Page 3 - 2017 Disc Rep FSRs Select Specialty
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FIELD SERVICE REPORT
Facility FHO Select Specialty Date 2-26-18
Address 601 E Rollins St. Technician Gage Stephens
City/State Orlando FL PO# 3428353
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) All
Description of work performed Discrepancy Repairs from 2017 Annual Med Gas Inspection: #1-Replace
Med Air Series 500 Face Plate.
Parts Used: 1 Series 500 Med Air Face Plate
Hours: Qt. 2863 Per Diem: Mileage: Rate:
Comments & Recommendations
Signature of Service Technician Gage 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
