Page 58 - 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 X-Ray Floor/Bldg 1 Floor Med Plaza
st

Zone Valve Location for this Area Outside of X-Ray ZVB Manufacturer Amico

FL Hosp. Tag # #000000227017 (only # for this ZVB)
Location IAW NFPA 99 Pass Labeled Pass Gauges Pass Leak Test Pass
Test Gauge O2 52 AIR 49 VAC 24 N2O 54
Pressure vs.
ZVB Gauge 52 50 24 57

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 <1 PPM
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

Test Location X-ray X-ray X-ray

Area Alarm Panel Location for this Area Nurses station in Pre-Op
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 PS PASS
AIR 50 40 60 P P P PS PASS
VAC -23 12 - P P P PS PASS
N2O 52 40 60 P P P PS PASS
PS= Patient Side SS= Source Side NW= Not Working CNT= Could Not Test NA = Not Applicable NP = Not Present

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©Daniel Voight 2009