OSHPD Special Seismic Certification Preapproval (OSP)

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OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENTFACILITIES DEVELOPMENT DIVISIONAPPLICATION FOR OSHPD SPECIAL SEISMICCERTIFICATION PREAPPROVAL (OSP)OFFICE USE ONLYAPPLICATION #:OSP – 0169 – 10OSHPD Special Seismic Certification Preapproval (OSP)Type:NewRenewalManufacturer InformationDIMPLEX THERMAL SOLUTIONSManufacturer:Manufacturer’s Technical Representative:Mailing Address:Telephone:Doug Mathews2625 Emerald Drive, Kalamazoo, MI 49001-4542(800) 968-5665Email:dmathews@dimplexthermal.comProduct InformationProduct Name:KOOLANT KOOLERS WO CHILLERSProduct Type:Air cooled condensing process chillersSee Attachment 1Product Model Number:(List all unique product identification numbers and/or part numbers)General Description:Cataloged, air cooled condensing process chillers acceptable for indoor or outdoor use.Cabinets are constructed of galvanized steel or stainless steel and meet UL Type 4 enclosure rating. Reservoir tanksare constructed of stainless steel. Seismic enhancements made to the test units and modifications required to addressthe anomalies observed during the tests shall be incorporated into the production unitsMounting Description:Rigid base mounted, vibration spring isolated base mounted and rigid wall mounted.Applicant InformationApplicant Company Name:EASE LLCContact Person:JONATHAN ROBERSON, S.E.Mailing Address:5877 Pine Ave, Suite 210, Chino Hills, CA. 91709Telephone:(909) 606-7622Email:j.roberson@easeco.comI hereby agree to reimburse the Office of Statewide Health Planning and Development review fees inaccordance with the California Administrative Code, 2016.Signature of Applicant:Title:Principal EngineerDate:Company Name:2/5/16EASE LLC“Access to Safe, Quality Healthcare Environments that Meet California’s Diverse and Dynamic Needs”STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCYOSH-FD-759 (REV 12/16/15)08/10/2016OSP-0169-10Page 1 of 3Page 1 of 11

OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENTFACILITIES DEVELOPMENT DIVISIONCalifornia Licensed Structural Engineer Responsible for the Engineering and Test Report(s)Company Name:Name:EASE LLCJONATHAN ROBERSON, S.E.Mailing Address:Telephone:California License Number:S41975877 Pine Ave, Suite 210, Chino Hills, CA. 91709(909) 606-7622Email:j.roberson@easeco.comSupports and Attachments PreapprovalSupports and attachments are preapproved under OPM(Separate application for OSHPD Preapproval of Manufacturer’s Certification (OPM) of Supports and attachments is required)Supports and attachments are not preapprovedCertification MethodTesting in accordance with:ICC-ES AC156Other (Please Specify):Testing LaboratoryCompany Name:Environmental Testing Laboratory, Inc.Contact Name:Brady RichardMailing Address:11034 Indian Trail, Dallas, TX 75229-3513Telephone:(972) 247-9657Email:brady@etldallas.com“Access to Safe, Quality Healthcare Environments that Meet California’s Diverse and Dynamic Needs”STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCYOSH-FD-759 (REV 12/16/15)08/10/2016OSP-0169-10Page 2 of 3Page 2 of 11

OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENTFACILITIES DEVELOPMENT DIVISIONSeismic ParametersDesign in accordance with ASCE 7-10 Chapter 13:YesNoDesign Basis of Equipment or Components (Fp/W p) See Attachment 1SDS (Design spectral response acceleration at short period, g) See Attachment 1 Table 1ap (In-structure equipment or component amplification factor) 2½Rp (Equipment or component response modification factor) 2 (Flexible Base); 6 (Rigid Base)Ω0 (System overstrength factor) 2Ip (Importance factor) 1.5See Attachment 1 Table 1z/h (Height factor ratio) Equipment or Component Natural Frequencies (Hz) See Attachment 2Overall dimensions and weight (or range thereof) See Attachment 1 Table 1Equipment or Components @ grade designed in accordance with ASCE 7-10 Chapter 15:YesNoDesign Basis of Equipment or Components (V/W) SDS (Design spectral response acceleration at short period, g) SD1 (Design spectral response acceleration at 1 second period, g) R (Response modification coefficient ) Ω0 (System overstrength factor) Cd (Deflection amplification factor) Ip (Importance factor) Height to Center of Gravity above base Equipment or Component Natural Frequencies (Hz) Overall dimensions and weight (or range thereof) Tank(s) designed in accordance with ASME BPVC, 2015:YesNoList of Attachments Supporting Special Seismic CertificationTest Report(s)Other(s) (Please Specify):DrawingsCalculationsManufacturer’s CatalogSEE ATTACHMENT 1OSHPD Approval (For Office Use Only) – Approval Expires on December 31, 2022Signature:Print Name:M. R. KarimSpecial Seismic Certification Valid Up to : SDS (g) See AboveDate:8/10/16Title:SHFRz/h See AboveCondition of Approval (if applicable):“Access to Safe, Quality Healthcare Environments that Meet California’s Diverse and Dynamic Needs”STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCYOSH-FD-759 (REV 12/16/15)08/10/2016OSP-0169-10Page 3 of 3Page 3 of 11

