R_PM_2026_VA Charleston_5.pdf

Project ID: VA Charleston PM

Project Date: 7/1/2026

Project Date: 7/1/2026

Report Authored By: Tanner Moore

Credential: 6030 - 12454599

David Gatlin

Engineering

Project Contact:

(803)621-6104

Project Site:

Ralph H. Johnson VA Medical Center

109 Bee St

Charleston, SC

MEDICAL GAS SOURCE EQUIPMENT PM & SERVICE

Project ID:

Technical Safety Services

VA Charleston Preventative Maintenance

Lead Technician

Tanner Moore

MEDICAL GAS SOURCE SYSTEM PREVENTIVE MAINTENANCE

PURPOSE

The purpose of the preventive maintenance documented in this report is to keep facility medical gas source systems in good repair, functioning at peak capacity, and maximize source system life as well as satisfy the NFPA

99 medical gas systems maintenance requirements.

REGULATORY REQUIREMENTS

Scheduled inspections for equipment and procedures shall be established through the risk assessment of the facility and developed with consideration of the original equipment manufacturer recommendations and other recommendations as required by the authority having jurisdication.

Additionally, The Joint Commission Standard EC 02.05.09 Ep 14 & other acceditation agencies requirements state that health care facilities must meet all applicable NFPA 99 codes related to medical gas systems. NFPA 99 sets out medical gas source system maintenance requirements including:

Facilities have a maintenance program for medical air compressor supply system(s) in accordance with the manufacturer's recommendations.

Facilities perform a testing and calibration procedure that ensures carbon monoxide monitors are calibrated at least annually or more often if recommended by the manufacturer.

Facilities have a maintenance program for the medical-surgical vacuum piping system to ensure the continued good performance of the entire medical-surgical vacuum system.

Facilities have a maintenance program for the WAGD system to ensure performance.

Audible and visual alarm indicators shall be periodically tested to determine that they are functioning properly.

Labels for shutoff valves shall be labeled and updated when modifications are made changing the area served.

MEDICAL GAS SOURCE SYSTEM PREVENTIVE MAINTENANCE

1)

2)

3)

PROCESS AND QUALIFICATIONS

In addition to adhering to applicable regulatory requirements for the maintenance of medical gas source systems, EMS service technicians follow recommended maintenance as defined in original equipment manufacturer guidelines.

EMS service technicians are qualified to perform medical gas source system preventive maintenance to one or more of the following qualification requirements per NFPA 99:

Documented training by which such persons are qualified to work with specific equipment as installed in that facility.

Credentialing to the requirements of ASSE 6040, Professional Qualification Standard for Medical Gas

Maintenance Personnel.

Credentialing to the requirements of ASSE 6030, Professional Qualification Standard for Medical Gas Systems

Verifiers.

All technicians performing work on medical gas systems or components are qualifed per NFPA 99 5.1.14 to perform these services and have had adequate training to safely work on these systems.

The maintenance, inspection and testing operations requirements as follows, per NFPA 99, apply to all facilities with Category 1-3 Medical Gas, Vacuum, WAGD, and Medical Support Gas systems.

SCOPE AND APPLICATION

PERFORMED BY:

SYSTEM VOLTAGE 460

CHECK VALVES OK OK

PANEL LAMPS OK OK

MOTOR GREASE FITTINGS Greased Greased

MAXIMUM VACUUM 29

PRESSURE SWITCH IN / OUT 19 / 25 18 / 20

PRESSURE (PSI) Lead Switch Lag Switch

OIL TEMPERATURE (°F) 175 175

EXHAUST TEMPERATURE (°F) 180 180

N/A N/A

OPERATIONAL / VISUAL

INSPECTION / NOISE

OK OK

SIGHT GLASS

LEAKS NO NO

COOLING FAN/HEAT EXCHANGE Cleaned Cleaned

EXHAUST FILTERS Changed Changed

INLET FILTERS Changed Changed

COUPLING OK OK

AMP DRAW L1 / L2 / L3 18.5 / 18.9 / 19.6 19.4 / 19.2 / 18.9

OVERLOAD SETTINGS (AMPS) 22 22

HOURS 49179 61133

HORSEPOWER 15 15

SERIAL NUMBER 2830891 2830891

MODEL VAC03-015 VAC03-015

MANUFACTURER Beacon (Becker) Beacon (Becker)

PUMP INFO PUMP #1 PUMP #2 PUMP #3 PUMP #4

AREA(S) SERVED: Entire Facility (Excluding OR Suite)SYSTEM SERIAL #: 261708-2BW

SYSTEM TYPE: MEDICAL VACUUM SYS MODEL/JOB 4107102732

SYSTEM LOCATION: BB116 SYSTEM MFR: Beacon

FACILITY CITY / STATE / ZIP: Charleston, SC Tanner Moore

7/1/2026

MEDICAL GAS SOURCE SYSTEM PREVENTIVE MAINTENANCE

FACILITY NAME: Ralph H. Johnson VA Medical CenterPROJECT ID: VA Charleston Preventative Maintenance

