Equipment List.pdf

System Manufacturer Model # Serial # Location / Room Details

Medical Air Powerex MPD10084P5 (H)2/26/2019-000001539-425 1st Floor Mech. Room C106 duplex, medical reciprocating piston compressors (oil-less), desiccant dyer

Medical Vacuum Dekker VMX0203KA3-40-ES I19576 1st Floor Mech. Room C106 triplex, oil-sealed liquid ring, separator reservoir, receiver tank

Dental Air Powerex TDR80GVLHPR50 (H)2/19/2019-000001539-395 4th Floor Mech. Room A421 quadplex, scroll compressors (oil-less), refrigerated dryer

Dental Vacuum Tech West Inc. VPD30D5 VPD30-5038 3rd Floor Mech. Room A327 duplex, dry rotary vane vacuum system, separator tank, amalgam separators

Liquid Oxygen Bulk

(with Reserve Cylinder Bank) AirGas Exterior Oxygen Storage Yard 18 reserve cylinder bank

Nitrous Oxide Cylinder Bank Allied Healthcare

Products Chemetron 4000 Series 20111206003 Mech. Yard Storage Room F103

Auto Switchover Manifold, 6 in-use & 6 reserve cylinder configuration

Nitrogen Cylinder Bank Allied Healthcare

Products Chemetron 4000 Series 20111209001 Mech. Yard Storage Room F102

Auto Switchover Manifold, 6 in-use & 6 reserve cylinder configuration

Medical Gas & Vacuum System Equipment List

**As of April 2026, could be subject to change by time of contract award**

Medical Air

Medical Vacuum

Dental Air

Dental Vacuum

Liquid Oxygen Bulk PRV

STATION

Nitrous Oxide Cylinder Bank

Nitrogen Cylinder Bank

PREPARED BY: BRAYDEN SEGER

SERVICE DATE: JANUARY 6TH, 2026

EL PASO VAMC

MEDICAL GAS

ANNUAL

INSPECTION

5001 N PIEDRAS ST

EL PASO, TX 79930

ITEMS TESTED/INSPECTED

OXYGEN MEDICAL AIR

MEDICAL

VACUUM

NITROUS

OXIDE

NITROGEN

CARBON

DIOXIDE

INST. AIR WAGD

SOURCE EQUIPMENT P P P P P

MASTER ALARMS P P P P P

ZONE VALVES P P P P P P

ZONE VERIFICATION P P P P P P

CROSS CONNECTION P P P P P P

AREA ALARMS P P P P P

PATIENT OUTLETS P P P P P P

PARTICLE ANALYSIS P P P P

PURITY ANALYSIS P P P P

MGI MEDICAL GAS VERIFIER: BRAYDEN SEGER

SIGNATURE:

DATE: 1/6/2026

MEDICAL GAS ANNUAL TESTING ANALYSIS

MEDICAL GAS TYPE

SCOPE OF

TESTING/VERIFICATION

NFPA 99 2018 Compliant Medical Gas Annual Inspection for a Category 1 Medical Facility. Includes testing of all medical gas source equipment, medical gas zone valves, medical gas master alarm panels, medical gas area alarm panels, medical gas control panels, medical gas flexible terminals and medical gas terminals and medical gas labeling.

ADDITIONAL COMMENTS

https://qrplanet.com/8lq61w

EXECUTIVE SUMMARY

SIGNALS

PASSED

SIGNALS

FAILED

TOTALS 2 46 39 7

MASTER ALARM PANEL OHIO HEALTHCAIR 1 23 20 3

MASTER ALARM PANEL OHIO HEALTHCAIR 1 23 19

2 2 0

SOURCE EQUIPMENT MASTER ALARMS

EQUIPMENT

EQUIPMENT MAKE &

MODEL

ALARM PANEL

COUNT

ALARM SIGNAL

COUNT

TOTAL 9 9 0

MASTER ALARM PANEL ALARMS

DENTAL AIR SCROLL 1 1 0

DENTAL VACUUM TURBINE 1 1 0

NITROGEN GAS X GAS MANIFOLD 1 1 0

OXYGEN BULK OXYGEN 1 1 0

MEDICAL AIR RECIPROCATING 1 1 0

EXECUTIVE OVERALL SUMMARY-SOURCE

SOURCE EQUIPMENT

GAS TYPE SOURCE TYPE TOTAL COUNT TOTAL PASSED TOTAL FAILED

VACUUM LIQUID RING 1 1 0

NITROUS OXIDE GAS X GAS MANIFOLD 1 1 0

FAILED REPAIRED FAILED REPAIRED

TOTAL PERCENTAGE OF

OUTLETS TESTED

100.0%

TOTAL OUTLET

FAILURES

TOTAL OUTLETS

REPAIRED

1 0

TOTAL 292 291 1 0

PERCENTAGE 99.7% 0.3% 0.0%

WAGD 16 16 0 0

NITROUS OXIDE 16 15 1 0

NITROGEN 25 25 0 0

VACUUM 104 104 0

03 0

PATIENT OUTLET TERMINALS

MEDICAL AIR 53 53 0 0

0 0

EXECUTIVE OVERALL SUMMARY-PIPELINE

ZONE VALVE BOXES AREA ALARM PANELS

TOTAL ZVB LOCATIONS TOTAL AREA ALARM PANELSTOTAL PASSED TOTAL PASSED

513 510

MISSING VALVES MISSING ALARMS

OXYGEN 78 78 0 0

GAS TYPE TOTAL COUNT TOTAL PASSED TOTAL FAILED TOTAL UNAVAILABLE

MGI TECHNICIAN: BRAYDEN SEGER

1 SPECIFIC OUTLET REPAIRED BY REPAIR DATE

NITROUS OXIDEOR-6 LEFT COLUMN ALLIED - CNT2 - CH LEAKS W/OUT ADAPTER INSERTED

END OF OUTLET ISSUES

OUTLET ISSUES EL PASO VAMC

ROOM OUTLET SPECS ISSUE

EL PASO VAMC

CORRECTED

CORRECTED

CORRECTED

CORRECTED

NFPA 99 2018 CODE 5.1.8.1.3*

The scale range of positive pressure analog indicators shall be such that the normal operating pressure is within the middle third of the total range [e.g., an indicator of 0 to 2070 kPa (0 to 300 psi) would have a lower third of 0 to 690 kPa (0 to 100 psig), a middle third of 690 kPa to 1380 kPa (100 psig to 200 psig), and a top third of 1380 kPa to 2070 kPa (200 psig to 300 psig)].

CORRECTIVE ACTIONS

AREA ISSUE NFPA 99 2018 CODE

ZONE VALVE FOR MEDICAL AIR SERVING

BIOMED

NORMAL OPERATING PRESSURE DOES NOT FALL IN

THE MIDDLE THIRD OF THE ZONE VALVE GAUGE.

NFPA 99 2018 CODE 5.1.8.1.3*

The scale range of positive pressure analog indicators shall be such that the normal operating pressure is within the middle third of the total range [e.g., an indicator of 0 to 2070 kPa (0 to 300 psi) would have a lower third of 0 to 690 kPa (0 to 100 psig), a middle third of 690 kPa to 1380 kPa (100 psig to 200 psig), and a top third of 1380 kPa to 2070 kPa (200 psig to 300 psig)].

CORRECTIVE

ACTION

INTALL A 0-100 PSI GAUGE ON THE MEDICAL AIR ZONE VALVE

AREA ISSUE NFPA 99 2018 CODE

CORRECTIVE

ACTION

AREA ISSUE NFPA 99 2018 CODE

NFPA 99 2018 CODE

PRESSURE SWITCH/GAUGES FOR OXYGEN,

VACUUM, NITROGEN, AND NITROUS OXIDE

PRESSURE SWITCHES/GAUGES ARE NOT ON GAS

SPECIFIC DISS DEMAND CHECKS.

