Inspection Report.pdf

Work Order Submitted Date Submitted By

4000667318 Oct 16, 2025 BENJHILL

CUSTOMER INFORMATION

Work Order # 4000667318

Inspection Date 10/14/2025

Customer GEORGE H OBRIEN VA MEDICAL CENTER

Address

300 W VETERANS BLVD, BIG SPRING, TX 79720-

Account 3462728

Contact

Email

Phone

Product OXYGEN USP BULK

Location Type Outdoor

Customer Owned NO

Type of Inspection PM

MAIN VESSEL INFORMATION

Tank Size 1500 GA

F5010 - AIR-119 - Bulk - PM Inspection - Medical LOX/LIN/N2O/CO2 System

AIR-119 - Bulk - PM Inspection - Medical LOX/LIN/N2O/CO2 System

Tank Code E-240400

NB# 2488

S/N E-240400

MFR Name LINDE

MFG Year

MAWP 250

PSV Inlet Size .75 in

PSV Outlet Size 1 in

PSV Set Point 250 psig

BD Inlet Size .75 in

BD Outlet Size .75 in

BD Set Point 339 psig

BAM# or FF# B0501600002473

Telemetry Type BAM

BAM Phone # 5278638651

Level Gauge Full 140 inH2O

Level Gauge Reorder 35 inH2O

RESERVE SUPPLY INFORMATION

Type Cylinders

For Reserve Cylinders, Qty

Cylinder Size (cylinder height excludes valve) 9 x 51

1. OVERALL SITE CONDITION

1.1 Adequate trailer access, clear for safe delivery?

(clear line of sight, less than 25’ from trailer to fill valves)?

Yes

1.2 Adequate lighting for night time deliveries? Yes

1.3 Site secured, fenced, and gates are locked? Yes

1.4 Vessel and system is protected where exposed

to vehicle impact by bollards or other approved means?

Yes

1.5 Site has adequate ventilation or mitigation (vents

captured, etc.) if indoor or courtyard installation?

Yes

1.6 Adequate and safe access to service

equipment? (3' around vessel and other equipment)

Yes

1.7 Pipe supports anchored, pipe clamps tight, and

unistrut stand plastic caps installed?

Yes

1.8 Vessel, vaporizers, and equipment anchored? Yes

1.9 Vessel and equipment concrete pad is in good

condition (no spalling, cracks, frost heaves, etc.)

Yes

1.10 Site has adequate drainage? Yes

1.11 Pressure relief devices installed between block

valves and discharge in a safe direction?

Yes

1.12 Electrical equipment and conduit in good

condition (no signs of damage, labeled, etc.)?

Yes

1.13 System piping and components leak checked

and free of leaks?

Yes

1.14 Overall site condition is free of debris, chemical

storage, combustibles, or other hazards?

Yes

1.15 Exposure distances comply with NFPA 55 and Airga s Standards?

Yes

NFPA Distances Table

LINK:

https://docs.google.com/spreadsheets/d/1vuovRlq8 X7jCJ9Qcrfn7jGR7JRkOI_iGpPdDt44i_ec/edit?

usp=sharing

1.16 Concrete off-load pad is installed, in good

condition, and free of combustibles for O2 or N2O installations?

Yes

1.17 'No Smoking' signs posted for O2 or N2O installations?

Yes

1.18 Grounding system (if installed for O2 and N2O

tanks, lightning protection, etc.) is in good condition and tight?

Yes

1.19 Telemetry system is functioning properly and

solar panel cleaned (if appl.)?

Yes

2. VESSEL CONDITION (MAIN TANK)

2.1 MAIN TANK: Vessel cosmetic condition (paint, dirt, logo, etc.) is adequate?

Yes

2.2 MAIN TANK: All required Airgas, NFPA, and

warning decals are in place, correct, and legible?

Yes

2.3 MAIN TANK: Tank code is legibly stenciled or

labeled on vessel (verify code if instructed)?

Yes

2.4 MAIN TANK: Vessel has pressure relief device

on the fill line?

Yes

2.5 MAIN TANK: Pressure gauges are functional

and legible?

Yes

2.6 MAIN TANK: Liquid level gauge is functional, legible, and zero checked, and has 'reorder' and 'full' arrows?

Yes

2.7 MAIN TANK: Vessel has no signs of poor

vacuum such as venting, cold spots, etc; (take vacuum reading if suspect)?

Yes

2.8 MAIN TANK: Fill connection correct, in good

condition, and equipped with dust or pressure cap?

