Page 136 - Womens Pavilion

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

Facility Florida Hosp. Orlando – Women’s Center Inspector Joseph Voight
City/State Orlando, FL Date 11-28-17 Page 1 of 5

Contractor n/a Facility Contact Darrell Huckaby
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Area Served Patient Rooms 11901-11912 Floor/Bldg 11 Floor

Zone Valve Location for this Area Corridor wall across from Rm 11910 ZVB Manufacturer Amico -4 Valves

FL Hosp. Tag # O2 000000244664 AIR 000000244663 VAC 000000244665
Location IAW NFPA 99 Pass Labeled Pass Gauges Pass Leak Test Pass
Test Gauge O2 53 AIR 50 VAC 22
Pressure vs.
ZVB Gauge 56 50 22

Valve Size ¾” ¾” 1 ½”
Comments:

Gas/Pipeline Purity Oxygen Med Air Comments
Hydrocarbons <1 PPM <1 PPM
Dew Point -44F 5F
Carbon Monoxide <1 PPM <1 PPM
Carbon Dioxide 0 PPM 120 PPM
Gas Concentration 99%O2 21.8(%O2)
Particulates None None
Odor/Discoloration None None

Test Location 11912 11912

Area Alarm Panel Location for this Area Nurses station across from Rm 11918

Location IAW NFPA 99 Pass Labeled Pass Gauges Pass Leak Test Pass
Area Alarm Panel Manufacture Data Amico LCD ADV# 000000244662
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 49 40 60 P P P PS PASS
VAC 21 12 NA P P P PS 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