MEDICAL VACUUM LUBRICATED ROTARY VANE PUMP

FACILITY ADDRESS: 109 Bee St DATE OF SERVICE:

INLET FILTER HOUSING MODEL# Beacon Beacon

INLET FILTER MODEL # 4107 4001 87 4107 4001 87

MEDICAL GAS SOURCE SYSTEM PREVENTIVE MAINTENANCE

MEDICAL VACUUM LUBRICATED ROTARY VANE PUMP

OIL LEVEL & COND Oil Changed / Oil level within manufacturer recommendations

ALTERNATION OK

LOCAL ALARMS OK

SYSTEM LABELING OK

VALVE LABELING OK

PIPE LABELING OK

COMMENTS

None

SYSTEM CHECKLIST

PERFORMED BY:

SYSTEM VOLTAGE 460 VFD #

COOLING FAN/HEAT EXCHANGE Cleaned Cleaned

28MAXIMUM VACUUM

PRESSURE SWITCH IN / OUT 19 / 25 18 / 20

PRESSURE (PSI) Lead Switch Lag Swithch

EXHAUST TEMPERATURE (°F) 165 155

OIL TEMPERATURE (°F) 185 185

OPERATIONAL / VISUAL

INSPECTION / NOISE / CHECKS

OK OK

LEAKS NO NO

PANEL LAMPS OK OK

OIL BREATHER CAP OK OK

MOTOR GREASE FITTINGS Greased Greased

COUPLING OK OK

AMP DRAW L1 / L2 / L3 13.3 / 13.9 / 14.1 13.9 / 14.6 / 13.5

OVERLOAD SETTINGS (AMPS) 20 20

HOURS 7348 7021

HORSEPOWER 10 10

SERIAL NUMBER 410765489 410765489

MODEL MM 1402 AV MM 1402 AV

MANUFACTURER Beacon (Busch) Beacon (Busch)

PUMP INFO PUMP #1 PUMP #2 PUMP #3 PUMP #4

AREA(S) SERVED: OR Suite SYSTEM SERIAL #: HOP302087

SYSTEM TYPE: MEDICAL VACUUM / WAGD SYSTEM MODEL: VHM10D-200V-DCV

SYSTEM LOCATION: C109 SYSTEM MFR: Beacon

FACILITY CITY / STATE / ZIP: Charleston, SC Tanner Moore

FACILITY ADDRESS: 109 Bee St DATE OF SERVICE: 7/1/2026

FACILITY NAME: Ralph H. Johnson VA Medical CenterPROJECT ID: VA Charleston Preventative Maintenance

MEDICAL VACUUM / WAGD CLAW PUMP

MEDICAL GAS SOURCE SYSTEM PREVENTIVE MAINTENANCE

INLET FILTERS Changed Changed

INLET FILTER HOUSING MODEL# Beacon Beacon

INLET FILTER MODEL # 4107 4001 16 4107 4001 16

RELIEF VALVE SETTING OK OK

MEDICAL VACUUM / WAGD CLAW PUMP

MEDICAL GAS SOURCE SYSTEM PREVENTIVE MAINTENANCE

None

VALVE LABELING OK

PIPE LABELING

COMMENTS

OK

LOCAL ALARMS OK

OIL LEVEL & COND Oil Changed / Oil level within manufacturer recommendations

SYSTEM LABELING OK

SYSTEM CHECKLIST

ALTERNATION OK

PERFORMED BY:

