HomeMy WebLinkAbout3257 CAMINO DE LOS COCHES; 304; US070109; Permit10/29/2020 US070109 Permit Data
City of Carlsbad
Hazardous Installations
Permit No: US070109
3257 CAM INO DE LOS 4f
Job Address: Status: ISSUED
COCHES
Permit Type: HI Applied 12/27/2007
Parcel No: 2550313200 Approved: 12/27/2007
Lot #: 0
Reference No.: Issued: 12/27/2007
PC #: Inspector:
Project Title: CARLSBAD CHILDREN'S DENISTRY MEDICAL GAS DISPENSING
SYSTEM
Applicant:
UTGARD CONSTRUCTION
STE L
12225 WORLD TRADE DR
SAN DIEGO CA
619 293-0234
Owner:
LOSCOCHES VILLAGE LLC
C/O CRAIG W CLARK
4180 LA JOLLA VILLAGE DR #405
LA JOLLA CA
Fees ($) Add'I Fees ($) Total ($) Balance ($)
235 L 0 235 0
1/1
Fe.b 20 08 03:02p Certified Medical Testing 5594358827 p2 Uooti
Certified Medical Testing
377 Fallbrook Avenue, Suite 208, Fresno, CA 93711
800/243-5427 Office
559 / 435-8827 Fax
certifiedrestings bcglobaL net
3 --s (L o CoCQJ 6 '30 '1•
February 15,2008
To; ATTN: Mr. Steve Utgard
Utgard Construction Company Inc.
12225 World Trade Drive, Ste. L
San Diego, CA 92128
PROJECT: CARLSBAD CHILDREN'S DENTISTRY, 3257 CAMINO DE LOS COCHES,
CARLSBAD, CA 92009: FINAL INSPECTION / CERTIFICATION
Subsequent to. the Remodel Construction involving the Dental Gas system - Construction Certification Testing of the Medical Gas
System OR PORTION THEREOF have been effected at the herein referenced facility. Testing procedures utilized, conform with and
are capable of determining functional results which meet the minimum requirement setforth in NFPA 1999, CGA, and JCAHO
requirements and/or recommendations. With the exception of those items so designated in the attached data sheets, THE DENTAL
GAS PIPING SYSTEM DESCRIBED HEREIN AT -
CARLSBAD CHILDREN'S DENTISTRY
comply with the minimum requirements set forth in the above referenced criteria.
PIPED GAS SYSTEMS - Level I
Tests Performed: Results: . - Tests Performed: Results: - Cross Connection NFPA 99 4-3.4.1.3(a).... PASS Final Tie-In Test NFPA 994-3.4.1.3(g).....PASS
Valve Test NFPA 994-3.4.1.3(b).... PASS Operational Pressure Test NFPA 99 4-3.4.1.3(h).....PASS'
Flow Test NFPA 994-3.4.1.3(c).... PASS Labeling NFPA 994-3.4.1.30) ...... PASS`
Alarm Test NFPA 994-3.4.1.3(4... PASS Gas Supply Source NFPA 994-3.4.1.3 ......... PASS '
Piping Purge Test NFPA 994-3.4.1.3(e).... PASS Medical Air Compressor NFPA 99 4-3.4.1.3(j).... -PA SS,
Piping Purity Test NFPA 99 4-3.4.1.3(f) ..... PASS
DENTAL GAS GAS PRESSURE TEST FLOW TEST TEMP. TEST I RESULTS CONCENTRATION RESULTS RESULTS RESULTS
Oxygen > 99% 51 psig. 200 1pm 70 0 F. I Nitrous Oxide > 99% 51 psig. 160 1pm 70 F.
TO BE COMPLETED - RELOCATION OF LIGHT SWITCH N MANIFOLD ROOM ABOVE 5 FEET
Irn
fltcn_ tlnh,.I.
ROLAND W. LAMER
i2Ld/I1.
