Attachment 28 - 668-16-110_Cross-Connection Inventory Report - APPENDIX E-F .pdf

Appendix E.

Room Service Inventory

Appendix E. Building 1 Room Service Inventory Floor: Basement

Room Item Comments

CS Main Water Supply Main CS Feeds Utility Room C001

D008A Cooling Water Make-up Main C001

D008C Sink Main C001

DOO8G Sink Main C001

C001 Drinking water Filter Main C001

C001 Equipment Main C002

C003A Men's Restroom Main C001

C004A Woman's Restroom Main C005

A004 Main Water Supply Main A004 Feeds Utility Room B008

C002 Dish Washing Room Hall Main Hallway

A002 Sink Hall Main Hallway

A006A Restroom Hall Main Hallway

A010 Janitors Closet Hall Main Hallway

A007 Kitchen Hall Main Hallway Front of Elevators

A007A Janitors Closet Hall Main Hallway End of the Kitchen Line

B005A Data Equipment Cooling Hall Main Hallway

B003 Utility Room Hall Main Hallway

B016 Sink Hall Main Hallway

B018 Sink Hall Main Hallway

B008 Utility Room Hall Main Main

C801 Utility Room (DW) 25, 47, 43 Drinking Fountain Line

NOTES:

Buildings 25, 26, and 27 are fed from Building 1 Basement, Room C005.

Abbreviations: CS = Crawl Space, DW = Drinking Water.

Stack or Location

Mann-Grandstaff VAMC | Cross-Connection Inventory Rpt

September 2018

CES - Spokane Valley, WA

Doc: App E. Building 1 Room Service Inventory.xlsx | Basement

Appendix E. Building 1 Room Service Inventory Floor: 1

C145B Restroom 7 C005

C145C Restroom 7 C005

C145E Sink 7 C005

C144 Sink 7 C005

C109 Restroom 15 C005 Stack 15 Feeds Building 27 from C111

C111 Restroom 15 C005 Stack 15 Feeds Building 27 from C111

C113 Restroom 15 C005 Stack 15 Feeds Building 27 from C111

A127D Restroom 31 A004A / CS

B119 Restroom 32 B119 Stack 32 - B119 - A237 - Stack 48

B102 Restroom 35 B106

B106 Restroom 35 B106

B107 Cafeteria 39 B107A

B107A Serving / Kitchen / Dishwashing 39 B107A

Hall Hallway 43, 40 Drinking Water Line

C112A Sinks C005 C005

C112B Sink C005 C005

D105 Sink Hall Main C001 Connection from Below in Basement

D107 Sink Hall Main C001 Connection from Below in Basement

D106 Sink Hall Main C001 Connection from Below in Basement

D109 Sink Hall Main C001 Connection from Below in Basement

D108A Restroom Hall Main C001 Connection from Below in Basement

D108 Locker room Hall Main C001 Connection from Below in Basement

D110 Locker room Hall Main C001 Connection from Below in Basement

D110A Restroom Hall Main C001 Connection from Below in Basement

D111 Sink Hall Main C001 Connection from Below in Basement

D113 Sink Hall Main C001 Connection from Below in Basement

D114 Sink Hall Main C001 Connection from Below in Basement

D115 Restroom Hall Main C001 Connection from Below in Basement

D117 Sink Hall Main C001 Connection from Below in Basement

D118 Sink Hall Main C001 Connection from Below in Basement

D119 Waist Disposal Hall Main C001 Connection from Below in Basement

D123 Sink Hall Main C001 Connection from Below in Basement

D124 Sink Hall Main C001 Connection from Below in Basement

D125 Sink Hall Main C001 Connection from Below in Basement

D127 Sink Hall Main C001 Connection from Below in Basement

D128 Sink Hall Main C001 Connection from Below in Basement

D130 Sink Hall Main C001 Connection from Below in Basement

D131 Sink Hall Main C001 Connection from Below in Basement

D132 Sink Hall Main C001 Connection from Below in Basement

D133 Sink Hall Main C001 Connection from Below in Basement

D134 Sink Hall Main C001 Connection from Below in Basement

D135 Sink Hall Main C001 Connection from Below in Basement

D103 Sink Hall Main C001 Connection from Below in Basement

D104 Sink Hall Main C001 Connection from Below in Basement

Lobby Sink / Coffee Maker etc. Hall Main C001 Connection from Below in Basement

Stack or Location

Mann-Grandstaff VAMC | Cross-Connection Inventory Rpt

September 2018 | Page 1 of 2

Doc: App E. Building 1 Room Service Inventory.xlsx | 1st Floor

Appendix E. Building 1 Room Service Inventory Floor: 1

Room Item CommentsStack or Location

A102 Eye Wash / Sink / Mop Sink Hall Main / 25

Hall Main

(Basement)

Stack 25

(1st Floor)