NFPA 99 2018 CODE 5.1.8.2.3

All pressure-sensing devices and main line pressure gauges downstream of the source valves shall be provided with a gas-specific demand check fitting to facilitate service testing or replacement.

ISSUE

INSTALL GAS SPECIFIC DISS DEMAND CHECKS ON THE PRESSURE SWITCH/GAUGE.

ZONE VALVE FOR NITROUS OXIDE SERVING

OR-4

NORMAL OPERATING PRESSURE DOES NOT FALL IN

THE MIDDLE THIRD OF THE ZONE VALVE GAUGE.

NFPA 99 2018 CODE 5.1.8.1.3*

The scale range of positive pressure analog indicators shall be such that the normal operating pressure is within the middle third of the total range [e.g., an indicator of 0 to 2070 kPa (0 to 300 psi) would have a lower third of 0 to 690 kPa (0 to 100 psig), a middle third of 690 kPa to 1380 kPa (100 psig to 200 psig), and a top third of 1380 kPa to 2070 kPa (200 psig to 300 psig)].

CORRECTIVE

ACTION

INSTALL 0-100 PSI GAUGE ON THE NITROUS OXIDE ZONE VALVE

CORRECTIVE

ACTION

INTALL A 0-100 PSI GAUGE ON THE MEDICAL AIR ZONE VALVE

AREA

ZONE VALVE FOR MEDICAL AIR SERVING

DENTAL CLINIC

NORMAL OPERATING PRESSURE DOES NOT FALL IN

THE MIDDLE THIRD OF THE ZONE VALVE GAUGE.

CORRECTIVE ACTIONS

CORRECTED

CORRECTED

CORRECTED

CORRECTIVE

ACTION

CHECK WIRING AT THE MASTER ALARM PANEL AND THE PRESSURE SWITCH.

AREA ISSUE NFPA 99 2018 CODE

MASTER ALARMS

THE MEDICAL AIR HIGH DEWPOINT DID NOT ALARM

AT THE ENGINEERING BUILDING MASTER ALARM

Master alarm panels for medical gas and vacuum systems shall each include the following signals: (NFPA

99 2018 5.1.9.2.4)

(10) Medical air dew point high alarm from each compressor site to indicate when the line pressure dew point is greater than +2°C (+35°F)

MASTER ALARMS

THE DENTAL AIR HIGH LINE PRESSURE ALARMED AS

LOW LINE PRESSURE AND THE LOW LINE PRESSURE

ALARMED AS HIGH LINE PRESSURE

Master alarm panels for medical gas and vacuum systems shall each include the following signals: (NFPA

99 2018 5.1.9.2.4)

(7) Alarm indication when the pressure in the main line of each separate medical gas system increases 20 percent or decreases 20 percent from the normal operating pressure.

CORRECTIVE

ACTION

REWIRE THE PRESSURE SWITCH TO FIX THE MISMATCHED ALARMS.

CORRECTIVE

ACTION

WIRE IN THE OXYGEN LINE PRESSURE HIGH TO BOTH MASTER ALARM PANELS.

AREA ISSUE NFPA 99 2018 CODE

AREA ISSUE NFPA 99 2018 CODE

MASTER ALARMS

OXYGEN LINE PRESSURE HIGH DOES NOT HAVE A

SIGNAL RAN TO THE MASTER ALARM PANELS

Master alarm panels for medical gas and vacuum systems shall each include the following signals: (NFPA

99 2018 5.1.9.2.4)

(7) Alarm indication when the pressure in the main line of each separate medical gas system increases 20 percent or decreases 20 percent from the normal operating pressure.

END OF CORRECTIVE ACTIONS

NOTE: CORRECTIVE ACTIONS ARE COMPONENTS OF THE MEDICAL GAS SYSTEM THAT DO NOT MEET THE NFPA 99 2018 CODE AND SHOULD BE UPGRADED OR REPAIRED TO MEET THE

NFPA 99 2018 CODE.

NOTE: THESE ARE COMPONENTS OF THE MEDICAL GAS SYSTEM THAT DO NOT MEET THE 2018 NFPA 99 CODE, HOWEVER THEY ARE PERMITTED TO

REMAIN IN USE UNTIL THE AREA(S) ARE UPGRADED OR RENOVATED DUE TO THE ABOVE NOT AFFECTING PATIENT CARE.

END OF FUTURE CORRECTIONS

FUTURE CORRECTIONS

AREA ISSUE NFPA 99 2018 CODE

NONE

FUTURE

CORRECTION

MEDICAL GAS MASTER

ALARM ANALYSIS

MASTER ALARM CODE REQUIREMENTS

Master alarm panels for medical gas and vacuum systems shall each include the following signals: (NFPA

99 2018 5.1.9.2.4)

(1) Alarm indication when, or just before, changeover occurs in a medical gas system that is supplied by a manifold or other alternating-type bulk system that has as a part of its normal operation a changeover from one portion of the operating supply to another.

(2) Alarm indication for a bulk cryogenic liquid system when the main supply reaches an average day’s supply, indicating low contents.

(3) Alarm indication when, or just before, the changeover to the reserve supply occurs in a medical gas system that consists of one or more units that continuously supply the piping system while another unit remains as the reserve supply and operates only in the case of an emergency.

(4) Alarm indication for cylinder reserve pressure low when the content of a cylinder reserve header is reduced below one average day’s supply.

(5) For bulk cryogenic liquid systems, an alarm when or at a predetermined set point before the reserve supply contents fall to one day’s average supply, indicating reserve low.

(6) Where a cryogenic liquid storage unit is used as a reserve for a bulk supply system, an alarm indication when the gas pressure available in the reserve unit is below that required for the medical gas system to function.

(7) Alarm indication when the pressure in the main line of each separate medical gas system increases 20 percent or decreases 20 percent from the normal operating pressure.

(8) Alarm indication when the medical–surgical vacuum pressure in the main line of each vacuum system drops.

(9) Alarm indication(s) from the local alarm panel(s) as described in 5.1.9.5.2 to indicate when one or more of the conditions being monitored at a site is in alarm.

(10) Medical air dew point high alarm from each compressor site to indicate when the line pressure dew point is greater than +2°C (+35°F)

(11) WAGD low alarm when the WAGD vacuum level or flow is below effective operating limits.

(12) An instrument air dew point high alarm from each compressor site to indicate when the line pressure dew point is greater than −30°C (−22°F).

(13) Alarm indication if the primary or reserve production stops on a proportioning system.

EL PASO VAMC MGI TECHNICIAN: BRAYDEN SEGER

EL PASO, TX 79930 TESTING DATE: 1/6/2026

VISUAL

STATUS

AUDIBLE

STATUS

LABELED

CORRECTLY

COMMENTS

P P P

P P P

P P P

NO SIGNAL RAN FOR HIGH

P P P

P P P

P DID NOT ALARM AT PANEL

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P ALARMED AS HIGH LINE PRESSURE

P P ALARMED AS LOW LINE PRESSURE

ALARM MAKE AND MODEL: ENGINEERING BUILDING

COMMENTS

PASS/FAIL

FAIL

PER NFPA 99 2018 WHERE IS THE MASTER ALARM LOCATED OF THE FOLLOWING LOCATIONS LOCATION

DENTAL AIR HIGH LINE PRESSURE FAIL

OHIO HEALTHCAIR LOCATION:

(1) One master alarm panel shall be located in the office or work space of the on-site individual responsible for the maintenance of the medical gas and vacuum piping systems.