EXECUTIVE DIRECTORDIRECTOR
TC1000I-60
Feb 20 08 03:02p Certified Medical Testing 5594358827 P.3
CARL SBAD CHILDREN'S DENTISTRY
CARLSBAD, CALIFORNIA
02/15/08
DENTAL OXYGEN SYSTEM
(SOURCE EQUIPMENT)
i ne iniormaiion presentea netow, evaluates rue existing design and configuration of the Dental Gas Systems "Source
Equipment" relative to the latest recognized Edition of the NFPA 99, (designated in "Bold Text" ) as well as the Code
Edition which initialized the Referenced Standard Requirement, (designated in "ItalacIzed" text). THIS DATA IS
PRESENTED FOR INFORMATION PURPOSES ONLY. No information provided herein shall imply that the existing
equipment fails to meet minimum standards.
Ref. NFPA 99, 1999, Par. 1.2.
"Construction and equipment requirements shall be applied only to new construction and new equipment, except as modified in
individual chapters. Only the altered, renovated, or modernized portion of an existing system or individual component shall be
required to meet installation and equipment requfrements slated in this standard."
MANUFACTURER: MODEL: NO. OF CYLS. LINE PRESSURE: STOR. CAPACITY
PORTER VANGUARD - - 248 SCF.
I. THE MANIFOLD MUST BE CONNECTED TO 2 BANKS OF CYLINDERS THAT ALTERNATELY SUPPLY THE
PIPING SYSTEM. (NFPA 565, 1951, Sect. 2.1b) (NFPA 99, 1999, Par. 4-3.1.1.7a)
EACH BANK MUST HAVE A PRESSURE REGULATOR AND CYLINDERS CONNECTED TO A
COMMON HEADER. (NFPA 565, 1951, Sect. 2-Ib) (NFPA 99, 1999, Par. 4-3.1.I.7a)
EACH BANK MUST CONTAIN A MINIMUM OF 2 CYLINDERS OR AT LEAST AND AVERAGE DAYS SUPPLY.
(NFPA 565,195 1, Sect. 2.lb)(NFPA 99, 1999, Par. 4-3.1.1.7b)
THE SECONDARY BANK MUST AUTOMATICALLY OPERATE TO SUPPLY THE SYSTEM WHEN THE
PRIMARY SUPPLY IS DEPLEATED. (NFPA 565, 1951, Sect. 2-1b) (NFPA 99, 1999, Par. 4-31.1.7a)
THE RESERVE IN USE PRESSURE SWITCH MUST BE CONNECTED TO THE MASTER ALARM PANEL. (NFPA
565, 1951, Sect. 2.1 b) (NFPA 99, 1999, Par. 4-3.1.1.5b)
EACH PIGTAIL MUST HAVE CHECK VALVE. (NFPA 565,1951, Sect 2-1.C.2) (NFPA 99, 1999, Par. 4-3.1.1.5b)
EACH HEADER BAR SHALL INCLUDE A SHUTOFF VALVE DOWNSTREAM OF THE NEAREST CYLINDER
CONNECTION, AND A CHECK VALVE TO PREVENT BACKFLOW INTO THE HEADER AND TO PERMIT
SERVICE TO THE HEADER. (NFPA 99,1999, Par. 4-3.1.1.8a)
THE CYLINDERS MUST BE APPROPRIATELY RESTRAINED. (NFPA 99,1987, Sect. 4-3.1.2.1c) (NFPA 99, 1999,
Par. 4-3.1.1.2a4)
ALL ELECTRIC FIXTURES MUST BE AT LEAST 5 FEET ABOVE FLOOR LAVEL. (NFPA 56, 1951, Sect. 2-1.D.4)
(NFPA 99, 1999, Par. 4-3.1.1.2a2)
THE STORAGE ENCLOSURE, DOOR, AND DOORFRAME MUST BE "ONE HOUR FIRE RATED".
(NFPA 565,195 1, Sect. 2-1 D.I) (NFPA 99,1999, Par. 4-3.11.2a5)
THE STORAGE AREA MUST BE FREE OF COMBUSTIBLE MATERIALS.