Connected through the Kitchen Plumbing

System

E107 Sink / Eyewash / Mop Sink WMR 201

E110 Restroom WMR 201

E113 Janitors Closet WMR 201

E118 Exam Room (Sink) WMR 201

E119 Exam Room (Sink) WMR 201

E120 Exam Room (Sink) WMR 201

E121 Utility Room WMR 201

E122 Exam Room (Sink) WMR 201

E124 Exam Room (Sink) WMR 201

E126 Exam Room (Sink) WMR 201

E128 Exam Room (Sink) WMR 201

E129 Restroom WMR 201

E130 Exam Room (Sink) WMR 201

E132 Exam Room (Sink) WMR 201

E133 Exam Room (Sink) WMR 201

E134 Exam Room (Sink) WMR 201

E135 Exam Room (Sink) WMR 201

E136 Exam Room (Sink) WMR 201

E139A Restroom WMR 201

E140 Break Room Sink WMR 201

C314 Mechanical Room (Hose Bib)

NOTE:

Abbreviations: CS = Crawl Space, WMR = West Mechanical Room.

Mann-Grandstaff VAMC | Cross-Connection Inventory Rpt

September 2018 | Page 2 of 2

Doc: App E. Building 1 Room Service Inventory.xlsx | 1st Floor

Appendix E. Building 1 Room Service Inventory Floor: 2

A237A Office 2 1, 2

C211 CAT Scan 4

C213 CAT Scan 4

C208D X-ray 15

C208F Restroom 15

C208G X-ray 15 1st Floor Service Connections from Below

C208H X-ray 15

C208J Restroom 15

C222A 3 Exam Room 15 1st Floor

C215 3 Restroom 15 1st Floor

C217 3 Office 15 1st Floor

C219 3 Exam Room 15 1st Floor

C221 3 Exam Room 15 1st Floor

A200E Restroom 22 1st Floor Service from Stack 22

C209 Restroom 24

Hall Drinking Water 25 Drinking Water Line

A232 Restroom 27

A234 Restroom 27

A236 Exam Room 27

B252M Mechanical Room 32

B252 Roof Mechanical Room 32 Water Package Make-Up Water

B250 Breakroom 33

B255 Exam Room 33

B257 Exam Room 33

B260 Restroom 40 Stack 40 1st Floor

A200A Lab 2 1, 2

/ 49 1, 2

A200D Lab 2 1, 2

/ 49 1, 2

A202 Janitors Closet 2 1, 2

/ 49 1, 2

C208 Stack 22 22A Stack 22A Originates from Stack 22

A240A Exam Room 30 / 24

A240B Exam Room 30 / 24

B246 Office 30 / 24

A238 Exam Room 30 / 24

Hall Drinking Water 40, 43 Drinking Water Line

A237 Office 47 and 48 3rd Floor Stack 47 on 3rd Floor and

Stack 48 on 2nd Floor

B266 Exam Room Hall Main Hall Main in Basement

B262J Restroom Hall Main Hall Main in Basement

B262H Office Hall Main Hall Main in Basement

NOTES:

1 Hot water recirculation line is connected between Stacks 2, 24, and 49. The line dead ends in Room B250.

2 Stacks 2 and 49 water lines are tied together (hot and cold water).

3 Stack 15 services Room C222A then to Rooms C221, C219, C217, and C215.

4 Hot water line is connected to the 3rd floor (Stack 29) and Stack 30 on the 2nd floor.

Stack or Location

Mann-Grandstaff VAMC | Cross-Connection Inventory Rpt

September 2018

Doc: App E. Building 1 Room Service Inventory.xlsx | 2nd Floor

Appendix E. Building 1 Room Service Inventory Floor: 3

C303 Janitors Closet 1 Stack 1 from the 2nd Floor

C315 Exam Room 5

C313 Exam Room 5

C327 Exam Room 7

C325 Exam Room 7

C321 Exam Room 7

C319 Exam Room 7

C324 Exam Room 16

C322 Exam Room 16

C320 Exam Room 16

C318 Breakroom 22

C312 Exam Room 22

C310 22

C308 Exam Room 22

C314 Mechanical Room 22 Hose Bib

C316 22 Splits into 22A Passes through the 3rd Floor

No Connection

C312 22 Splits into 22B Stack 22B Originates from Stack 22

C311 Exam Room 24 Hot, Cold, and Hot Recirculation Lines

Continue to the 4th Floor

C307 Restroom 24

A334A Restroom 29

A338 Breakroom 29

A340 Breakroom 29

A342 Laundry Room 29

B353 Patients Room 29 Unable to Verify, Plumbing Located in

Wall

B351 Restroom 29

B349 Patients Room 29

B358 Day Room 40

B339 Dirty Laundry Room 46

A333A Sink 48 Feeds from 2nd Floor

A335 Patients Room 48

A337 Patients Room 48

B347 Patients Room 44 / 45 Serviced from Stacks 44 and 45

B345 Patients Room 44 / 45 Serviced from Stacks 44 and 45

Hall Drinking Water 25 Drinking Water Line (Not Used)

