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FIELD SERVICE REPORT
Facility FHO Med Plaza/Cancer Center Date 2-27-18
Address 601 E Rollins St. Technician Seth Stephens/Steve Gourley
City/State Orlando FL PO# 3442460
Facility Contact/Supervisor Darrell Huckaby Department Engineering
Phone# 352-613-0549 Fax# Email Darrell.Huckaby@flhosp.org
Equipment Description 2017 Discrepancy Repairs
Equipment Manufacturer(s)
Model #/ Part # /Ser #
Equipment Location (s) Med Plaza/Cancer Center
Description of work performed Discrepancy Repairs from 2017 Annual Med Gas Inspection: #’s 1, 2, 3 &
7.
Parts Used: 3 Ohio Black Face Bulbs & 4 Series 500 Blanks.
Hours: Qt. 2863 Per Diem: Mileage: Rate:
Comments & Recommendations
Signature of Service Technician Seth Stephens
Signature of Responsible Facility Authority
Corporate Office ∙ 4518 Clements Rd. Lakeland Florida 33811 Phone: 863-646-7555 ∙ Fax 863-646-2999
“Medical Gas Pipeline Equipment Service, Sales & Verifications”
www.medgaspro.org
