under Normal Conditions: N/AHEPA Filters are at least duplex: N/A

HEPA Filters can be…