Page 124 - Air-Lakeside FSR PM

PREVENTATIVE MAINTENANCE SERVICE REPORT

Facility Florida Hospital Orlando Date 12-15-17

Address Address Technician Anthony Voight
City/State Orlando, FL PO#
Facility Contact/Supervisor Darrell Huckaby Department Engineering/Maint.

Phone# 407-123-4567 Fax# 407-123-4567 Email
Equipment Description Equipment Manufacturer Model #/ Part # /Ser # Equipment Location
Lakeside
Med Air System Triplex Recip. LPS-20T-D200-TCY
Base Mount Vertical Tank 20hp Beacon Hitachi (12/9/2002) 59021 Plant Ops
System Voltage 460/3/60 Wiring Dia. Present Y System Operating Pressure Lead 96 #2 80 #3 75 #4
☐ Inspected/Changed Oil & Filter ☒ Tested Alternation & Minimum Run Time
☐ Inspected/Changed Exhaust filters/Drained Drip legs ☒ Tested All Local Alarms
☒ Inspected Inlet Filters ☒ Inspected Control Cabinet/Tightened Connections
☒ Inspected Dryer Pre-Filters ☒ Inspected/Tested Dew Point -11.0F CO Monitor 0ppm
☒ Inspected Dryer After Filters ☒ Room Ventilation/Ambient Temperature 75F
☒ Inspected Drain Floats ☒ Pump1 Amps L1 22.6 L2 19.2 L3 22.1 HR 15711 Temp 130F

☒ Inspected Dryer Desiccant ☒ Pump2 Amps L1 20.5 L2 22.4 L3 22.2 HR 15867 Temp 121F
☒ Inspected Belts ☒ Pump3 Amps L1 21.7 L2 21.3 L3 19.6 HR 15757 Temp 128F

☒ Inspected all Pressure Gauges/Switches ☐ Pump4 Amps L1 L2 L3 HR Temp
☒ Inspected/Tested After Cooler Drains ☒ Inspected/Adjusted Final Line Pressure Regulators
☒ Inspected/Tested Receiver Tank Drains ☒ Inspected System for Unusual Noise and Vibration
☒ Inspected/Tested all Discharge/Inlet Check Valves ☒ Inspected System for Air Leaks
☒ Inspected Intake/Exhaust Air Locations (Roof) ☐ Presence of Hydrocarbons/Air Tested
Hours: Per Diem: Mileage: Rate:
Comments & Recommendations

Signature of Service Technician Anthony Voight

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