(2) In order to ensure continuous surveillance of the medical gas and vacuum systems while the facility is in operation, the second master alarm panel shall be located in an area of continuous observation (e.g., the telephone switchboard, security office, or other continuously staffed location).

DENTAL AIR LOW LINE PRESSURE FAIL

NITROGEN LINE PRESSURE HIGH PASS

NITROGEN LINE PRESSURE LOW PASS

NITROUS OXIDE RESERVE IN USE PASS

DENTAL AIR SYSTEM GENERAL ALARM PASS

NITROUS OXIDE LINE PRESSURE HIGH PASS

NITROUS OXIDE LINE PRESSURE LOW PASS

DENTAL AIR HIGH DEW POINT PASS

NITROGEN RESERVE IN USE PASS

MEDICAL VACUUM LAG IN USE PASS

MEDICAL VACUUM LINE PRESSURE LOW PASS

MEDICAL VACUUM HIGH TEMP SHUTDOWN PASS

MEDICAL AIR GENERAL ALARM PASS

MEDICAL AIR LINE PRESSURE HIGH PASS

MEDICAL AIR LINE PRESSURE LOW PASS

MASTER ALARM ANALYSIS

MASTER ALARM SIGNALS PASS/FAIL

OXYGEN PRIMARY LIQUID LEVEL LOW PASS

OXYGEN RESERVE IN USE PASS

OXYGEN RESERVE LOW PASS

OXYGEN LINE PRESSURE HIGH FAIL

OXYGEN LINE PRESSURE LOW PASS

MEDICAL AIR RESERVE COMP IN USE PASS

MEDICAL AIR HIGH DEW POINT FAIL

EL PASO VAMC MGI TECHNICIAN: BRAYDEN SEGER

EL PASO, TX 79930 TESTING DATE: 1/6/2026

VISUAL

STATUS

AUDIBLE

STATUS

LABELED

CORRECTLY

COMMENTS

P P P

P P P

P P P

NO SIGNAL RAN FOR HIGH

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P ALARMED AS HIGH LINE PRESSURE

P P ALARMED AS LOW LINE PRESSURE

ALARM MAKE AND MODEL: BIOMED

COMMENTS

MASTER ALARM ANALYSIS

MASTER ALARM SIGNALS PASS/FAIL

OXYGEN PRIMARY LIQUID LEVEL LOW PASS

OXYGEN RESERVE LOW PASS

OXYGEN LINE PRESSURE HIGH FAIL

OXYGEN RESERVE IN USE PASS

OXYGEN LINE PRESSURE LOW PASS

MEDICAL AIR RESERVE COMP IN USE PASS

MEDICAL AIR HIGH DEW POINT PASS

MEDICAL AIR GENERAL ALARM PASS

MEDICAL AIR LINE PRESSURE HIGH PASS

MEDICAL AIR LINE PRESSURE LOW PASS

MEDICAL VACUUM LAG IN USE PASS

MEDICAL VACUUM LINE PRESSURE LOW PASS

MEDICAL VACUUM HIGH TEMP SHUTDOWN PASS

OHIO HEALTHCAIR LOCATION:

NITROUS OXIDE LINE PRESSURE HIGH PASS

NITROUS OXIDE LINE PRESSURE LOW PASS

DENTAL AIR HIGH LINE PRESSURE FAIL

DENTAL AIR SYSTEM GENERAL ALARM PASS

DENTAL AIR HIGH DEW POINT PASS

DENTAL AIR LOW LINE PRESSURE FAIL

PER NFPA 99 2018 WHERE IS THE MASTER ALARM LOCATED OF THE FOLLOWING LOCATIONS LOCATION

(1) One master alarm panel shall be located in the office or work space of the on-site individual responsible for the maintenance of the medical gas and vacuum piping systems.

(2) In order to ensure continuous surveillance of the medical gas and vacuum systems while the facility is in operation, the second master alarm panel shall be located in an area of continuous observation (e.g., the telephone switchboard, security office, or other continuously staffed location).

PASS/FAIL

FAIL

NITROUS OXIDE RESERVE IN USE PASS

NITROGEN RESERVE IN USE PASS

NITROGEN LINE PRESSURE HIGH PASS

NITROGEN LINE PRESSURE LOW PASS

MEDICAL GAS AREA

ALARM ANALYSIS

(2) *Critical Care Areas

(4) Means to visually indicate a lamp or LED failure

AREA ALARM CODE REQUIREMENTS

Area alarm systems used for medical gas and vacuum systems shall include the following:

(NFPA 99 2018 5.1.9.1)

(1) Separate visual indicators for each condition monitored, except as permitted in 5.1.9.5.2 for local alarms that are displayed on master alarm panels.

(2) Visual indicators that remain in alarm until the situation that has caused the alarm is resolved.

(3) Cancelable audible indication of each alarm condition that produces a sound with a minimum level of

80 dBA at 0.92m (3 ft)

(2)*Anesthetizing locations where moderate sedation, deep sedation, or general anesthesia is administered shall have the sensors installed either on the source side of any of the individual room zone valve box assemblies or on the patient or use side of each of the individual zone valve box assemblies.

(5) Visual and audible indication that the communication with an alarm-initiating devices is disconnected.

(6) Labeling of each indicator, indication the condition monitored.

(7) Labeling of each alarm panel for its area of surveillance.

(8) Reinitiating of the audible signal if another alarm condition occurs while the audible alarm is silenced.

(9) Power for master, area alarms, sensors, and switches from the life safety branch of the emergency electrical system as described in Chapter 6.

Area Alarms. Area alarm panels shall be provided to monitor all medical gas, medical–surgical vacuum, and piped WAGD systems supplying the following: (NFPA 99 2018 5.1.9.4)

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

Area alarm panels for medical gas systems shall indicate if the pressure in the lines in the area being monitored increases or decreases by 20 percent from the normal line pressure. (NFPA 99 2018 5.1.9.4.2)

Area alarm panels for medical–surgical vacuum systems shall indicate if the vacuum in the area drops to or below 300 mm (12 in.) gauge HgV. (NFPA 99 2018 5.1.9.4.3)

Alarm sensors for area alarms shall be located as follows: (NFPA 99 2018 5.1.9.4.4)

(1)*Critical care areas shall have the alarm sensors installed on the patient or use side of each individual zone valve box assemblies.

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 53 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 46 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 23" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 3RD ALARM LOCATION:

END OF 3RD FLOOR AREA ALARM ANALYSIS

AREA ALARM ANALYSIS

3RD FLOOR

AREA MONITORED: COMMENTS

RADIOLOGY ROOMS B309,

B312, B315, B317

RADIOLOGY CHECK IN ALARM MAKE AND MODEL: CHEMETRON IMPACT

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 56 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 47 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 21" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 4TH ALARM LOCATION:

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 55 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 21" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 4TH ALARM LOCATION:

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 54 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 48 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 21" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 4TH ALARM LOCATION:

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 55 PSI PASS 60 PSI 40 PSI PASS PASS MAINLINE P

MED AIR 46 PSI PASS 60 PSI 40 PSI PASS PASS MAINLINE P

VACUUM 20" HG PASS N/A 12" HG PASS PASS MAINLINE P

N2O 52 PSI PASS 60 PSI 40 PSI PASS PASS MAINLINE P

NITROGEN 160 PSI PASS 195 PSI 155 PSI PASS PASS MAINLINE P

FLOOR: 4TH ALARM LOCATION:

AREA ALARM ANALYSIS

4TH FLOOR

AREA MONITORED: COMMENTS

ASU RECOVERY BAYS 1-16

CHEMETRON IMPACT

NURSES STATION ALARM MAKE AND MODEL: CHEMETRON IMPACT

END OF 4TH FLOOR AREA ALARM ANALYSIS

AREA MONITORED: COMMENTS

PROCEDURE ROOMS B459 AND

B457

ACROSS CHECK IN DESK ALARM MAKE AND MODEL:

AREA MONITORED: COMMENTS

OR'S 1-8

CLEAN CORE ALARM MAKE AND MODEL: CHEMETRON IMPACT

AREA MONITORED: COMMENTS

DENTAL CLINIC

OUTSIDE B421 ALARM MAKE AND MODEL: CHEMETRON IMPACT

MEDICAL GAS

ZONE VALVE ANALYSIS

Zone valves shall be readily operable from a standing position in the corridor on the same floor they serve. (NFPA 99 2018 5.1.4.6.2)

ZONE VALVE CODE REQUIREMENTS

Zone Valves. All station outlets/inlets shall be supplied through a zone valve as follows:

(NFPA 99 2018 5.1.4.6.1)

(1) The zone valve shall be placed such that a wall intervenes between the valve and outlets/inlets that it controls.