2.9 MAIN TANK: Fill line check valve is installed &

operationally checked by safely opening top fill valve to check back-flow?

Yes

2.10 MAIN TANK Hose drain and full trycock valves

are installed and working properly?

Yes

2.11 MAIN TANK: Pressure building system tested

and is operating correctly at system set point per data label?

Yes

2.12 MAIN TANK: All valve handles are in good

working order and valves tagged properly?

Yes

2.13 MAIN TANK: Vessel has diverter assembly with

dual PSVs/BDs? Cycle to both sides to check flow and for any leaks.

Yes

2.14 MAIN TANK: Vessel PSVs are in good

condition, legible, seals intact, and have no signs of weeping?

Yes

2.15 MAIN TANK: Vessel PSVs marked test date will

be less than 5 years old at time of next PM (capture test date)?

Yes

Test date 09/14/2022

2.16 MAIN TANK: Vessel PSVs are secure, free

from obstruction, and venting towards ground or safe location?

Yes

2.17 MAIN TANK: Vessel burst disks (BDs) visually

inspected; set point < 150% tank MAWP, good condition, and not weeping?

Yes

EQUIPMENT INFORMATION

Main Vaporizer Type Ambient

Main Vap. Qty. 2

Main Vap. MFG Thermax/Chart

Main Vap. Model # TMF048A-HF-SG

Reserve Vaporizer Type

Reserve Vap. Qty.

Reserve Vap. MFR

Reserve Vap. Model #

PCM Type Liq Main/Cyl Reserve

Reg. MFG Generant

Reg. Model 2GDR-1000B-V-BM

Reg. Size 1

Delivery Pressure Set Point 55

Final Line PSV Set Point: 75

Auxiliary Manifold (Hyperbarics) No

Aux Manifold Set Point

Aux PSV Set Point

Vaporizer Switching Manifold No

Local Alarm Light Panel Yes

Other Equip. Notes

3. EQUIPMENT CONDITION

3.1 Piping material and/or insulation is correct for

the service and in good working condition?

Yes

3.2 Process vaporizers at least 50% free of ice build

up?

Yes

3.3 Vaporizer switching (if installed) verified for

proper operation?

N/A

3.4 Vaporizers are protected with thermal PSV and

inspected for set point, orientation, and condition?

3.5 Line regulators are inspected and checked for

proper operation and set point?

Yes

3.6 Final line PSV inspected and is in good

condition, legible, and has no signs of weeping?

Yes

4. MEDICAL SYSTEM REQUIREMENTS

4.1 Bulk system alarm contacts are wired to the

facility?

Yes

4.2 Discussed with facility their requirements to test

alarms?

Yes

4.3 Main vessel low level alarm signal works

correctly?

Yes

Set Point 30

4.4 Reserve-in-use alarm signal works correctly? Yes

Set Point 47

4.5 Reserve vessel low pressure alarm or reserve

cylinders low pressure alarm works correctly?

Yes

Set Point 1600

4.6 Reserve vessel low level alarm works correctly? N/A

4.7 Local alarm light panel (if installed) functions

properly?

Yes

4.8 Emergency oxygen supply connection (EOSC)

installed? (N/A for stand-alone hyperbarics facility.)

Yes

4.9 Cylinder Reserve: In acceptable condition, with

legible product label and lot number, and properly secured?

Yes

4.10 Cylinder Reserve: Pressure is acceptable (not

depleted)? Consider replacing if ~1900 psig.

Pressure 2100

4.11 System will automatically switch to reserve

supply

Yes

4.12 System verified to be free of unauthorized

changes?

Yes

5. NITROUS OXIDE AND CARBON DIOXIDE

5.1 Each fill connection has blow down valve at the

CGA connection and hose restraint cable in good condition?

N/A

5.2 Electrical disconnects appear to be in good

condition and no visual signs of blown fuses, loose conduit?

N/A

5.3 Refrigeration unit and compressor verified for

proper operation and maintained per MFR recommendations?

N/A

5.4 Vessel pressure is above 250 psig and within

design range on data label? Record pressure in notes.

N/A

5.5 Pressure building system tested and is operating

correctly at system set point per data label?

N/A

5.6 N2O only: 240 V power plug with disconnect and

grounding source for N2O truck are in good condition?

N/A

FORM CLOSURE

Comments

Replaced pigtails. While changing pigtails found that six of the cylinders were isolated off and empty.

Replaced cylinders with full ones that were on site.

Also replaced two missing cylinders that were not on manifold. Found no other issues with equipment.

Technician Name Ben Hill

Technician Signature

Customer Name

Customer Signature