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Medical Gas Equipment Certification

Tri-Tech Medical Inc. provides a certification of conformance for medical gas pipeline equipment shipped to Manuel La Cruz Costa Cont Gles Eirl. The shipment includes oxygen DISS wall outlets, a digital manifold, oxygen headers, a vacuum DISS wall outlet, valve boxes with gauges, touch area alarms, and a master alarm system. Tri-Tech certifies that the equipment has been assembled, inspected, packaged, leak tested, and flow tested according to manufacturer specifications, NFPA 99 standards, clean for oxygen use requirements, and internal production standards. Quality records are available upon request to substantiate the certification.

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Víctor Suárez
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369 views2 pages

Medical Gas Equipment Certification

Tri-Tech Medical Inc. provides a certification of conformance for medical gas pipeline equipment shipped to Manuel La Cruz Costa Cont Gles Eirl. The shipment includes oxygen DISS wall outlets, a digital manifold, oxygen headers, a vacuum DISS wall outlet, valve boxes with gauges, touch area alarms, and a master alarm system. Tri-Tech certifies that the equipment has been assembled, inspected, packaged, leak tested, and flow tested according to manufacturer specifications, NFPA 99 standards, clean for oxygen use requirements, and internal production standards. Quality records are available upon request to substantiate the certification.

Uploaded by

Víctor Suárez
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Tri-Tech Manufacturer of

Medical Inc. Medical Gas Pipeline Equipment


Customer PO #: 7893 TTM # S/O #: 0095665

Certification of Conformance
Sold to: Ship To:
Manuel La Cruz Costa Cont Gles Eirl Manuel La Cruz Costa Cont Gles Eirl
RUC: 20101499911 RUC: 20101499911
Av. Manuel Olguin NRO. 327 Int. 1002 URB. Av. Manuel Olguin NRO. 327 Int. 1002 URB.
Los Granados Lima-Lima-Santiago De Surco Lima Los Granados Lima-Lima-Santiago De Surco Lima
150140 150140

Item number Description QTY


DPN93XF1124A DISS REC WALL OUTLET-OXY 1
CCU12OX1H Fully Auto Digital Manifold 1
Serial # 20220324-F
CSF540072XXFXX HEADERS, CSF 7X7 - OXY 1
CSC540072XXCXX HEADERS, CSC 7X7 - OXY 1
DPN93XF1122 DISS REC WALL OUTLET - VAC 1
VU22O3V 2 GAS VALVE BOX WITH GAUGES 2
VU23O3V 2 GAS VALVE BOX WITH GAUGES 1
T2UOFFF TS 1-GAS MED TOUCH AREA ALARM 1
Serial # 20220304-001
T2UIFFF TS 1-GAS MED TOUCH AREA ALARM 1
Serial # 20220304-002
T2UVFFF TS 1-GAS MED TOUCH AREA ALARM 1
Serial # 20220304-003
T2UPPFF TS MED MSTR ALRM W/16-SIG 1
Serial # 20220304-004

Tri-Tech Medical certifies the assemblies supplied to you in this shipment have (as applicable), been assembled,
inspected, and packaged in conformance with purchased order requirements, written specifications,
dimensional and material requirements and applicable standards and specifications listed below;

Medical Gas Outlets and Risers


Manufacturer’s specifications
NFPA 99
CGA G 4.1 Clean for Oxygen Use
Internal Production & Specification Standards
100% leak tested
100% flow tested

Alarm Systems
Manufacturer’s specifications
NFPA 99
CGA G 4.1 Clean for Oxygen Use
Internal Production & Specification Standards

e6954rA 07/13/21 Tri-Tech Medical Inc., 35401 Avon Commerce Parkway, Avon, Ohio 44011 99-0457
Tel. 1-800-253-8692 -or- 440-937-6244 Fax. 440-937-5060
Web site www.tri-techmedical.com E mail address: [email protected]
Page 1 of 2
Tri-Tech Manufacturer of
Medical Inc. Medical Gas Pipeline Equipment
Customer PO #: 7893 TTM # S/O #: 0095665

Manifold Systems and Header Assemblies


Manufacturer’s specifications
NFPA 99
CGA G 4.1 Clean for Oxygen Use
Internal Production & Specification Standards
100% leak tested
100% flow tested

Zone Valve Boxes and Ball Valves


Manufacturer’s specifications
NFPA 99
CGA G 4.1 Clean for Oxygen Use
Internal Production & Specification Standards

We hereby certified that the parts/and or materials that were furnished on referenced purchase order were produced
in accordance with the specified requirements along with our Quality Systems Manual Rev I. Objective evidence, such
as material certifications, inspection/test data and/or other evidence to substantiate this certification is on file at our
facility or our supplier’s facility and is available upon request.

Steve Flesher
Quality Manager

e6954rA 07/13/21 Tri-Tech Medical Inc., 35401 Avon Commerce Parkway, Avon, Ohio 44011 99-0457
Tel. 1-800-253-8692 -or- 440-937-6244 Fax. 440-937-5060
Web site www.tri-techmedical.com E mail address: [email protected]
Page 2 of 2

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