(NFPA 99, 1987, Sect. 4-3.12.1.14) (NFPA 99,1999, Par. 4-3.1.1.2a.11b)
NO STORAGE OF FLAMMABLE GASES IS ALLOWED IN AN OXIDIZER LOCATION. (NFPA 565,195 1, Sect 2-
I .D.3) (NFPA 99, 1999, Par. 4-3.1.1.2a..11g)
NO SOURCES OF HEAT OTHER THAN STEAM OR HOT WATER ARE PERMISSIBLE IN THE AREA OF THE
SYSTEM ENCLOSURE. (NFPA 56F, 1973, Sect. 2264) (NFPA 99, 1999, Par. 4-3.I.1.2a.1lg)
Feb 20 08 03:02p Certified Medical Testing 5594358827 P.4
CARLSBAD CHILDREN'S DENTISTRY
CARLSBAD, CALIFORNIA
02/15/08
DENTAL OXYGEN SYSTEM
(SOURCE EQUIPMENT)
14. (A) IF SYSTEM IS MORE THAN THE MANIFOLD'S PRESSURE RELIEFS IT SHALL BE VENTED TO THE
OUTSIDE OR MECHANICALLY VENTED TO INCLUDE THE PRESSURE RELIEF VALVE VENTED TO THE
OUTSIDE. (NFPA 56F, 1973, Sect. 225) (NFPA 99, 1999, Par. 4-3.1.I.2b4)
THE STORAGE AREA MUST BE PROVIDED WITH 72 SQ. IN. OF TOTAL FREE AREA. (NFPA 56F, 1973,
Sect. 23 1) (NFPA 99,1999, Par. 4-3.1.1.2b4)
IF THE DOOR OPENS ONTO AN EXIT ACCESS CORRIDOR THEN THE VENTS MUST HAVE FIRE
DAMPERS OF APPROPRIATE RATING. (NFPA 99, 1990, Sect. 4-3.1.2.3) (NFPA 99, 1999, Par. 4-3.1.2Je)
15. NO SOFT SOLDERED JOINTS ARE PERMISSIBLE ON THE PIPING SYSTEM. (NFPA 565,195 1, Sect. 4-lb)(NFPA
99, 1999, Par. 4-3.1.2.7)
16. FINAL LINE REGULATORS SHALL BE DUPLEXED. (NFPA 99, 1990, Sect. 4-3.1-87) (NFPA 99,1999, Par. 4-
3.1.1.8g)
17. A MANUALLY OPERATED SHUTOFF VALVE SHALL BE INSTALLED UPSTREAM OF EACH PRESSURE
REGULATOR, AND A SHUTOFF VALVE OR A CHECK VALVE SHALL BE INSTALLED DOWNSTREAM.
(NFPA 99, 1999, Par. 4-3.1.1.8d)
18. ALL GAUGES MUST BE LABELED "USE NO OIL". (NFPA 565, 1934, Sect. 14b) (NFPA 99, 1999, Par. 4-5.1.2.9b)
19. A PRESSURE RELIEF VALVE MUST BE PROVIDED DOWNSTREAM OF THE LINE REGULATOR. (NFPA 565,
1951, Sect. 2-1.C.5) (NFPA 99,1999, Par. 4-3.1.1.8e)
20. THE PRESSURE RELIEF VALVE MUST BE RATED AT 50% ABOVE NORMAL LINE PRESSURE. (NFPA 565,
1951, Sect. 2-1.C.4) (NFPA 99, 1999, Par. 4-3.1.1.8e)
21. A SHUTOFF VALVE MUST BE LOCATED DOWNSTREAM OF ALL MANIFOLD EQUIPMENT AND
IMMEDIATELY WITHIN THE STORAGE AREA. (NFPA 99, 1990, Sect 4-4.1.2.2B) (NFPA 99,1999, Par. 4-3.1.2.3a)
22. THE "SOURCE" SHUTOFF VALVE MUST BE LABELED "SOURCE VALVE" FOR THE (SOURCE NAME). (NFPA
99, 1990, Sect 4-4.1.2.2B) (NFPA 99, 1999, Par. 4-3.1.2.3b)
23. THE SHUTOFF VALVE MUST BE PROVIDED IN THE MAIN LINE ACCESSIBLE FROM WITHIN THE
BUILDING SERVED AND OUTSIDE OF THE SOURCE ROOM, AND IT MUST BE ACCESSIBLE 24 HOURS A
DAY. (NFPA 99,1990, Sect. 4-4.12.2B)(NFPA 99,1999, Par 4-3.1.23b)
24. A PRESSURE GAUGE MUST BE LOCATED DOWNSTREAM OF THE SOURCE VALVE ADJACENT TO THE
ALARM INITIATING DEVICE, AND MUST BE ABLE TO BE VIEWED FROM A STANDING POSITION. (NFPA
56F, 1977, Sect. 341) (NFPA 99, 1999, Par. 4-3.1.2.2e.1)
25. A PRESSURE GAUGE MUST BE LOCATED DOWNSTREAM OF TEE MAINLINE SHUTOFF VALVE AND ABLE
TO YE VIEWED FROM A STANDING POSITION. (NFPA 56F, 1977, Sect. 341) (NFPA 99,1999, Par. 4-3.1.2.2e.2)
Design or configuration variances from the referenced standard are represented by "Highlight".
