Page 84 - 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 12-4-17 Page 1 of 2
Contractor n/a Facility Contact Darrell Huckaby

Area Served OR 3 Floor/Bldg 4 Floor Med Plaza
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Zone Valve Location for this Area Outside OR3 ZVB Manufacturer Medaes

FL Hosp. Tag # MA/VA/O2/NO/C2/N2-P-5PC-04-B-Z-W-03
Location IAW NFPA 99 Pass Labeled Pass Gauges Pass Leak Test Pass
Test Gauge O2 51 AIR 50 VAC 25 N2O 52 N2 170 CO2 52
Pressure vs.
ZVB Gauge 50 50 25 52 170 51

Valve Size 1/2 1/2 1 1/2 1/2 1/2
Comments:

Gas/Pipeline Purity Oxygen Med Air N2O CO2 Comments
Hydrocarbons <1 PPM <1 PPM <1 PPM <1 PPM
Dew Point -46 23 -27 -17
Carbon Monoxide <1 PPM <1 PPM <1PPM <1 PPM
Carbon Dioxide <1 PPM 370 PPM <1 PPM 5000PPM
Gas Concentration 99.9%O2 21.0 (%O2) 99.9%N2O 99.9%CO2

Particulates <1 <1 <1 <1
Odor/Discoloration None None None None
Test Location OR3 OR3 OR3 OR3

Area Alarm Panel Location for this Area In OR nurses station
Location IAW NFPA 99 Pass Labeled Pass Gauges Pass Leak Test Pass
Area Alarm Panel Manufacture Data Medaes Analog (GP-L-5PC-04-5G-SA4) Vac(GP-L-5PC-04-6G-Z03)
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 51 40 60 P P P SS PASS
VAC 25 12 - P P P SS PASS
N2O 54 40 60 P P P SS PASS
N2 172 130 200 P P P SS PASS
CO2 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
Corporate Office ∙ 4518 Clements Rd. Lakeland Florida 33811 Phone: 863-646-7555 ∙ Fax 863-646-2999
“Medical Gas Pipeline Equipment Service, Sales & Verifications”
©Daniel Voight 2009