Stack or Location

Mann-Grandstaff VAMC | Cross-Connection Inventory Rpt

September 2018

Doc: App E. Building 1 Room Service Inventory.xlsx | 3rd Floor

Appendix E. Building 1 Room Service Inventory Floor: 4

A400G Restroom 2 Service from Stack 2 via the 3rd Floor

C413 Patients Room 5

C413A Bathroom 5

C415A Patients Room 7

C415A Bathroom 7

C414 Patients Room 16

C414A Bathroom 16

C411 Patients Room 24

C411A Bathroom 24

Hall Drinking Fountain 25 Drinking Fountain Lne

C404 Patients Room 26

C404A Bathroom 26

A420 Patients Room 27

A420A Bathroom 27

A426A Restroom 29

A428 Janitors Closet 29

Hall Drinking Fountain 29 Domestic Water Supply

A436 Restroom 30

A440 Breakroom 30

A430 Ice Machine 30

C4-B1 Hallway Sink 32

B448 Patients Room 32

B448A Bathroom 32

B452 Patients Room 34

B452A Bathroom 34

B453 Patients Room 42

B453A Bathroom 42

B449 Patients Room 45

B449A Bathroom 45

A427 Storage / Coffee Machine 47

A433 Rehabilitation Room 47

C412 Patients Room 22A

C412A Bathroom 22A

C406 Patients Room 22B

C406A Bathroom 22B

C410 Patients Room 22B

C410A Bathroom 22B

B454 Patients Room 40 / 45

B454A Bathroom 40 / 45

B456 Patients Room 40 / 45

B456A Bathroom 40 / 45

B458 Restroom 40 / 45

B457 Patients Room 40 / 45

B457A Bathroom 40 / 45

B455 Patients Room 40 / 45

B455A Bathroom 40 / 45

Stack or Location

Mann-Grandstaff VAMC | Cross-Connection Inventory Rpt

September 2018

Doc: App E. Building 1 Room Service Inventory.xlsx | 4th Floor

Appendix E. Building 1 Room Service Inventory Floor: 5

C515 Patients Room 5

C515A Bathroom 5

C517 Patients Room 7

C517A Bathroom 7

C518 Patients Room 16

C518A Bathroom 16

C513 Patients Room 24

C513A Bathroom 24

C5-C1 Hall Sink 24

Hall Drinking Fountain Line 25 Not Connected

A500E Breakroom 28

A500G Restroom 28

A501 Restroom 28

A531 Janitors Closet 28

B538A Bathroom 28

B539 Patients Room 28

B539A Bathroom 28

B542 Patients Room 28

B542A Bathroom 28

B540 Patients Room 28

B541 Patients Room 28

B541A Bathroom 28

B543 Patients Room 28

B543A Bathroom 28

B545A Bathroom 28

B546A Bathroom 28

B544 Patients Room 28

B544A Bathroom 28

C5-A3 Drinking Fountain 28 Domestic Water

A526 Service Room 29 Ice Machine

A530A Patients Room 30

A530B Patients Room 30

A530C Patients Room 30

A530 Nurses Station (Sink) 30

B538 Patients Room 30

B545 Patients Room 40

B546 Patients Room 40

B547 Restroom 40

Hall Drinking Fountain Line 43 Connected

C516 Patients Room 22A

C516A Bathroom 22A

C514 Patients Room 22B

C514A Bathroom 22B

A535 Rehabilitation Room 46 and 47

NOTE:

A524 has 2 dead end lines in it (Hot and Cold).

Stack or Location

Mann-Grandstaff VAMC | Cross-Connection Inventory Rpt

September 2018

Doc: App E. Building 1 Room Service Inventory.xlsx | 5th Floor

Appendix E. Building 1 Room Service Inventory Floor: 6

C623 Exam Room 5

C621 Exam Room 5

C619 Exam Room 5

C625 Exam Room 7

C625A Restroom 7

C624 Exam Room 16

C624A Restroom 16

C617 Exam Room 24

C617A Restroom 24

C613 Office (Sink) 24

C615 Restroom 24

C608 Dirty Laundry (Sink) 26

C603 Storage (Sink) 26

A632A Restroom 27

A630 Restroom 27

A632 Breakroom 29

A636 Recovery Room 30

A633 Janitors Closet 30

A637C Recovery Room 30

A637C Restroom 30

A638 Service Room 30

B646 Procedures Room 34

B648 Procedures Room 34

B650 Procedures Room 34

B654 Procedures Room 40

B656 Restroom 40

B655 Procedures Room 40

B649 Procedures Room 40

B647 Procedures Room 42

B645 Storage (Sink) 42

C618 Supply Room (Sink) 22A

C620 Exam Room 22A

C622 Exam Room 22A

C6-C1 Hall Sink 22A

C610 Exam Room 22B

C612 Exam Room 22B

C614 Exam Room 22B

C616 Exam Room 22B

B643 Recovery Room 32 / 45 2 Sinks Each Feed from Different Stacks

NOTE:

1 Stack 29 feeds Rooms A732 and A730 then back to Stack 29 and room A726. Room A726 connects to the 9th Floor at Stack 29.

