Page 86 - 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

th
Area Served OR 4 Floor/Bldg 4 Floor Med Plaza

Outside OR4
Zone Valve Location for this Area door frame# K-5PN-04-E-85-& ZVB Manufacturer Medaes
FL Hosp. Tag # O2/MA/VA/NO/N2/CO-P-5PN-04-B-Z-W-04
Location IAW NFPA 99 Pass Labeled Pass Gauges Pass Leak Test Fail
Test Gauge O2 52 AIR 49 VAC 24 N2O 52 N2 169 CO2 51
Pressure vs.
ZVB Gauge 52 49 25 51 175 51

Valve Size
Comments: Gauges leak, N2 reading high

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 OR4 OR4 OR4 OR4

Area Alarm Panel Location for this Area Behind 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 Alarm (GP-L-5PC-04-6-G-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 23 12 - P P P SS PASS
N2O 54 40 60 P P P SS PASS
N2 173 130 200 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