SYSTEM VOLTAGE 460 VFD # N/A

PRESSURE SWITCH IN / OUT 80 / 100 65 / 85

PRESSURE (PSI) Lead Switch Lag Switch

DISCHARGE TEMPERATURE (°F) 195 180

OPERATIONAL / VISUAL

INSPECTION / NOISE OK OK

LEAKS NO NO

PANEL LAMPS OK OK

CHECK VALVES OK OK

AFTERCOOLER DRAIN VALVES OK OK

INLET FILTER Changed Changed

BELT TENSION & CONDITION OK / OK OK / OK

AMP DRAW L1 / L2 / L3 19.8 / 20.6 / 21.3 20.6 / 20.9 / 21.1

OVERLOAD SETTINGS (AMPS) 25 25

HOURS 3193 3307

HORSEPOWER 15 15

SERIAL NUMBER AIA2064048 AIA2064048

MODEL 1916 7418 83 1916 7418 83

MANUFACTURER Atlas Copco Atlas Copco

COMPRESSOR INFO COMP #1 COMP #2 COMP #3 COMP #4

AREA(S) SERVED: Entire Facility (Excluding OR Suite)SYSTEM SERIAL #: HOP400765

SYSTEM TYPE: MEDICAL AIR SYSTEM MODEL: 4107005599

SYSTEM LOCATION: BB116 SYSTEM MFR: Beacon

FACILITY CITY / STATE / ZIP: Charleston, SC Tanner Moore

FACILITY ADDRESS: 109 Bee St DATE OF SERVICE: 7/1/2026

FACILITY NAME: Ralph H. Johnson VA Medical CenterPROJECT ID: VA Charleston Preventative Maintenance

MEDICAL AIR SCROLL COMPRESSOR

MEDICAL GAS SOURCE SYSTEM PREVENTIVE MAINTENANCE

MEDICAL AIR SCROLL COMPRESSOR

MEDICAL GAS SOURCE SYSTEM PREVENTIVE MAINTENANCE

MUFFLER

DRYER #4DRYER #3DRYER #2

VALVE LABELING OK

-45 PIPE LABELING OK

-45 AUTODRAIN OK

OK

COMMENTS

None

MODEL

SERIAL NUMBER 14 87875 14 87875

FILTRATION INFO PRE-FILTER AFTER-FILTER

MANUFACTURER Atlas Copco Atlas Copco

DRYER TYPE Dessicant Dessicant

DESSICANT MATERIAL COND. OK OK

MANUFACTURER Beacon Beacon

SERIAL NUMBER

DRYER SYSTEM INFO

MODEL LifeLine LifeLine

DEW POINT UNIT READING

DEW POINT (AS MEASURED)

MANUAL DRAIN OK

DRYER #1

LOCAL ALARMS

RECEIVER SIGHT GLASS

SYSTEM CHECKLIST

ALTERNATION CO UNIT READING 0

CO CALIBRATION Yes

SYSTEM LABELING

OK

OK

OK OK

PERFORMED BY:

SYSTEM VOLTAGE 460 VFD # N/A

PRESSURE SWITCH IN / OUT 80 / 100 65 / 85

OIL PRESSURE N/A

PRESSURE (PSI) Lead Switch Lag Switch

DISCHARGE TEMPERATURE (°F) 166 150

OIL TEMPERATURE (°F) N/A N/A

OPERATIONAL / VISUAL / NOISE OK OK

LEAKS NO NO

PANEL LAMPS OK OK

CRANK CASE FILTER Changed Changed

DISCHARGE CHECK VALVES OK OK

AFTERCOOLER DRAINS OK OK

UNLOADERS & SOLENOIDS OK OK

RIDER & PISTON RINGS OK OK

30 30

BELT TENSION / CONDITION OK / OK OK / OK

AMP DRAW L1 / L2 / L3 16.1 / 16.8 / 16.6 16.9 / 16.5 / 16.2

OVERLOAD SETTING (AMPS)

HOURS 8585 7551

HORSEPOWER 20 20

SERIAL NUMBER

MODEL 15U-9.5V5A 15U-9.5V5A

MANUFACTURER Beacon Beacon

COMPRESSOR INFO COMP #1 COMP #2 COMP #3 COMP #4

AREA(S) SERVED: OR Suite SYSTEM SERIAL #: 56635

SYSTEM TYPE: MEDICAL AIR SYSTEM MODEL: LSM-20DN-DCY-001

SYSTEM LOCATION: C109 SYSTEM MFR: Beacon

FACILITY CITY / STATE / ZIP: Charleston, SC Tanner Moore

FACILITY ADDRESS: 109 Bee St DATE OF SERVICE: 7/1/2026

FACILITY NAME: Ralph H. Johnson VA Medical CenterPROJECT ID: VA Charleston Preventative Maintenance

MEDICAL AIR RECIPROCATING COMPRESSOR

MEDICAL GAS SOURCE SYSTEM PREVENTIVE MAINTENANCE

MEDICAL AIR RECIPROCATING COMPRESSOR

MEDICAL GAS SOURCE SYSTEM PREVENTIVE MAINTENANCE

MUFFLER

DRYER #1 DRYER #2 DRYER #3 DRYER #4

OK OK

COMMENTS

None

FILTRATION INFO

MANUFACTURER

MODEL

SERIAL NUMBER No nameplate No nameplate

No nameplate No nameplate

SERIAL NUMBER

DRYER TYPE

DESSICANT MATERIAL COND.