(2) The zone valves shall serve only outlets/inlets located on that same story.

(3) The zone valve shall not be located in a room with station outlets/inlets that it controls.

Zone valves shall be labeled in accordance with 5.1.11.2.7

Zone valves shall be so arranged that shutting off the supply of medical gas or vacuum to one zone will not affect the supply of medical gas or vacuum to another zone or the rest of the system.

(NFPA 99 2018 5.1.4.6.3)

A pressure/vacuum indicator shall be provided on the station outlet/inlet side of each zone valve.

(NFPA 99 2018 5.1.4.6.4)

Zone valve boxes shall be installed where they are visible and accessible at all times.

(NFPA 99 2018 5.1.4.6.1)

Zone valve boxes shall not be installed behind normally open or normally closed doors or otherwise hidden from plain view. (NFPA 99 2018 5.1.4.6.1)

Zone valve boxes shall not be located in closed or locked rooms, areas, or closets.

(NFPA 99 2018 5.1.4.6.1)

Zone valves shall be so arranged that shutting off the supply of gas to any one operating room or anesthetizing location will not affect the others. (NFPA 99 2018 5.1.4.6.3)

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 58 PSI PASS PASS 1/2" BALL PASS PASS P

MED AIR 50 PSI PASS PASS 1/2" BALL PASS PASS

VACUUM 22" HG PASS PASS 1" BALL PASS PASS P

N2 160 PSI PASS PASS 1/2" BALL PASS PASS P

FLOOR: 1ST VALVE LOCATION: OUTSIDE BIOMED VALVE MANUFACTURER: CHEMETRON

END OF 1ST FLOOR ZONE VALVE ANALYSIS

ZONE VALVE ANALYSIS

1ST FLOOR

AREA SERVED: COMMENTS

BIOMED

MED AIR GAUGE NEEDS

TO BE O-100 PSI

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 56 PSI PASS PASS 1/2" BALL PASS PASS P

MED AIR 52 PSI PASS PASS 1/2" BALL PASS PASS P

VACUUM 22" HG PASS PASS 3/4" BALL PASS PASS P

FLOOR: 3RD VALVE LOCATION:

END OF 3RD FLOOR ZONE VALVE ANALYSIS

ACROSS B317 VALVE MANUFACTURER: CHEMETRON

ZONE VALVE ANALYSIS

3RD FLOOR

AREA SERVED: COMMENTS

RADIOLOGY ROOMS B309, B312, B315,

B317

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 59 PSI PASS PASS 1" BALL PASS PASS P

MED AIR 52 PSI PASS PASS 1" BALL PASS PASS P

VACUUM 25" HG PASS PASS 1-1/2" BALL PASS PASS P

FLOOR: 4TH VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 58 PSI PASS PASS 3/4" BALL PASS PASS P

VACUUM 25" HG PASS PASS 3/4" BALL PASS PASS P

FLOOR: 4TH VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 53 PSI PASS PASS 3/4" BALL PASS PASS P

MED AIR 50 PSI PASS PASS 3/4" BALL PASS PASS

VACUUM 24" HG PASS PASS 3/4" BALL PASS PASS P

FLOOR: 4TH VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 58 PSI PASS PASS 1/2" BALL PASS PASS P

MED AIR 50 PSI PASS PASS 1/2" BALL PASS PASS P

VACUUM

WAGD

24" HG PASS PASS 3/4" BALL PASS PASS P

N2O 51 PSI PASS PASS 1/2" BALL PASS PASS P

N2 170 PSI PASS PASS 1/2" BALL PASS PASS P

FLOOR: 4TH VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 58 PSI PASS PASS 1/2" BALL PASS PASS P

MED AIR 58 PSI PASS PASS 1/2" BALL PASS PASS P

VACUUM

WAGD

21" HG PASS PASS 3/4" BALL PASS PASS P

N2O 50 PSI PASS PASS 1/2" BALL PASS PASS P

N2 165 PSI PASS PASS 1/2" BALL PASS PASS P

FLOOR: 4TH VALVE LOCATION:

PROCEDURE ROOMS B459 AND B457

ZONE VALVE ANALYSIS

4TH FLOOR

AREA SERVED: COMMENTS

ASU RECOVERY BAYS 1-16

OUTSIDE RECOVERY VALVE MANUFACTURER: CHEMETRON

AREA SERVED: COMMENTS

AREA SERVED: COMMENTS

DENTAL CLINIC

MEDICAL AIR NEEDS A 0-

100 PSI GAUGE

ACROSS B414 VALVE MANUFACTURER:

OUTSIDE OR-1 VALVE MANUFACTURER: CHEMETRON

OR-1 (A-405)

AREA SERVED: COMMENTS

OUTSIDE OR-2 VALVE MANUFACTURER:

OUTSIDE PROCEDURE ROOMS VALVE MANUFACTURER: CHEMETRON

CHEMETRON

AREA SERVED: COMMENTS

CHEMETRON

OR-2 (A-406)

ZONE VALVE ANALYSIS

4TH FLOOR

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 58 PSI PASS PASS 1/2" BALL PASS PASS P

MED AIR 50 PSI PASS PASS 1/2" BALL PASS PASS P

VACUUM

WAGD

22" HG PASS PASS 3/4" BALL PASS PASS P

N2O 55 PSI PASS PASS 1/2" BALL PASS PASS P

N2 170 PSI PASS PASS 1/2" BALL PASS PASS P

FLOOR: 4TH VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 55 PSI PASS PASS 1/2" BALL PASS PASS P

MED AIR 48 PSI PASS PASS 1/2" BALL PASS PASS P

VACUUM 24" HG PASS PASS 3/4" BALL PASS PASS P

N2O 55 PSI PASS PASS 1/2" BALL PASS PASS

N2 160 PSI PASS PASS 1/2" BALL PASS PASS P

FLOOR: 4TH VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 59 PSI PASS PASS 1/2" BALL PASS PASS P

MED AIR 48 PSI PASS PASS 1/2" BALL PASS PASS P

VACUUM 22" HG PASS PASS 3/4" BALL PASS PASS P

N2O 50 PSI PASS PASS 1/2" BALL PASS PASS P

N2 175 PSI PASS PASS 1/2" BALL PASS PASS P

FLOOR: 4TH VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 58 PSI PASS PASS 1/2" BALL PASS PASS P

MED AIR 50 PSI PASS PASS 1/2" BALL PASS PASS P

VACUUM 26" HG PASS PASS 3/4" BALL PASS PASS P

N2O 53 PSI PASS PASS 1/2" BALL PASS PASS P

N2 175 PSI PASS PASS 1/2" BALL PASS PASS P

FLOOR: 4TH VALVE LOCATION:

AREA SERVED: COMMENTS

OR-3 (B-473)

OUTSIDE OR-3 VALVE MANUFACTURER: CHEMETRON

AREA SERVED: COMMENTS

OR-4 (B-474)

N2O NEEDS A 0-100 PSI

GAUGE

OUTSIDE OR-4 VALVE MANUFACTURER: CHEMETRON

AREA SERVED: COMMENTS

OR-5 (B-475)

ACROSS OR-5 VALVE MANUFACTURER: CHEMETRON

AREA SERVED: COMMENTS

OR-6 (D-403)

OUTSIDE OR-6 VALVE MANUFACTURER: CHEMETRON

ZONE VALVE ANALYSIS

4TH FLOOR

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 56 PSI PASS PASS 1/2" BALL PASS PASS P

MED AIR 48 PSI PASS PASS 1/2" BALL PASS PASS P

VACUUM 23" HG PASS PASS 3/4" BALL PASS PASS P

N2O 54 PSI PASS PASS 1/2" BALL PASS PASS P

N2 165 PSI PASS PASS 1/2" BALL PASS PASS P

FLOOR: 4TH VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 59 PSI PASS PASS 1/2" BALL PASS PASS P

MED AIR 50 PSI PASS PASS 1/2" BALL PASS PASS P

VACUUM 26" HG PASS PASS 3/4" BALL PASS PASS P

N2O 52 PSI PASS PASS 1/2" BALL PASS PASS P

N2 170 PSI PASS PASS 1/2" BALL PASS PASS P

FLOOR: 4TH VALVE LOCATION:

END OF 4TH FLOOR ZONE VALVE ANALYSIS

AREA SERVED: COMMENTS

OR-7 (C-409)

OUTSIDE OR-7 VALVE MANUFACTURER: CHEMETRON

AREA SERVED: COMMENTS

OR-8 (C-408)

OUTSIDE OR-8 VALVE MANUFACTURER: CHEMETRON

MEDICAL GAS

OUTLET ANALYSIS

Support gas outlets shall deliver 140 SLPM (5.0 SCFM) with a pressure drop of not more than 35 kPa (5 psi) gauge and static pressure of 1100 kPa to 1275 kPa (160 psi to 185 psi) gauge.

(NFPA 99 2018 5.1.12.4.10.3)

OUTLET CODE REQUIREMENTS

Each station outlet/inlet for medical gases or vacuums shall be gas-specific, whether the outlet/inlet is threaded or is a noninterchangeable quick coupler. (NFPA 99 2018 5.1.5.1)

Each outlet/inlet shall be legibly identified in accordance with 5.1.11.3. (NFPA 99 2018 5.1.5.5)

Each station outlet/inlet, including those mounted in columns, hose reels, ceiling tracks, or other special installations, shall be designed so that parts or components that are required to be gas specific for compliance with 5.1.5.1 and 5.1.5.9 cannot be interchanged between the station outlet/inlet for different gases. (NFPA 99 2018 5.1.5.7)

All gas outlets with a gauge pressure of 345 kPa (50 psi), including, but not limited to, oxygen, nitrous oxide, medical air, and carbon dioxide, shall deliver 100 SLPM (3.5 SCFM) with a pressure drop of not more than 35 kPa (5 psi) and static pressure of 345 kPa to 380 kPa (50 psi to 55 psi).

(NFPA 99 2018 5.1.12.4.10.2)

Medical–surgical vacuum inlets shall draw 85 Nl/min (3 SCFM) without reducing the vacuum pressure below 300 mm (12 in.) gauge HgV at any adjacent station inlet. (NFPA 99 2018 5.1.12.4.10.4)

Oxygen and medical air outlets serving critical care areas shall allow a transient flow rate of 170 SLPM

(6 SCFM) for 3 seconds. (NFPA 99 2018 5.1.12.4.10.5)

Medical gas concentration & flow rate requirements. (NFPA 99 2018 Table 5.1.12.4.11)