Stack or Location

Mann-Grandstaff VAMC | Cross-Connection Inventory Rpt

September 2018

Doc: App E. Building 1 Room Service Inventory.xlsx | 6th Floor

Appendix E. Building 1 Room Service Inventory Floor: 7

C708 Exam Room 26

C708A Restroom 26

C722A Restroom 16

C721A Restroom 7

C717 Restroom 5

C713A Restroom 24 Service from Stack 24 Could Not be

Directly Observed

A733A Breakroom 44 / 47

2, 3 Service from Stacks Could Not be

Directly Observed

B737 Restroom 44 / 47

2, 3 Service from Stacks Could Not be

Directly Observed

B739 Exam Room 44 / 47

2, 3 Service from Stacks Could Not be

Directly Observed

B755 Restroom 40

A706 Restroom 26 / 5 1 Hot Water is Connected Between Stacks 5 and 26

A704 Restroom 26 / 5 1 Hot Water is Connected Between Stacks 5 and 26

A702 Restroom 26 / 5 1 Hot Water is Connected Between Stacks 5 and 26

A701 Office (Sink) 26 / 5 1 Hot Water is Connected Between Stacks 5 and 26

NOTES:

1 Lines from Stack 5 feed up to Rooms A804 and A806.

2 Could not directly observe which individual stacks supply domestic hot and cold water for room (either Stack 44 or 47).

3 Stack 47 feeds up to Rooms B803, B803A, and B803B.

Stack or Location

Mann-Grandstaff VAMC | Cross-Connection Inventory Rpt

September 2018

Doc: App E. Building 1 Room Service Inventory.xlsx | 7th Floor

Appendix E. Building 1 Room Service Inventory Floor: 8

A806 Janitors Closet 5 1 From Stack 5 to 7th Floor Room C719

A804 Storage 5 1 From Stack 5 to 7th Floor Room C719

A804A Storage 5 1 From Stack 5 to 7th Floor Room C713

A809 Scrub Room 22 From Stack 22 to 7th Floor Room C716

A809A Nurses Clean room 22 Plumbing is Disconnected

C8-A2 Drinking Fountain 25 Hallway

A802 2 Equipment Room 29 From Stack 29 to 7th Floor Room A728

A800A 2 Equipment Room 29 From Stack 29 to 7th Floor Room A728

B806 Bath / Shower Room 29 Stack 29 from 7th Floor Room A732

B808 Locker Room (Men) 30 Stack 30 from the 6th Floor

B810 Locker Room (Women) 30 Stack 30 from the 6th Floor

B818 Breakroom 33 Stack 33 from the 6th Floor

C8-B1 Drinking Fountain 43 Hallway

B803 Sterilization Rooms 47

B803C Sterilization Rooms 47

B803A Sterilization Rooms 47

B803B Sterilization Rooms 47

A805A Utility Room 5

/ 26 3 From Stacks 5 and 26 on the 7th floor

B801 4 Autoclave Service Room 9th Floor Dionized Water Equipment

B803D 4 Surgical Equipment Cleaning 9th Floor Dionized Water Equipment

NOTES:

1 Lines come off Stack 5 on the 7th Floor and go up to feed Rooms A804 and A806 from Room C719 and C713.

2 Stack 29 in Room A728 feeds lines up to Equipment in Room A802 and A802A. The line then continues up to the 9th Floor where it is tied into a hot water heater and Stack 46.

3 Stacks 5 and 26 feed up to sinks in Room A805A, just off of Room A805.

8 Rooms B803D and B801 are fed from the 9th Floor deionized water system.

Stack or Location

Mann-Grandstaff VAMC | Cross-Connection Inventory Rpt

September 2018

Doc: App E. Building 1 Room Service Inventory.xlsx | 8th Floor

Appendix E. Building 1 Room Service Inventory Floor: 9

901 Pressure Booster System 46 Supply Side

901 Pressure Booster System 29 Booster Side

901 Hot Water Heater 29

/ 46 Hot Water Recirculation to Water Tank

901 Heating and Cooling 29

/ 46 Makeup Water

901 Equipment 29

/ 46 All Other Serviced Equipment

NOTES:

The deoinized water system on the 9th Floor feeds directly down to Rooms B803D and B801 on the 8th Floor.

The 9th Floor, serviced by Stack 46, is pressure boosted and services equipment on the 9th Floor before returning downward to the 8th Floor via Stack 29.

Stack or Location

Mann-Grandstaff VAMC | Cross-Connection Inventory Rpt

September 2018

Doc: App E. Building 1 Room Service Inventory.xlsx | 9th Floor

Appendix F.