LEAKAGE NOTE: 0
COMMENTS:
Feb 20 08 03:02p Certified Medical Testing 5594358827 P.5
CARLSBAD CHILDREN'S DENTISTRY
CARLSBAD, CALIFORNIA
02/15/08
DENTAL NITROUS OXIDE SYSTEM
(SOURCE EQUIPMENT)
C11IU uviow, evuivares me exisming aesign ana configuration of the Dental Gas Systems "Source
Equipment" relative to the latest recognized Edition of the NFPA 99, (designated in "Bold Text" ) as well as the Code Edition which initialized the Referenced Standard Requirement, ( designated in "Izalacfted" text). THIS DATA IS
PRESENTED FOR INFORMATION PURPOSES ONLY. No information provided herein shall imply that the existing
equipment tatis to meet minimum standards. -
Ref. NFPA 99, 1999, Par. 1-2.
"Construction and equipment requirements shall be applied only to new construction and new equipment, except as modfled in
individual chapters. Only the altered, renovated, or modernized portion clan existing system or individual component shall be
required to meet installation and equipment requirements stated in this standard."
MANUFACTURER: MODEL: NO. OF CYLS. LINE PRESSURE: STOR. CAPACITY PORTER VANGUARD - - 56 LBS.
THE MANIFOLD MUST BE CONNECTED TO 2 BANKS OF CYLINDERS THAT ALTERNATELY SUPPLY THE
PIPING SYSTEM. (NFPA 565, 1951, Sect. 2.1b) (NFPA 99, 1999, Par. 4-3.1.1.7a)
EACH BANK MUST HAVE A PRESSURE REGULATOR AND CYLINDERS CONNECTED TO A
COMMON HEADER. (NFPA 565, 1951, Sect. 2-1b) (NFPA 99, 1999, Par. 4-3.1.1.7a)
EACH BANK MUST CONTAIN A MINIMUM OF 2 CYLINDERS OR AT LEAST AND AVERAGE DAYS SUPPLY.
(NFPA 565, 1951, Sect. 2.1b) (NFPA 99, 1999, Par. 4-3.1.I.7b)
THE SECONDARY BANK MUST AUTOMATICALLY OPERATE TO SUPPLY THE SYSTEM WHEN THE
PRIMARY SUPPLY IS DEPLEATED. (NFPA 565,195 1, Sect. 2-Ib) (NFPA 99,1999, Par. 4-31-1.7a)
THE RESERVE IN USE PRESSURE SWITCH MUST BE CONNECTED TO THE MASTER ALARM PANEL. (NFPA
565, 1951, Sect. 2.1b) (NFPA 99, 1999, Par. 4-3.1.1.5b)
EACH PIGTAIL MUST HAVE CHECK VALVE. (NFPA 565, 1951, Sect. 2-I.C.2) (NFPA 99,1999, Par. 4-3.1.1.51,)
EACH HEADER BAR SHALL INCLUDE A SHUTOFF VALVE DOWNSTREAM OF THE NEAREST CYLINDER
CONNECTION, AND A CHECK VALVE TO PREVENT BACKFLOW INTO THE HEADER AND TO PERMIT
SERVICE TO THE HEADER. (NFPA 99,1999, Par. 4-3.1.1.8a)
THE CYLINDERS MUST BE APPROPRIATELY RESTRAINED. (NFPA 99, 1987, Sect. 4-3.1.2.Ic) (NFPA 99, 1999,
Par. 4-3.1.1.2a4)
ALL ELECTRIC FIXTURES MUST BE AT LEAST 5 FEET ABOVE FLOOR LAVEL. (NFPA 56, 1951, Sect. 2-1.D.4)
(NFPA 99,1999, Par. 4-3.1.1.2a2)
THE STORAGE ENCLOSURE, DOOR, AND DOORFRAME MUST BE "ONE HOUR FIRE RATED".