DRYER SYSTEM INFO

MODEL

MANUFACTURER

LifeLine LifeLine

Beacon Beacon

No nameplate No nameplate

Dessicant Dessicant

DEW POINT UNIT READING

DEW POINT (AS MEASURED)

LOCAL ALARMS

RECEIVER SIGHT GLASS

OK VALVE LABELING OK

-13.6 PIPE LABELING OK

-13.5 AUTODRAIN OK

MANUAL DRAIN OK

SYSTEM CHECKLIST

ALTERNATION

PRE-FILTER AFTER-FILTER

Beacon Beacon

OK CO UNIT READING 0

OK CO CALIBRATION Yes

OK SYSTEM LABELING OK

PERFORMED BY:

COMMENTS

NFPA recommends replacing flexible connections (pigtails) every 5 years. Manufacture's tag with date is missing. Flexible connections are in functional condition.

OPERATIONAL / VISUAL INSPECTION OK

OK

PIPE LABELING OK

NFPA 99 COMPLIANCE OK

Local & Remote (Master

Alarm Panels)

CHANGE-OVER ACTUATION (PSI)

CHANGE-OVER ALARM

250 VALVE LABELING

Missing tag

4 SOURCE VALVE OK

250 SYSTEM LABELING OK

RIGHT BANK # OF CONNECTIONS

RIGHT # CONNECTIONS IN USE

RIGHT INTERMEDIATE PRESSURE

4 FLEXIBLE CONNECTORS DATE

PRV LINE (LABELING & LOCATION) OK

LEFT BANK # OF CONNECTIONS

1250 RESERVE ACTUATION (PSI) 250

4 LEAKS NO

LEFT BANK PRESSURE

LEFT # CONNECTIONS IN USE

LEFT INTERMEDIATE PRESSURE

RIGHT BANK PRESSURE 1600

CONTAINER/CYLINDER VALVES

SYSTEM CHECKLIST

MANIFOLD TYPE: (HP/LIQ) HP MANIFOLD MODEL: M2HD-D-HH-U-NIT

SYSTEM GAS: NITROGEN MANIFOLD SERIAL #: 20080915-I-A

AREA(S) SERVED: OR Suite

109 Bee St DATE OF SERVICE: 7/1/2026

FACILITY CITY / STATE / ZIP: Charleston, SC Tanner Moore

OK

250 HEADER BAR VALVES OK

MEDICAL GAS SOURCE SYSTEM PREVENTIVE MAINTENANCE

NITROGEN MANIFOLD

FACILITY NAME: Ralph H. Johnson VA Medical CenterPROJECT ID: VA Charleston Preventative Maintenance

MANIFOLD LOCATION: 2 Fl Mechanical Manifold Room MANIFOLD MFR: Amico

FACILITY ADDRESS:

PERFORMED BY:

OPERATIONAL / VISUAL INSPECTION OK

COMMENTS

NFPA recommends replacing flexible connections (pigtails) every 5 years. Manufacture's tag with date is missing. Flexible connections are in functional condition.

CHANGE-OVER ALARM PIPE LABELING OK

NFPA 99 COMPLIANCE OK

Local & Remote (Master

Alarm Panels)

RIGHT INTERMEDIATE PRESSURE 150 SYSTEM LABELING OK

CHANGE-OVER ACTUATION (PSI) 150 VALVE LABELING OK

RIGHT BANK # OF CONNECTIONS 12 FLEXIBLE CONNECTORS DATE Missing Tag

RIGHT # CONNECTIONS IN USE 12 SOURCE VALVE OK

LEFT INTERMEDIATE PRESSURE 150 HEADER BAR VALVES OK

RIGHT BANK PRESSURE 200 PRV LINE (LABELING & LOCATION) OK

LEFT BANK # OF CONNECTIONS 12 LEAKS NO

LEFT # CONNECTIONS IN USE 12 CONTAINER/CYLINDER VALVES OK

SYSTEM CHECKLIST

LEFT BANK PRESSURE 750 RESERVE ACTUATION (PSI) 150

SYSTEM GAS: NITROUS OXIDE MANIFOLD SERIAL #: 20060831-O-A

AREA(S) SERVED: OR Suite

MANIFOLD TYPE: (HP/LIQ) HP MANIFOLD MODEL: M2HD-DHHH-U-N2O

FACILITY ADDRESS: 109 Bee St DATE OF SERVICE: 7/1/2026

FACILITY CITY / STATE / ZIP: Charleston, SC Tanner Moore

MANIFOLD LOCATION: C110 MANIFOLD MFR: Amico

MEDICAL GAS SOURCE SYSTEM PREVENTIVE MAINTENANCE

NITROUS OXIDE MANIFOLD

FACILITY NAME: Ralph H. Johnson VA Medical CenterPROJECT ID: VA Charleston Preventative Maintenance