Cross-Connection Inventory

Appendix F. Cross-Connection Inventory Building: 1

Issue

Location Usage Comments

OS Southwest Corner Main Service Connection

Campus

Protected City Water Main

(Main-Supply-000-001)

OS Northeast Corner Main Service Connection

Campus

Protected City Water Main

(Main-Supply-000-002)

* Crawl Space Water Main Storage 1-BAS-CS-001

Crawl Space Fire Protection 1-BAS-CS-002

D008A Cooling - Water Makeup 1-BAS-D008A-001

C001 Drinking Water System 1-BAS-C001-002

* C001 Cooling Equipment 1-BAS-C001-002

* C002 Dishwashing Room -

Dishwasher

1-BAS-C002-001

* C002 Dishwashing Room -

Chemical Feed Unit

1-BAS-C002-002

* A010 Janitor's Closet - Chemical

Unit

1-BAS-A010-001

* A007 Kitchen - Ice Machine 1-BAS-A007-001

* A007 Kitchen - Steamer 1-BAS-A007-002

* A007 Kitchen Coffee Machine 1-BAS-A007-003

B005A Cooling 1-BAS-B005A-001

* B003 Utility - Chemical Feed 1-BAS-B003-001

* B003 Utility - Hose 1-BAS-B003-002

* B003 Utility - Sink (Hose) Remove Hose

* B004 Soft Water Equipment 1-BAS-B004-001

* B008 Main Water Line 1-BAS-B008-001

B008 RPBA AC Unit - Room

B014A

1-BAS-B008-002

* B008 Hot Water Supply 1-BAS-B008-003

West Basement

Mechanical Room Lab Water Treatment 1-BAS-MECH-001

West Basement

Mechanical Room Lab Water Treatment 1-BAS-MECH-002

West Basement

Mechanical Room Hot Water Makeup 1-BAS-MECH-003

West Basement

Mechanical Room Main Water Supply 1-BAS-MECH-004

West Basement

Mechanical Room Fire Protection System 1-BAS-MECH-005

West Basement

Mechanical Room Fire Protection System 1-BAS-MECH-006

* D119 Waste Disposal 1-001-D119-001

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September 2018 | Page 1 of 3

Doc: App F. Cross-Connections Inventory.xlsx | Building 1

Location Usage Comments

* Lobby Starbucks - Ice Machine 1-001-LOBBY-001

* Lobby Starbucks - Coffee Maker 1-001-LOBBY-002

* Outside Hosebibs 1-05-IRR-001

A102 Pharmacy Mop Sink (Hose) 1-001-A102-001

Dining Room /

Cafeteria

* B107A Hot Drink Machine 1-001-B107A-001

B107A Soda Machine 1-001-B107A-002

* B107A Coffee Machine 1-001-B107A-003

* B107A Tea Machine 1-001-B107A-004

B107A Ice Machine 1-001-B107A-005

* B107A Convection Oven 1-001-B107A-006

* B107A Dishwasher 1-001-B107A-007

B107A Steam Table 1-001-B107A-008

* E113 Janitor's Closet - Chemical

Feed 1-001-E113-001

* E107 Pharmacy Mop Sink (Hose) 1-001-E107-001

* B252 Hall Access to Mechanical

Room 1-002-B252(mec)-001

B252 Hall Access to Hose Bibb 1-002-B252(mec)-002

* A200 Water Purification 1-002-A200-001

* A202 Chemical Feed 1-002-A202-001

* C213 Catscan 1-002-C213-001

C330 Mechanical Room 1-003-C330-001

* C303 Chemical Feed 1-003-C303-001

C314 Heat Transfer 1-003-C314-001

* C314 Water Feed 1-003-C314-002

* A427 Coffee Machine 1-004-A427-001

* A428 Chemical Feed 1-004-A428-001

* A430 Ice Machine 1-004-A430-001

* A433 Rehab Room Tub & Hose 1-004-A433-001

* A433 Rehab Room - Chemical

Feed 1-004-A433-002

* A526 Service Room

(Ice Machine) 1-005-A526-001

A505 Vermacare Disposal 1-005-A505-001

* A531 Janitor's Closet - Chemical

Feed 1-005-A531-001

Mann-Grandstaff VAMC | Cross-Connection Inventory Rpt

September 2018 | Page 2 of 3

Location Usage Comments

A535 Rehab Room Tub w/ Hose 1-005-A535-001

A535 Rehab Room - Chemical

Feed Unit 1-005-A535-002

A633 Janitor's Closet - Chemical

Feed 1-006-A633-002

A633 Janitor's Closet - Swamp

Cooler 1-006-A633-002

A633 Cooling Unit 1-006-A633-002

* A731 Janitor's Closet - Chemical

Feed 1-007-A731-001

* A806 Janitor's Closet - Chemical

Feed 1-008-A806-001

B803D Surgical Equipment

Washers 1-008-B803D-001

B803D Surgical Equipment

Washers 1-008-B803D-002

B801 Autoclave Room

(Backside) 1-008-B801-001

B801 Autoclave Room

(Backside) 1-008-B801-002

* B810 Janitor's Closet - Chemical

Feed 1-008-B810-001

* B802 Laparoscopic Sterilizing

Room 1-008-B802-001

A900 Domestic Service 1-009-A900-001

A900 Hot Water System 1-009-A900-002

A900 Deionized Water 1-009-A900-003

A900 Heating & Cooling 1-009-A900-004

A900 Heating & Cooling 1-009-A900-005

A900 Heating & Cooling 1-009-A900-006

A900 Hose Bib - Stack 46 1-009-A900-007

A900 Hot Water - Makeup 1-009-A900-008

A900 Booster Pump 1-009-A900-009

NOTE:

Abbreviations: RPBA = Reduced Pressure Backflow Assembly , Rehab = Rehabilitation.