(NFPA 565, 1951, Sect. 2-I .D.1) (NFPA 99, 1999, Par. 4-3.1.1-225)
THE STORAGE AREA MUST BE FREE OF COMBUSTIBLE MATERIALS.
(NFPA 99, 1987, Sect 4-3.I.2.LH) (NFPA 99, 1999, Par. 4-3.1.1.2a.11b)
NO STORAGE OF FLAMMABLE GASES IS ALLOWED IN AN OXIDIZER LOCATION. (NFPA 565,195 1, Sect. 2-
1.D.3) (NFPA 99, 1999, Par. 4-3.1.I.2a.11g)
NO SOURCES OF HEAT OTHER THAN STEAM OR HOT WATER ARE PERMISSIBLE IN THE AREA OF THE
SYSTEM ENCLOSURE. (NFPA 56F, 1973, Sect. 2264) (NFPA 99, 1999, Par. 4-3.1.1.2a.I1g)
Feb 20 08 03:02p Certified Medical Testing 5594358827 p.6
CARLSBAD CHILDREN'S DENTISTRY
CARLSBAD, CALIFORNIA
DENTAL NITROUS OXIDE SYSTEM
(SOURCE EQUIPMENT)
14. (A) IF SYSTEM IS MORE THAN THE MANIFOLD'S PRESSURE RELIEFS IT SHALL BE VENTED TO THE
OUTSIDE OR MECHANICALLY VENTED TO INCLUDE THE PRESSURE RELIEF VALVE VENTED TO THE
OUTSIDE. (NFPA 56F, 1973, Sect. 225) (NFPA 99, 1999, Par. 4-3.1.1.2b4)
THE STORAGE AREA MUST BE PROVIDED WITH 72 SQ. IN. OF TOTAL FREE AREA. (NFPA 56F, 1973,
Sect. 23 1) (NFPA 99, 1999, Par. 4-3.1.1.2b4)
IF THE DOOR OPENS ONTO AN EXIT ACCESS CORRIDOR THEN THE VENTS MUST HAVE FIRE
DAMPERS OF APPROPRIATE RATING. (NFPA 99, 1990, Sect. 4-3.1.2.3) (NFPA 99, 1999, Par. 4-3.1.2.1e)
15. NO SOFT SOLDERED JOINTS ARE PERMISSIBLE ON THE PIPING SYSTEM. (NFPA 565,195 1, Sect. 4-lb)(NFPA
99, 1999, Par. 4-3.1.2.7)
16. FINAL LINE REGULATORS SHALL BE DUPLEXED. (NFPA 99, 1990, Sect. 4-3.1.8.7) (NFPA 99,1999, Par. 4-
3.1.1.8g)
17. A MANUALLY OPERATED SHUTOFF VALVE SHALL BE INSTALLED UPSTREAM OF EACH PRESSURE
REGULATOR, AND A SHUTOFF VALVE OR A CHECK VALVE SHALL BE INSTALLED DOWNSTREAM.