GAS FLOW RATE CONCENTRATION

OXYGEN Non-critical 3.5 SCFM Critical 6.0 SCFM ≥99% oxygen

MEDICAL AIR Non-critical 3.5 SCFM Critical 6.0 SCFM 19.5%–23.5% oxygen

NITROUS OXIDE 3.5 SCFM ≥99% nitrous oxide

NITROGEN 5.0 SCFM ≤1% O2 or ≥99% N2

OTHER GASES 3.5 SCFM

As specified by ±1%, unless otherwise specified

VACUUM 3.0 SCFM N/A

WAGD 3.0 SCFM N/A

OUTLET LOCATION

Le ak ag e w

A d ap te r Le ak ag e w

/o

A d ap te r O p er a ti o n al

Fl o w

St at ic P re ss u re

C o n ce n tr a ti o n

C o n d it io

La b el in g

PASS FAIL

PARTICULATE

CONTAMINATION

REPAIRED BY

1ST FLOOR OXYGEN MEDICAL AIR VACUUM N2

BIOMED 1 1 1 1 ALLIED CNT2 CH P P P P P P P <1MG ALL OUTLETS

3RD FLOOR

B309 1 1 1 ALLIED 500 CH P P P P P P P <1MG ALL OUTLETS

B312 1 1 1 ALLIED 500 CH P P P P P P P <1MG ALL OUTLETS

B315 1 1 1 ALLIED 500 CH P P P P P P P <1MG ALL OUTLETS

B317 1 1 1 ALLIED 500 CH P P P P P P P <1MG ALL OUTLETS

TOTAL COUNT: 5 5 5 1

OUTLET ANALYSIS

OUTLET SPECS COMMENTS

N2 IS ALLIED - 500 - DISS

GAS TYPE & OUTLET QUANTITY

OUTLET LOCATION

Le ak ag e w

A d ap te r Le ak ag e ap te r O p e ra ti o w

St at ic P re ss u re

C o n ce n tr at io n

C o n d it io e lin g

PASS FAIL

PARTICULATE

CONTAMINATION

REPAIRED BY

4TH FLOOR OXYGEN MEDICAL AIR VACUUM

ASU BAY 1 2 2 3 ALLIED 400 CH P P P P P P P <1MG ALL OUTLETS

ASU BAY 2 2 2 3 ALLIED 400 CH P P P P P P P <1MG ALL OUTLETS

ASU BAY 3 2 2 3 ALLIED 400 CH P P P P P P P <1MG ALL OUTLETS

ASU BAY 4 2 2 3 ALLIED 400 CH P P P P P P P <1MG ALL OUTLETS

ASU BAY 5 2 2 3 ALLIED 400 CH P P P P P P P <1MG ALL OUTLETS

ASU BAY 6 2 2 3 ALLIED 400 CH P P P P P P P <1MG ALL OUTLETS

ASU BAY 7 2 2 3 ALLIED 400 CH P P P P P P P <1MG ALL OUTLETS

ASU BAY 8 2 2 3 ALLIED 400 CH P P P P P P P <1MG ALL OUTLETS

ASU BAY 9 2 2 3 ALLIED 400 CH P P P P P P P <1MG ALL OUTLETS

ASU BAY 10 2 2 3 ALLIED 400 CH P P P P P P P <1MG ALL OUTLETS

ASU BAY 11 2 2 3 ALLIED 400 CH P P P P P P P <1MG ALL OUTLETS

ASU BAY 12 2 2 3 ALLIED 400 CH P P P P P P P <1MG ALL OUTLETS

ASU BAY 13 2 2 3 ALLIED 400 CH P P P P P P P <1MG ALL OUTLETS

ASU BAY 14 2 2 3 ALLIED 400 CH P P P P P P P <1MG ALL OUTLETS

ASU BAY 15 2 2 3 ALLIED 400 CH P P P P P P P <1MG ALL OUTLETS

ASU BAY 16 2 2 3 ALLIED 400 CH P P P P P P P <1MG ALL OUTLETS

B457 1 2 ALLIED 500 CH P P P P P P P <1MG ALL OUTLETS

B459 1 2 ALLIED 500 CH P P P P P P P <1MG ALL OUTLETS

DENTAL ROOM B403 1 1 ALLIED 500 CH P P P P P P P <1MG ALL OUTLETS

DENTAL ROOM B409 1 1 ALLIED 500 CH P P P P P P P <1MG ALL OUTLETS

DENTAL ROOM B412 1 1 ALLIED CNT2 CH P P P P P P P <1MG ALL OUTLETS

DENTAL ROOM B413 1 1 ALLIED 500 CH P P P P P P P <1MG ALL OUTLETS

DENTAL ROOM B414 1 1 ALLIED 500 CH P P P P P P P <1MG ALL OUTLETS

DENTAL ROOM B415 1 1 ALLIED 500 CH P P P P P P P <1MG ALL OUTLETS

DENTAL ROOM B416 1 1 ALLIED 500 CH P P P P P P P <1MG ALL OUTLETS

TOTAL COUNT: 41 32 59

OUTLET ANALYSIS

GAS TYPE & OUTLET QUANTITY OUTLET SPECS COMMENTS

BACK WALL VAC IS

ALLIED - CNT2 - CH

BACK WALL VAC IS

ALLIED - CNT2 - CH

OUTLET LOCATION

Le ak ag e w

A d ap te r Le ak ag e ap te r O p e ra ti o w

St at ic P re ss u re

C o n ce n tr at io n

C o n d it io e li n g

PASS FAIL

PARTICULATE

CONTAMINATION

REPAIRED

OR'S OXY MED AIR

MED

VAC

N2O N2 WAGD

OR-1 RIGHT COLUMN 2 1 1 1 1 1 ALLIED CNT2 CH P P P P P P P <1MG ALL OUTLETS

OR-1 LEFT COLUMN 2 1 1 1 1 1 ALLIED CNT2 CH P P P P P P P <1MG ALL OUTLETS

OR-1 WALL 3 1 ALLIED 500 CH P P P P P P P <1MG ALL OUTLETS

OR-2 RIGHT COLUMN 2 1 1 1 1 1 ALLIED CNT2 CH P P P P P P P <1MG ALL OUTLETS

OR-2 LEFT COLUMN 2 1 1 1 1 1 ALLIED CNT2 CH P P P P P P P <1MG ALL OUTLETS

OR-2 WALL 3 1 ALLIED 500 CH P P P P P P P <1MG ALL OUTLETS

OR-3 RIGHT COLUMN 2 1 1 1 1 1 ALLIED CNT2 CH P P P P P P P <1MG ALL OUTLETS

OR-3 LEFT COLUMN 2 1 1 1 1 1 ALLIED CNT2 CH P P P P P P P <1MG ALL OUTLETS

OR-3 WALL 3 1 ALLIED 500 CH P P P P P P P <1MG ALL OUTLETS

OR-4 RIGHT COLUMN 2 1 1 1 1 1 ALLIED CNT2 CH P P P P P P P <1MG ALL OUTLETS

OR-4 LEFT COLUMN 2 1 1 1 1 1 ALLIED CNT2 CH P P P P P P P <1MG ALL OUTLETS

OR-4 WALL 3 1 ALLIED 500 CH P P P P P P P <1MG ALL OUTLETS

OR-5 RIGHT COLUMN 2 1 1 1 1 1 ALLIED CNT2 CH P P P P P P P <1MG ALL OUTLETS

OR-5 LEFT COLUMN 2 1 1 1 1 1 ALLIED CNT2 CH P P P P P P P <1MG ALL OUTLETS

OR-5 WALL 3 1 ALLIED 500 CH P P P P P P P <1MG ALL OUTLETS

OR-6 RIGHT COLUMN 2 1 1 1 1 1 ALLIED CNT2 CH P P P P P P P <1MG ALL OUTLETS

OR-6 LEFT COLUMN 2 1 1 1 1 1 ALLIED CNT2 CH P P P P P <1MG ALL OUTLETS

OR-6 WALL 3 1 ALLIED 500 CH P P P P P P P <1MG ALL OUTLETS

OR-7 RIGHT COLUMN 2 1 1 1 1 1 ALLIED CNT2 CH P P P P P P P <1MG ALL OUTLETS

OR-7 LEFT COLUMN 2 1 1 1 1 1 ALLIED CNT2 CH P P P P P P P <1MG ALL OUTLETS

OR-7 WALL 3 1 ALLIED 500 CH P P P P P P P <1MG ALL OUTLETS

OR-8 RIGHT COLUMN 2 1 1 1 1 1 ALLIED CNT2 CH P P P P P P P <1MG ALL OUTLETS

OR-8 LEFT COLUMN 2 1 1 1 1 1 ALLIED CNT2 CH P P P P P P P <1MG ALL OUTLETS

OR-8 WALL 3 1 ALLIED 500 CH P P P P P P P <1MG ALL OUTLETS

TOTAL COUNT: 32 16 40 16 24 16

OUTLET ANALYSIS

GAS TYPE & OUTLET QUANTITY OUTLET SPECS COMMENTS

N2 IS CHEMETRON - CP - DISS

N2 IS CHEMETRON - CP - DISS

N2 IS CHEMETRON - CP - DISS

N2 IS CHEMETRON - CP - DISS

N2 IS CHEMETRON - CP - DISS

N2O LEAKS W/O ADAPTER

INSERTED

N2 IS CHEMETRON - CP - DISS

N2 IS CHEMETRON - CP - DISS

N2 IS CHEMETRON - CP - DISS

MEDICAL GAS SOURCE

EQUIPMENT ANALYSIS

LOCATION BULK PAD

AREA(S) OF FACILITY SERVED ENTIRE FACILITY

BULK SUPPLIER AIRGAS

SYSTEM TYPE LIQ X 18 HP RESERVE

PRIMARY LIQUID LEVEL 53"

PRIMARY PRESSURE 155 PSI

RESERVE LIQUID LEVEL N/A

RESERVE PRESSURE 2200 PSI

PRIMARY FINAL LINE PRESSURE 55 PSI

RESERVE FINAL LINE PRESSURE 55 PSI

SOURCE VALVE PRESSURE 53 PSI

MAIN VALVE PRESSURE 54 PSI

SOURCE VALVE TYPE BALL

SOURCE VALVE LOCATION AT SOURCE

PRESSURE SWITCH LOCATION C100 MECHANICAL ROOM

EOSC VALVE SIZE 1" BALL

EOSC LOCATION(S) OUTSIDE DOCK

PASS FAIL N/A

P

P

P

P

P

P

P

P

P

P

P

P

P

P

Proper fill circuit (inlet, strainer, check valve, purge valve, supports)

BULK OXYGEN

SOURCE EVALUATION DATA

NFPA 99 2018 SCHEMATIC

NFPA 99 2018 CHECKLIST

System visibly complies with above schematic per NFPA 99.