1 An '*' indicates if a cross-connection issue was found.

Mann-Grandstaff VAMC | Cross-Connection Inventory Rpt

September 2018 | Page 3 of 3

Appendix F. Cross-Connection Inventory Building: 2

Issue Location Usage Comments

Outside Hose Bibbs (1) 2-05-IRR-001

Outside Fire Protection System 2-05-FIRE-001

Chilled Water Area -

Chilled Water Makeup 2-001-124-001

Chilled Water Area -

Cooling Tower Makeup 2-001-124-002

Chilled Water Area -Boiler

Blowoff Cooling 2-001-124-003

Boiler Room - Main Water

Supply #1 2-001-122-001

Boiler Room - Main Water

Supply #2 2-001-122-002

Boiler Room - Main Water

Supply #3 (Soft Water) 2-001-122-003

122 Boiler Room - Ice Machine 2-001-122-004

122 Hot Water Heater Air Gap 2-002-122-001

Janitor's Closet Chemical

Feed 2-001-104-001

Finish and Assembly Ice

Machine 2-001-116-001

Mann-Grandstaff VAMC | Cross-Connection Inventory Rpt

September 2018

Doc: App F. Cross-Connections Inventory.xlsx | Building 2

Appendix F. Cross-Connection Inventory Building: 3

Location Usage Comments

* Outside Hose Bibs (5) Need Vacuum Breaker

3-OS-IRR-001

Outside Fire Protection System 3-001-Fire-001

113 Hot Water Makeup Line 3-001-113-001

Carpentry - Main Water

Supply Containment 3-001-108-001

NOTE:

1 An '*' indicates if a cross-connection issue was found.

Mann-Grandstaff VAMC | Cross-Connection Inventory Rpt

September 2018

Doc: App F. Cross-Connections Inventory.xlsx | Building 3

Appendix F. Cross-Connection Inventory Building: 4

Outside Hose Bibs (4) Not Protected

4-OS-IRR-001

Janitor's Closet Janitor's Closet - Chemical

Feed

4-001-JC-001

Main Water Supply Main Water Connection 4-001-MWS-001

105A Recirculation Hot Water 4-001-MECH-001

Mann-Grandstaff VAMC | Cross-Connection Inventory Rpt

September 2018

Doc: App F. Cross-Connections Inventory.xlsx | Building 4

Appendix F. Cross-Connection Inventory Building: 5

Location Usage Comments

* 105A Janitor's Closet 5-001-105A-001

Irrigation Irrigation Connection 5-OS-IRR-001

Irrigation Irrigation Connection 5-OS-IRR-002

Irrigation Irrigation Connection 5-OS-IRR-003

* Outside Hose Bibbs (5) 5-OS-IRR-004

* 105A Main Connection 5-001-105A-002

NOTE:

1 An '*' indicates if a cross-connection issue was found.

Mann-Grandstaff VAMC | Cross-Connection Inventory Rpt

September 2018

Doc: App F. Cross-Connections Inventory.xlsx | Building 5

Appendix F. Cross-Connection Inventory Building: 6

Outside Hose Bibbs (3) Not Protected

6-OS-IRR-001

Main Water Supply Main Service Connection 6-001-MWS-001

Mann-Grandstaff VAMC | Cross-Connection Inventory Rpt

September 2018

Doc: App F. Cross-Connections Inventory.xlsx | Building 6

Appendix F. Cross-Connection Inventory Building: 6A

Main Water Supply Main Service Connection Need a Duel Check Installed

6A-001-MWS-001

Mann-Grandstaff VAMC | Cross-Connection Inventory Rpt

September 2018

Doc: App F. Cross-Connections Inventory.xlsx | Building 6A

Appendix F. Cross-Connection Inventory Building: 7

Location Usage Comments

Mechanical Room - Main

Water Line 7-001-126-001

Mechanical Room - Fire

Protection 7-001-126-002

Mechanical Room - Hot

Water Air Gap OK

* 147 Janitor's Closet - Chemical

Feed 007-001-147-001

* 126 Hot Water Recirculation 007-001-126-003

NOTE:

1 An '*' indicates if a cross-connection issue was found.

Mann-Grandstaff VAMC | Cross-Connection Inventory Rpt

September 2018

Doc: App F. Cross-Connections Inventory.xlsx | Building 7

Appendix F. Cross-Connection Inventory Building: 10

Mechanical Room Mechanical Equipment

(Makeup Water)