(NFPA 99, 1999, Par. 4-3.I.1.8d)
18, ALL GAUGES MUST BE LABELED "USE NO OIL". (NFPA 565, 1934, Sect. 14b) (NFPA 99, 1999, Par. 4-5.1.2.9b)
A PRESSURE RELIEF VALVE MUST BE PROVIDED DOWNSTREAM OF THE LINE REGULATOR. (NFPA 565,
1951, Sect. 2-1 .C.5) (NFPA 99, 1999, Par. 4-3.1.1.8e)
THE PRESSURE RELIEF VALVE MUST BE RATED AT 50% ABOVE NORMAL LINE PRESSURE. (NFPA 565,
1951, Sect. 2-1.C.4) (NFPA 99, 1999, Par. 4-3.1.1.8e)
A SHUTOFF VALVE MUST BE LOCATED DOWNSTREAM OF ALL MANIFOLD EQUIPMENT AND
IMMEDIATELY WITHIN THE STORAGE AREA. (NFPA 99, 1990, Sect. 4-4.1.2.2B) (NFPA 99,1999, Par. 4-3.1.2.3a)
THE "SOURCE" SHUTOFF VALVE MUST BE LABELED "SOURCE VALVE" FOR THE (SOURCE NAME). (NFPA
99, 1990, Sect. 44.1.2.2B) (NFPA 99, 1999, Par. 4-3.1.2.3b)
THE SHUTOFF VALVE MUST BE PROVIDED IN THE MAIN LINE ACCESSIBLE FROM WITHIN THE
BUILDING SERVED AND OUTSIDE OF THE SOURCE ROOM, AND IT MUST BE ACCESSIBLE 24 HOURS A
DAY. (NFPA 99, 1990, Sect. 4-4.I22B) (NFPA 99, 1999, Par. 4-3.1.2.3b)
A PRESSURE GAUGE MUST BE LOCATED DOWNSTREAM OF THE SOURCE VALVE ADJACENT TO THE
ALARM INITIATING DEVICE, AND MUST BE ABLE TO BE VIEWED FROM A STANDING POSITION. (NFPA
56F, 1977, Sect. 34 1) (NFPA 99, 1999, Par. 4-3.1.2.2e.1)
A PRESSURE GAUGE MUST BE LOCATED DOWNSTREAM OF THE MAINLINE SHUTOFF VALVE AND ABLE
TO VE VIEWED FROM A STANDING POSITION. (NFPA 56F, 1977, Sect 34 1) (NFPA 99,1999, Par. 4-3.1.2.2e.2)
Design or configuration variances from the referenced standard are represented by "Highlight".
LEAKAGE NOTE: 0
COMMENTS:
Feb 20 08 03:03p Certified Medical Testing 5594358827 P.7
CARLSBAD CHILDREN'S DENTISTRY
CARLSBAD, CALIFORNIA
02/15/08
DENTAL OXYGEN SYSTEM
(STATION OUTLETS)
THE SYSTEM COMPONENTS DESIGNATED BELOW HAVE BEEN TESTED FOR FUNCTIONAL CAPACITY PER
NFPA 99, 1999 CRITERIA. EXCEPT AS NOTED IN THE COLUMN MARKED (FAIL), ALL COMPONENTS
DESCRIBED HEREIN ARE CERTIFIED AS OPTIMALLY FUNCTIONAL.
I LOCATION NO. OF OUTLETS FLOW RATE (LPM) FAIL COMMENTS
3RD FLOOR:
STATION 1 1 200
2 1 200
3 1 200
4 1 200
5 1 200
FUTURE 6 1 260
DENTAL NITROUS OXIDE SYSTEM
(STATION OUTLETS)
THE SYSTEM COMPONENTS DESIGNATED BELOW HAVE BEEN TESTED FOR FUNCTIONAL CAPACITY PER
NFPA 99,1999 CRITERIA. EXCEPT AS NOTED IN THE COLUMN MARKED ( FAIL ), ALL COMPONENTS
DESCRIBED HEREIN ARE CERTIFIED AS OPTIMALLY FUNCTIONAL.
ILOCATION NO. OF OUTLETS FLOW RATE (LPM) FAIL COMMENTS
3RD FLOOR:
STATION 1 1 160
2 1 160
3 1 160
4 1 160
5 1 160
FUTUTRE6 1 260
Feb 20 08 03:03p Certified Medical Testing 5594358827 p.8
CARLSBAD CHILDREN'S DENTISTRY
CARLSBAD, CALIFORNIA
02/15/08
DENTAL OXYGEN SYSTEM
(SHUTOFF VALVES)
THE SYSTEM COMPONENTS DESIGNATED BELOW HAVE BEEN TESTED FOR FUNCTIONAL CAPACITY PER
NFPA 99,1999 CRiTERIA. EXCEPT AS NOTED IN THE COLUMN MARKED (FAIL). ALL COMPONENTS
DESCRIBED HEREIN ARE CERTIFIED AS OPTIMALLY FUNCTIONAL.