Enclosure (min 6' height) non-combustible, proper ventilation & 2 lockable entries/exits

Containers permanently anchored & cylinders adequately secured

Noncombustible pad w/3' maintenance clearance, accessible for delivery & pad adequately sized for vehicles

Top & bottom fill, hose purge, & vent valves present

Piped w/brazed copper, brass, or stainless & no flex connects/fittings wear & leaks

Reserve and primary check valves in place for reserve to feed automatically

Reserve economizer in place to feed upstream final regulators

Drainage prevented towards (buildings, drains, etc.) & from hazards

Labeling: pipeline, source/main valves & "Oxygen-No Smoking, No Open Flames"

Vaporizer appears adequately sized & isolation valves arranged for service w/o supply interruption

Emergency Supply (3' clearance) or (IBER) w/2 checks, secured, & labeled

Distance from the following: 1' - all structures (Type I & II), * 50' - wood framed Type III, IV, or V building types, * 50' - Public assembly or nearest non- ambulatory patient, * 5' -

Property lines & overhead electrical wiring, 10' building openings, * 10' - public sidewalks & parked vehicles, * 15' - Hazardous piping materials & below ground flammable liquid tanks, * 25' - 0-1000 gal flammable liquids/liquefied gas, below ground flammable liquid fill or vent, 0-25,000 scf flammable gases, or slow burning solids, * 50' - >1000 gal flammable liquids/liquefied gas, >25,000 scf flammable gases, or rapidly burning solids, 3' - combustible surfaces (asphalt & expansion joint filler) where liquid oxygen may fall, 8' - Sewer or drain openings to delivery connects, reliefs, mobile supply equipment, & liquid withdrawal connects, Walls may not form a 3-4 sided court.

MEETS ALL NFPA 99 2018 CODE REQUIREMENTS PASS

ADDITIONAL COMMENTS

LOCATION C106 MECHANICAL ROOM LINE PRESSURE

AREA(S) OF FACILITY SERVED ENTIRE FACILITY DRYER TYPE

MANUFACTURER POWEREX DRYER INFO

MODEL NUMBER MPD10084P5 DEW POINT MONITOR INFO

SERIAL NUMBER (H)2/26/2019-000001539-425 CO MONITOR INFO

SYSTEM TYPE RECIPROCATING SOURCE VALVE LOCATION

CONFIGURATION DUPLEX PRESSURE SWITCH LOCATION

PUMP MAKE AND MODEL N/A PUMP 1 HOURS

HORSEPOWER 10 H.P. PUMP 2 HOURS

LEAD ON/OFF 95 PSI / 115 PSI PUMP 3 HOURS

LAG ON/OFF 65 PSI / 85 PSI PUMP 4 HOURS

ELEMENT NFPA LIMIT READING PASS/FAIL

DEW POINT (MONITOR ON SYSTEM) 35 DEG F -75 DEG F PASS

DEW POINT (CS MONITOR) 35 DEG F -55 DEG F PASS

CARBON MONOXIDE (MONITOR ON SYSTEM) 10 PPM 0 PPM PASS

CARBON MONOXIDE (CS MONITOR) 10 PPM 0 PPM PASS

CARBON DIOXIDE 500 PPM 97 PPM PASS

METHANE 25 PPM 1 PPM PASS

CHLOROFORM 2 PPM 0 PPM PASS

OXYGEN 19.5%-23.5% 21.3% PASS

PASS FAIL N/A

P

P

P

P

P

P

P

P

P

P

P

P

P

P

P

P

P

PIntake turned down and screened

MEETS ALL NFPA 99 2018 CODE REQUIREMENTS PASS

ADDITIONAL COMMENTS

Intake above roof level, >20' above ground, 10 ft from doors, windows, other openings, and 25' from exhausts

System is equipped with manual disconnects

System is equipped with a local lag, dew point and CO alarm

The local alarms are wired to the master alarm panel

Receiver tank is supplied with an Auto drain, pressure gauge, sight glass, pressure relief, & ASME label

There is a receiver bypass valve so the receiver can be serviced without interruption of the system

Each pump has an isolation valve so a pump can be serviced without interruption of the system

System automatically alternates the pumps evenly

Duplexed dryer system

1/4" sample port installed

Source valve in proper location and labeled

Mainline and intake piping properly labeled

System power supplied from emergency power

N/A

MEDICAL AIR COMP MAINTENANCE REQUIRED

NFPA 99 2018 SCHEMATIC MEDICAL AIR PURITY ANALYSIS

COMMENTS

NFPA 99 2018 CHECKLIST

System visibly complies with above schematic per NFPA 99.

Indoors in a dedicated mechanical equipment area, adequately ventilated and with any required utilities

System has two or more medical air compressors

System is supplied with flexible connectors on inlet and outlet sides of the compressors

N/A

MEDICAL AIR SYSTEM

SOURCE EVALUATION DATA

50 PSI

DESICCANT

PMD35000AJ

POWEREX BUILT IN

ENMET CO GUARD

AT SOURCE

AT SOURCE

LOCATION C106 MECHANICAL ROOM

AREA(S) OF FACILITY SERVED ENTIRE FACILITY

MANUFACTURER DEKKER

MODEL NUMBER VMX0203KA3-40-ES

SERIAL NUMBER 119576

SYSTEM TYPE LIQUID RING

CONFIGURATION TRIPLEX

PUMP MAKE AND MODEL DEKKER DV0200B-KA3

HORSEPOWER 15 H.P.

LEAD ON/OFF 19" HG / 24" HG

LAG ON/OFF 14" HG / 19" HG

LINE PRESSURE 24" HG

SOURCE VALVE LOCATION AT SOURCE

PRESSURE SWITCH LOCATION AT SOURCE

PUMP 1 HOURS 37630

PUMP 2 HOURS 41941

PUMP 3 HOURS 31451

PUMP 4 HOURS N/A

PASS FAIL N/A

P

P

P

P

P

P

P

P

P

P

P

P

P

P

P

P

P

PASS

ADDITIONAL COMMENTS

System automatically alternates the pumps evenly

Source valve in proper location and labeled

Mainline and exhaust piping properly labeled

Exhaust is turned down and screened

Exhaust ≥25' from doors, windows, intakes, building openings & public assembly & copper or stainless, no dips, drip legs installed, & sufficient diameter

MEETS ALL NFPA 99 2018 CODE REQUIREMENTS

Each pump has an isolation valve so a pump can be serviced without interruption of the system

System visibly complies with above schematic per NFPA 99.

Located in a dedicated mechanical equipment area, adequately ventilated and with any required utilities

System has two or more medical vacuum pumps

System has flexible connectors

System has antivibration mountings

System power supplied from emergency power

System is equipped with manual disconnects

System is equipped with a local lag alarm

The local alarms are wired to the master alarm panel

Receiver tank is supplied with an Auto drain & ASME label

There is a receiver bypass valve so the receiver can be serviced without interruption of the system

NFPA 99 2018 CHECKLIST

MEDICAL VACUUM SYSTEM

SOURCE EVALUATION DATA

NFPA 99 2018 SCHEMATIC

LOCATION NITROUS OXIDE MANIFOLD ROOM

AREA(S) OF FACILITY SERVED OR'S

MANUFACTURER CHEMETRON

MODEL NUMBER 4000

SERIAL NUMBER 20111206003

SYSTEM TYPE HP X HP

CYLINDERS ON RIGHT BANK 6

CYLINDERS ON LEFT BANK 6

RIGHT BANK PRESSURE 600 PSI

LEFT BANK PRESSURE 600 PSI

CHANGE OVER PRESSURE 150 PSI

LINE PRESSURE 55 PSI

SOURCE VALVE TYPE BALL

SOURCE VALVE LOCATION AT SOURCE

PRESSURE SWITCH LOCATION C100 MECHANICAL ROOM

PASS FAIL N/A

P

P

P

P

P

N/A

P

P

P

P

P

P

P

P

P

P

ADDITIONAL COMMENTS

Cylinders secured with racks or chains

Headers have header valve and check valves

Cylinders prevented from reaching temperatures in excess 130°F. and lower than 20°F.