10-001-MECH-001

Mann-Grandstaff VAMC | Cross-Connection Inventory Rpt

September 2018

Doc: App F. Cross-Connections Inventory.xlsx | Building 10

Appendix F. Cross-Connection Inventory Building: 12

Location Usage Comments

OS

Hose Bibbs - Irrigation

Facility Protection Fire

Protection

Have Vacuum Breakers

* 106 Janitor's Closet - Chemical

Feed 12-001-106-001

* 106 Janitor's Closet -

Wheelchair Wash 12-001-106-002

104 Janitor's Closet

Mechanical Room - Heat

Exchanger 12-001-110-001

* 110 Mechanical Room -

Building Water Source 12-001-110-002

* 110 Mechanical Room - Fire

Protection System 12-001-110-003

115B Shower Room

(Note: Hose in Shower) Standard Plumbing

* 116 Dining Room - Coffee

Machine 12-001-116-001

* 116 Dining Room - Ice

Machine 12-001-116-002

* 147 Kitchenette - Ice Machine 12-001-147-001

* 127 Janitor's Closet - Chemical

Unit 12-001-127-001

* 146 Treatment Room - Bed Pan

Wash 12-001-146-001

* 146 Treatment Room - Tubs -

Hoses 12-001-146-002

* 146 Treatmennt Room -

Chemical Feed 12-001-146-003

* 129 Patient Room - Bath Tub

Hose 12-001-129-001

* 133 Patient Room - Bath Tub

Hose 12-001-133-001

Patient Room - Bath Tub

Hose 12-001-142-001

Patient Room - Bath Tub

Hose 12-001-162-001

* 153 Patient Room - Bath Tub

Hose 12-001-153-001

Mann-Grandstaff VAMC | Cross-Connection Inventory Rpt

September 2018 | Page 1 of 2

Doc: App F. Cross-Connections Inventory.xlsx | Building 12

Appendix F. Cross-Connection Inventory Building: 12

Location Usage Comments

* 111 Janitor's Closet - Chemical

Feed

* Garden Area Hose Bibbs (3) 2 Need Vacuum Breakers

* 201 Solar Water Heating 12-002-201-001

201 Heating and Cooling 12-002-201-003

* 201 Hot Water Pressure Relief 12-002-201-002

Outside Hose Bibb Has a Vacuum Breaker

NOTE:

1 An '*' indicates if a cross-connection issue was found.

Mann-Grandstaff VAMC | Cross-Connection Inventory Rpt

September 2018 | Page 2 of 2

Doc: App F. Cross-Connections Inventory.xlsx | Building 12

Appendix F. Cross-Connection Inventory Building: 14

Location Usage Comments

105A Fire Protection System 14-001-105A-001

* 105A Water Main 14-001-105A-002

* 103 Janitor's Sink - Chemical

Feed 14-001-103-001

* 101A Heating & Cooling Unit

Makeup Water 14-001-101A-001

NOTE:

1 An '*' indicates if a cross-connection issue was found.

Mann-Grandstaff VAMC | Cross-Connection Inventory Rpt

September 2018

Doc: App F. Cross-Connections Inventory.xlsx | Building 14

Appendix F. Cross-Connection Inventory Building: 16

Issue Room No. Usage Comments

1 Hose Bibb OK

Mann-Grandstaff VAMC | Cross-Connection Inventory Rpt

September 2018

Doc: App F. Cross-Connections Inventory.xlsx | Building 16

Appendix F. Cross-Connection Inventory Building: 27

Location Usage Comments

* Building 1 (C005D) Main Water Supply (27) 27-BAS-025-001

* Building 1 (C005D) Main Water Supply (26) 26/27-BAS-SHOP-001

* 25 Hot Water Recirculation 27-BAS-025-002

* Shop / Storage Hot Water Recirculation 26/27-BAS-SHOP-002

27 Fire Protection System 27-BAS-027-001

Shop / Storage Chilled Water System 26/27-BAS-SHOP-003

Heating Unit Makeup

Water

27-BAS-025-003

Outside Hose Bibb (3) Have Vacuum Breaker

Building 26 Fire Protection System 26-BAS-VAULT-001

Building 1 (C005D) Main Water Supply (25) 25-BAS-000-001

Janitor's Closet - Chemical

Feed 27-001-126-001

Janitor's Closet - Chemical

Feed 27-001-183-001

NOTE:

1 An '*' indicates if a cross-connection issue was found.

Mann-Grandstaff VAMC | Cross-Connection Inventory Rpt

September 2018

Doc: App F. Cross-Connections Inventory.xlsx | Building 27

Appendix F. Cross-Connection Inventory Building: 30

Location Usage Comments

Mechanical Room - Hot

Water Heater 30-001-122-001

* 122 Mechanical Room - Fire

Protection 30-001-122-002

* 122 Mechanical Room -

Building Protection 30-001-122-003

* 124 Janitor's Closet - Chemical

Feed 30-001-124-001

122 Hot Water Heater Makeup 30-001-122-004

NOTE:

1 An '*' indicates if a cross-connection issue was found.

Mann-Grandstaff VAMC | Cross-Connection Inventory Rpt

September 2018

Doc: App F. Cross-Connections Inventory.xlsx | Building 30

Appendix F. Cross-Connection Inventory Building: 31

Location Usage Comments

OS Hose Bibbs (2) Have Vacuum Breakers

* 115 Mechanical Room - Hot

Water Heater 31-001-115-001

* 115 Mechanical Room - Tank

Hose Bibbs 31-001-115-002

Mechanical Room -

Building Protection 31-001-115-004

Mechanical Room - Fire

Protection 31-001-115-003

* 123 Janitor's Closet - Chemical

Feed 31-001-123-001

* 135 Bathroom - Shower 1 Hose in Shower

* 135 Bathroom - Shower 2 Hose in Shower

* 145 Treatment - Ice Machine 31-001-145-001

* 146 Treatment - Ice Machine 31-001-146-001

NOTE:

1 An '*' indicates if a cross-connection issue was found.

Mann-Grandstaff VAMC | Cross-Connection Inventory Rpt

September 2018

Doc: App F. Cross-Connections Inventory.xlsx | Building 31

Appendix F. Cross-Connection Inventory Building: 33

111A Mechanical Room -

Protection 33-001-111A-001

111A Mechanical Room - Water

Main 31-001-111A-002

Janitor's Closet - Hot Water

Heater 33-001-123-001

Janitor's Closet - Chemical

Feed 33-001-123-002

Mechanical Room - Hot

Water Recirculation 33-001-123-003

Mann-Grandstaff VAMC | Cross-Connection Inventory Rpt

September 2018

Doc: App F. Cross-Connections Inventory.xlsx | Building 33

Appendix F. Cross-Connection Inventory Building: 37

Sweat Lodge Sweat Lodge 37-OS-SW-001

Mann-Grandstaff VAMC | Cross-Connection Inventory Rpt

September 2018

Doc: App F. Cross-Connections Inventory.xlsx | Building 37

Appendix F. Cross-Connection Inventory Building: 40

Location Usage Comments

Mechanical (East) Mechanical Room - Hose

Bibb

40-BAS-ME-001

Mechanical (East) Mechanical Room - Snow

Melting Equipment

40-BAS-ME-002

* Mechanical (East) Mechanical Room - Trap

Primers

40-BAS-ME-003

* 12 Janitor's Closet - Chemical

Unit

40-BAS-012-001

Mechanical (West) Main Water Feed 40-BAS-MW-002

Mechanical (West) Main Water Feed 40-BAS-MW-003

Mechanical (West) Fire Protection 40-BAS-MW-001

Mechanical (West) Fire Protection 40-BAS-MW-004

Outside Hose Bibbs (6) Have Vacuum Breakers

* 111 Janitor's Closet - Chemical

Unit 40-001-111-001

Janitor's Closet - Chemical

Unit 40-002-209-001

NOTE:

1 An '*' indicates if a cross-connection issue was found.

Mann-Grandstaff VAMC | Cross-Connection Inventory Rpt

September 2018

Doc: App F. Cross-Connections Inventory.xlsx | Building 40

Appendix F. Cross-Connection Inventory Building: 41

Location Usage Comments

OS Hose Bibbs (4) OK - Have Vacuum Breakers

126A Mechanical Room - Main

Water Supply 41-001-126A-001

126A Mechanical Room - Fire

Protection 41-001-126A-002

126A Mechanical Room - Fire

Protection 41-001-126A-003

126A Mechanical Room -

Heating & Cooling 41-001-126A-004

* 126A Mechanical Room - Trap

Primers 41-001-126A-005

* 126A Mechanical Room - Hot

Water Recirculation 41-001-126A-006

* 130 Housekeeping Closet -

Chemical Feed 41-001-130-001

* 104 Restroom - Trap Primer 41-001-104-001

* 111 Restroom - Trap Primer 41-001-111-001

* 127 Restroom - Trap Primer 41-001-127-001

NOTE:

1 An '*' indicates if a cross-connection issue was found.

Mann-Grandstaff VAMC | Cross-Connection Inventory Rpt

September 2018

Doc: App F. Cross-Connections Inventory.xlsx | Building 41

Appendix F. Cross-Connection Inventory IRR - 42

Location Usage Comments

Irrigation-1 Landscape Irrigation IRR-000-000-001

Irrigation-2 Landscape Irrigation IRR-000-000-002

Irrigation-3 Landscape Irrigation IRR-000-000-003

Irrigation-4 Landscape Irrigation IRR-000-000-004

* Irrigation-5 Landscape Irrigation IRR-000-000-005

Irrigation-6 Landscape Irrigation IRR-000-000-006

NOTE:

1 An '*' indicates if a cross-connection issue was found.

Mann-Grandstaff VAMC | Cross-Connection Inventory Rpt

September 2018

Doc: App F. Cross-Connections Inventory.xlsx | IRR-42