IAREA OR VALVE LOCATION AREA & GAS LEAKS FAIL COMMENTS
3RD FLOOR:
MAIN Y Y N
DENTAL NITROUS OXIDE SYSTEM
(SHUTOFF VALVES)
THE SYSTEM COMPONENTS DESIGNATED BELOW HAVE BEEN TESTED FOR FUNCTIONAL CAPACITY PER
NFPA 99, 1999 CRITERIA. EXCEPT AS NOTED IN THE COLUMN MARKED ( FAIL). ALL COMPONENTS
DESCRIBED HEREIN ARE CERTIFIED AS OPTIMALLY FUNCTIONAL.
AREA OR VALVE LOCATION AREA & GAS LEAKS FAIL COMMENTS
3RD FLOOR:
MAIN Y Y N
Feb 20 08 03:03p Certified Medical Testing 5594358827 P.9
CARLSBAD CHILDREN'S DENTISTRY
CARLSBAD, CALIFORNIA
02/15/08
DENTAL OXYGEN SYSTEM
(WARNING ALARM PANELS)
THE SYSTEM COMPONENTS DESIGNATED BELOW HAVE BEEN TESTED FOR FUNCTIONAL CAPACITY PER NFPA 99, 1999 I 'CRITERIA. EXCEPT AS NOTED IN THE COLUMN MARKED (FAIL). ALL COMPONENTS DESCRIBED HEREIN ARE
LCERTIFIED AS OPTIMALLY FUNCTIONAL.
ALP (ABNORMAL LINE PRESSURE • LLL (LIQUID LEVEL LOW)
LPL (LINE PRESSURE LOW) • TS (THERMAL SHUTDOWN)
LPH (LINE PRESSURE HIGH) • RLL (RESERVE LIQUID LEVEL LOW)
RH) (RESERVE IN USE) + RPL (RESERVE PRESSURE LOW)
MASTER ALARM PANELS:
SIGNAL REQUIREMENTS: Abnormal Line Pressure OR Line Pressure Low & Line Pressure High, Reserve in Use; Liquid Level Low;
Reserve Pressure Low
LOCATION VIS. I AUD. I ALP I LPL I LPH I RIU I LLL I RLL RPL TSD I FAIL I COMMENTS
IND. IND.
I I
FRONT DESK Y Y X X X
DENTAL NITROUS OXIDE SYSTEM
(WARNING ALARM PANELS)
THE SYSTEM COMPONENTS DESIGNATED BELOW HAVE BEEN TESTED FOR FUNCTIONAL CAPACITY PER NF PA
CRITERIA. EXCEPT AS NOTED iN THE COLUMN MARKED (FAIL). ALL COMPONENTS DESCRIBED HEREIN A
CERTIFIED AS OPTIMALLY FUNCTIONAL
ALP (ABNORMAL LINE PRESSURE • LLL (LIQUID LEVEL LOW)
LPL (LINE PRESSURE LOW) • TS (THERMAL SHUTDOWN)
LPH (LINE PRESSURE HIGH) • RLL (RESERVE LIQUID LEVEL LOW)
RIU (RESERVE IN USE) • RPL (RESERVE PRESSURE LOW
MASTER ALARM PANELS:
SIGNAL REQUIREMENTS: Abnormal Line Pressure OR Line Pressure Low & Line Pressure High; Reserve in Use
LOCATION VIS. I AUD. I ALP I LPL LPH I RIU I LLL RLL I RPL I TSD I FAIL I COMMENTS
IND. IND.
FRONT DESK Y Y X X X
Feb 20 08 03:03p Certified Medical Testing 5594358827 P.10
CARLSBAD CHILDREN'S DENTISTRY
CARLSBAD, CALIFORNIA
02/1 5/08
DEW POINT TESTING
DEW POINT LEVELS WERE ESTABLISHED BY OBTAINING A SAMPLE DIRECTLY FROM THE NITROGEN
CYLINDER UTILIZED TO PRESSURIZE THE SYSTEM AND COMPARING TO SAMPLES OBTAINED FROM THE
MOST REMOTE OUTLET IN EACH ZONE OF EACH PIPING SYSTEM.