Door Labeling: CAUTION, Medical Gases, No Smoking or Open Flame, Room May Have Insufficient Oxygen Open Door & Allow Room to Ventilate before

Entering

MEETS ALL NFPA 99 2018 CODE REQUIREMENTS PASS

Electrical devices protected in room

System visibly complies with above schematic per NFPA 99.

Secured with lockable doors or gates or otherwise secured.

1 hour fire rated door and walls.

Source valve labeled per NFPA 99.

Proper natural ventilation

Proper mechanical ventilation

Manifold power supplied from emergency power

Automatic bank alternation

Warning lights when banks alternate

Relief Valves vented outside, pipe size, turned down, & screened

No flammable materials, cylinders containing flammable gases, or containers containing flammable liquids

NFPA 99 2018 CHECKLIST

NITROUS OXIDE MANIFOLD SYSTEM

LOCATION NITROGEN MANIFOLD ROOM

AREA(S) OF FACILITY SERVED BIOMED AND OR'S

MANUFACTURER CHEMETRON

MODEL NUMBER 4000

SERIAL NUMBER 20111209001

SYSTEM TYPE HP X HP

CYLINDERS ON RIGHT BANK 6

CYLINDERS ON LEFT BANK 6

RIGHT BANK PRESSURE 2000 PSI

LEFT BANK PRESSURE 1400 PSI

CHANGE OVER PRESSURE 250 PSI

LINE PRESSURE 165 PSI

SOURCE VALVE TYPE BALL

SOURCE VALVE LOCATION AT SOURCE

PRESSURE SWITCH LOCATION C100 MECHANICAL ROOM

PASS FAIL N/A

P

P

P

P

P

N/A

P

P

P

P

P

P

P

P

P

P

ADDITIONAL COMMENTS

Cylinders secured with racks or chains

Headers have header valve and check valves

Cylinders prevented from reaching temperatures in excess 130°F. and lower than 20°F.

Door Labeling: CAUTION, Medical Gases, No Smoking or Open Flame, Room May Have Insufficient Oxygen Open Door & Allow Room to Ventilate before

Entering

MEETS ALL NFPA 99 2018 CODE REQUIREMENTS PASS

Electrical devices protected in room

System visibly complies with above schematic per NFPA 99.

Secured with lockable doors or gates or otherwise secured.

1 hour fire rated door and walls.

Source valve labeled per NFPA 99.

Proper natural ventilation

Proper mechanical ventilation

Manifold power supplied from emergency power

Automatic bank alternation

Warning lights when banks alternate

Relief Valves vented outside, pipe size, turned down, & screened

No flammable materials, cylinders containing flammable gases, or containers containing flammable liquids

NFPA 99 2018 CHECKLIST

NITROGEN MANIFOLD SYSTEM

LOCATION A421 MECHANICAL ROOM LINE PRESSURE

AREA(S) OF FACILITY SERVED DENTAL CLINIC DRYER TYPE

MANUFACTURER POWEREX DRYER INFO

MODEL NUMBER SEQ200740AJ DEW POINT MONITOR INFO

SERIAL NUMBER (M)3/18/2019-S1539-905 CO MONITOR INFO

SYSTEM TYPE ENCLOSED SCROLL SOURCE VALVE LOCATION

CONFIGURATION QUADPLEX PRESSURE SWITCH LOCATION

PUMP MAKE AND MODEL POWEREX PUMP 1 HOURS

HORSEPOWER 20 H.P. PUMP 2 HOURS

LEAD ON/OFF 95 PSI / 115 PSI PUMP 3 HOURS

LAG ON/OFF 65 PSI / 85 PSI PUMP 4 HOURS

ELEMENT NFPA LIMIT READING PASS/FAIL

DEW POINT (MONITOR ON SYSTEM) 35 DEG F 53 DEG F FAIL

DEW POINT (CS MONITOR) 35 DEG F 50 DEG F FAIL

CARBON MONOXIDE (MONITOR ON SYSTEM) 10 PPM 0 PPM PASS

CARBON MONOXIDE (CS MONITOR) 10 PPM 0 PPM PASS

PASS FAIL N/A

P

P

P

P

P

P

P

P

P

P

P

P

P

P

P

P

DENTAL AIR SYSTEM

SOURCE EVALUATION DATA

50 PSI

REFRIGERANT

HANKISON HPR50

NEWPORT SCIENTIFICS 1092E

DYNAMATION ABL-4021

AT SOURCE

AT SOURCE

NFPA 99 SCHEMATIC DENTAL AIR PURITY ANALYSIS

COMMENTS

Each pump has an isolation valve so a pump can be serviced without interruption of the system

NFPA 99 CHECKLIST

System visibly complies with above schematic per NFPA 99.

Indoors in a dedicated mechanical equipment area, adequately ventilated and with any required utilities

System has two or more instrument air compressors or a standby header

System is supplied with flexible connectors on inlet and outlet sides of the compressors

System power supplied from emergency power

System is equipped with manual disconnects

System is equipped with a local lag and dew point alarm

The local alarms are wired to the master alarm panel

Receiver tank is supplied with an Auto drain, pressure gauge, sight glass, pressure relief, & ASME label

There is a receiver bypass valve so the receiver can be serviced without interruption of the system

PASS

ADDITIONAL COMMENTS

FACILITY IS AWARE OF THE HIGH DEWPOINT. THEY HAVE ORDERED A NEW DRYER TO FIX THIS ISSUE.

System automatically alternates the pumps evenly

Duplexed dryer system

1/4" sample port installed

Source valve in proper location and labeled

Mainline and intake piping properly labeled

MEETS ALL NFPA 99 CODE REQUIREMENTS

LOCATION A421 MECHANICAL ROOM

AREA(S) OF FACILITY SERVED DENTAL CLINIC

MANUFACTURER TECH WEST

MODEL NUMBER VPD30D5

SERIAL NUMBER VPD30-5038

SYSTEM TYPE TURBINE

CONFIGURATION DUPLEX

PUMP MAKE AND MODEL N/A

HORSEPOWER 7.5 H.P.

LEAD ON/OFF 7" HG / 10" HG

LAG ON/OFF 5" HG / 7" HG

LINE PRESSURE 10" HG

SOURCE VALVE LOCATION AT SOURCE

PRESSURE SWITCH LOCATION N/A

PUMP 1 HOURS 10366

PUMP 2 HOURS 10193

PUMP 3 HOURS N/A

PUMP 4 HOURS N/A

PASS FAIL N/A

P

P

P

P

P

P

P

N/A

N/A

P

P

P

P

P

P

N/A

N/A

NFPA 99 2018 CHECKLIST

MEDICAL VACUUM SYSTEM

SOURCE EVALUATION DATA

NFPA 99 2018 SCHEMATIC

Each pump has an isolation valve so a pump can be serviced without interruption of the system

System visibly complies with above schematic per NFPA 99.

Located in a dedicated mechanical equipment area, adequately ventilated and with any required utilities

System has two or more medical vacuum pumps

System has flexible connectors

System has antivibration mountings

System power supplied from emergency power

System is equipped with manual disconnects

System is equipped with a local lag alarm

The local alarms are wired to the master alarm panel

Receiver tank is supplied with an Auto drain & ASME label

There is a receiver bypass valve so the receiver can be serviced without interruption of the system

PASS

ADDITIONAL COMMENTS

System automatically alternates the pumps evenly

Source valve in proper location and labeled

Mainline and exhaust piping properly labeled

Exhaust is turned down and screened

Exhaust ≥25' from doors, windows, intakes, building openings & public assembly & copper or stainless, no dips, drip legs installed, & sufficient diameter

MEETS ALL NFPA 99 2018 CODE REQUIREMENTS

END OF REPORT

5001 N PIEDRAS ST

EL PASO, TX 79930