Page 34 - Med Plaza and Cancer Center

ZONE VALVE/ AREA ALARM / OUTLET PERFORMANCE/GAS CONCENTRATION AND PURITY INSPECTION DOCUMENT

Facility Florida Hospital Orlando-Med Plaza Inspector Steve Gourley
City/State Orlando, FL Date 11-30-17 Page 1 of 2
Contractor n/a Facility Contact Darrell Huckaby

Area Served OR 1 Floor/Bldg 1 Floor Med Plaza
st

Zone Valve Location for this Area Outside OR1 ZVB Manufacturer Amico

FL Hosp. Tag # #0000000227018 (only # for ZVB)
Location IAW NFPA 99 Pass Labeled Pass Gauges Pass Leak Test Pass
Test Gauge O2 52 AIR 49 VAC 25 N2O 53
Pressure vs.
ZVB Gauge 51 50 25 52

Valve Size ½” ½” 1” ½”
Comments:

Gas/Pipeline Purity Oxygen Med Air N2O Comments
Hydrocarbons <1 PPM <1 PPM <1 PPM
Dew Point -46 23 -27
Carbon Monoxide <1 PPM <1 PPM <1PPM
Carbon Dioxide <1 PPM 370 PPM <1 PPM
Gas Concentration 99.9%O2 21.0 (%O2) 99.9%N2O

Particulates <1 <1 <1
Odor/Discoloration None None None/Heavy
Test Location OR1 OR1 OR1

Area Alarm Panel Location for this Area Nurses station
Location IAW NFPA 99 pass Labeled Pass Gauges Pass Leak Test Pass
Area Alarm Panel Manufacture Data Amico LCD FL Hosp. Tag# 000000227015
GAUGE LOW HIGH TEST
GAS/VAC PSI ALARM ALARM VISUAL AUDIBLE SWITCH SENSOR COMMENTS PASS/FAIL
OXY 52 40 60 P P P SS PASS
AIR 50 40 60 P P P SS PASS
VAC 23 12 - P P P SS PASS
N2O 52 40 60 P P P SS PASS
PS= Patient Side SS= Source Side NW= Not Working CNT= Could Not Test NA = Not Applicable NP = Not Present

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