I DEW POINT RECORDING
L SYSTEM SOURCE GAS PIPING SYSTEM VARIANCE
IOXYGEN 100 F. 100 F.
[NITROUS OXIDE 10° F. 10° F.
CONCLUSION: ALL TEST RESULTS REFLECT VARIANCE LEVELS WITHIN THE PARAMETERS SETFORTH
BY THE NFPA 99 CRITERIA,
MAXIMUM ALLOWABLE VARIANCE TABLE
Dew Point 5 DEG. C. @ 50 PSIG.
Feb 20 08 03:04p Certified Medical Testing 5594358827 P.11
CARLSBAD CHILDREN'S DENTISTRY
CARLSBAD, CALIFORNIA
02/15/08
DENTAL GAS SYSTEM
FLOW TEST
OPERATIONAL PRESSURE TEST
THE SYSTEM COMPONENTS DESIGNED BELOW HAVE BEEN FUNCTION-TESTED PER NFPA 99, 1999 CRITERIA.
EXCEPT AS NOTED IN THE COLUMN MARKED <FAIL>, ALL COMPONENTS DESCRIBED HEREIN ARE CERTIFIED AS
OPTIMALLY FUNCTIONAL. FLOW TEST CRITERIA - NFPA 99, 1999 SECT. 4-5.13.3; OPERATIONAL PRESSURE TEST
CRITERIA - NFPA 99, 1999 SECT. 4-5.1.3.8.
SPECIFIC AREA PRESSURE DROP WI SOURCE GAS
OXYGEN 2PSIG
NITROUS OXIDE 2 PSIG
MAXIMUM ALLOWABLE DROP TABLE
PRESSURE DROP <=5 PSIG
{ VACUUM SYSTEM MUST BE CAPABLE OF MAINTAINING PRESSURE OF 12 inHG WHILE
EVACUATING 3 SCFM AT AN ADJACENT STATION INLET }
Feb 20 08 03:04p Certified Medical Testing 5594358827 P.12
CARLSBAD CHILDREN'S DENTISTRY
CARLSBAD, CALIFORNIA
02/15/08
PARTICULATE TESTING
PARTICULATE FILTER
SYSTEM FILTER NUMBER FLOW TIME WEIGHT PASS/FAIL
OXYGEN LINE 1 +200 LPM 5 minutes <1 Pass NITROUS OXIDE LINE 2 +200 LPM 5 minutes <1 Pass
CONCLUSION: All Filter Samples were taken from the piping systems listed above with Eli Flow Rates
(greater than 200 1pm). They were in place for 5 minutes. There was no particulate matter
or debris noted.
Feb 20 08 03:04p Certified Medical Testing 5594358827 P.13
CARLSBAD CHILDREN'S DENTISTRY
CARLSBAD, CALIFORNIA
02/15/OS
HYDROCARBON ANALYSIS
THE DENTAL GAS PIPING "ZONES' DESCRIBED BELOW CONSTITUTE ALL ZONES IN THE SUBJECT SYSTEM EACH
ZONE WAS TESTED AT THE MOST REMOTE OUTLET FOR HYDROCARBONS AS METHANE AND HALOGENATED
HYDROCARBONS.
TOTAL HYDROCARBONS AS METHANE
I ZONE SOURCE GAS PIPING SYSTEM VARIANCE
LOXYGEN 1.2793 PPM 0.9068 PPM
1
- 0.3725 PPM
NITROUS OXIDE 1.2793 PPM 0.5064 PPM - 0.7729 PPM
TOTAL HALOGENATED HYDROCARBONS
ZONE SOURCE GAS PIPING SYSTEM VARIANCE
OXYGEN 0 PPM 0 PPM 0 PPM
NITROUS OXIDE 0 PPM 0 PPM 0 PPM
ICONCLUSION: ALL TEST RESULTS REFLECT VARIANCE LEVELS WITHIN THE PARAMETERS SETFORTH
BY THE NFPA 99 CRITERIA.
MAXIMUM ALLOWABLE VARIANCE TABLE
TOTAL HYDROCARBONS AS METHANE I PPM
HALOGENATED HYDROCARBONS 2 PPM