EASEEQUIPMENT ANCHORAGE& SEISMIC ENGINEERINGATTACHMENT 1: SEISMIC CERTIFIED COMPONENTSATTACHMENT PAGE 1 OF 3Table 1:ManufacturerSystemDIMPLEX THERMAL SOLUTIONSKOOLANT KOOLERS WO CHILLERSMODELNUMBERCOMPONENT3 Ton Chiller WO3000-NF-L-M-407C3 Ton Chiller WO3000-NF-L-M-407C-HAHigh AmbientAPPROX. DIMENSIONS (IN.)WDHDRYWT lexibleUUT-A2S1.23.2 1WallUUT61.441.132.02.51012½2BASIS505028 1/228 1/265.2565.25730730RigidRigidUUT-1INT5 Ton Chiller WO5000-NF-L-M-407C7.5 Ton Chiller .25935RigidINT10 Ton Chiller WO2-5000-2P-NF-L-M-407C10934.476.252000RigidINT15 Ton Chiller WO2-7500-2P-NF-L-M-407C12 Ton Chiller 0002200RigidRigidUUT-3INT20 Ton Chiller 1R20 Ton Chiller 0 Ton Chiller 540 Ton Chiller 3 Ton Chiller WO3000-NF-L-M-407C3 Ton Chiller WO3000-NF-L-M-407C-HAHigh Ambient505028 1/228 1/265.2565.25730730FlexibleFlexibleUUT-2INT5 Ton Chiller WO5000-NF-L-M-407C7.5 Ton Chiller 565.25935FlexibleINT10 Ton Chiller WO2-5000-2P-NF-L-M-407C15 Ton Chiller 02000FlexibleFlexible12 Ton Chiller WO2-2-3000-2P-NF-L-M-407C10934.476.25220020 Ton Chiller WO2-10000-2P-NF-L-M-407C11544.2588.520 Ton Chiller WO2-2-5000-2P-NF-L-M-407C13544.2530 Ton Chiller WO2-2-7500-2P-NF-L-M-407C13544.2540 Ton Chiller WO2-2-10000-2P-NF-L-M-407C135Remote Display6.1MountNotesCarel pGDRIGID (BASE): free-standing, base-mounted condition with the component rigidly attached to a supporting structure and no lateral support above the base.FLEXIBLE (BASE / SPRING ISOLATOR): a free-standing, base mounted condition with spring isolators positioned between the equipment and supporting structure with or without adunnage frame.WALL: unit is fully supported by a vertical wall or partition.1. BASIS: UUT#: Indicates that a test specimen matching these characteristics was tested as part of this testing program. INT (Interpolate/Extrapolate): indicates a model that was not specifically tested, and by which seismic certification is established through evaluation of testing of other, similarmodels in the product line2.See Table 2 for seismic qualified subcomponents and options.08/10/2016OSP-0169-10Phone (909) 606-7622 OSP@EaseCo.comPage 4 of 11

EASEEQUIPMENT ANCHORAGE& SEISMIC ENGINEERINGATTACHMENT 1: SEISMIC CERTIFIED COMPONENTSATTACHMENT PAGE 2 OF 3TABLE 2: SEISMIC CERTIFIED SUBCOMPONENTS & RT NO.Sanyo / PanasonicSanyo / PanasonicSanyo / PanasonicSanyo / H8KPumpPumpWalrusWalrusTPHK2T5-5STPHK4T5-5S3/4 HP Pump1-1/2 HP Pump12.713.9ExtrapolateUUT1 / UUT2 / UUT3 / 7-7STPHK8T6-3STPHK8T6-4STPHK8T6-5S2 HP Pump1-1/2 HP Pump3 HP Pump3 HP Pump14.624.32728INTINTINTUUT5/UUT-A1R / UUT-A1S /UUT-A2SMarathon048A17OF1H144 mm diameter, 1/2 ION/RATINGScroll 3 Ton, 3.5 HP, 2.6KWScroll 5.0 Ton, 6.0 HP, 4.5KWScroll 7.5 Ton, 8.0HP, 6.0KWScroll 10.0 Ton, 10.0HP, 7.5KWMax. WEIGHT (kg)37396771BASISUUT1 / UUT2INTUUT3 / UUT4 / UUT5UUT-A1R / UUT-A1S / UUT-A2SPUMPSFAN MOTORSFan Motor7UUT1/UUT2/UUT3/UUT4/UUT5/UUT-A1R / UUT-A1S / UUT-A2SFAN BLADE16" Fan Blade18" Fan eeprite11046151104619110461611046171104618406 mm diameter457 mm diameter1.10.9UUT5/UUT-A1R/UUT-A1SUUT1 / UUT2 / UUT3 / UUT4 /UUT-A1R / UUT-A1S7.59.713.115.522.82841UUT1 / UUT2INTUUT3 / UUT4INTUUT-A1R / UUT-A1SUUT5UUT-A2R / UUT-A2S55586594120UUT1 / UUT2INTUUT3 / UUT4UUT-A1R / UUT-A1SUUT5 / UUT-A2SHEAT EXCHANGERSBrazed Plate Heat ExchangerBrazed Plate Heat ExchangerBrazed Plate Heat ExchangerBrazed Plate Heat ExchangerBrazed Plate Heat ExchangerBrazed Plate Heat ExchangerBrazed Plate Heat enserCondenser3-6 Ton5 Ton7.5-10 Ton15 Ton20 TonTable continues next page08/10/2016OSP-0169-10Phone (909) 606-7622 OSP@EaseCo.comPage 5 of 11

EASEEQUIPMENT ANCHORAGE& SEISMIC ENGINEERINGATTACHMENT 1: SEISMIC CERTIFIED COMPONENTSATTACHMENT PAGE 3 OF 3TABLE 2: SEISMIC CERTIFIED SUBCOMPONENTS & OPTIONSSUBCOMPONENTFLOW SWITCHMANUFACTURERMODEL/PART NO.Johnson ControlsJohnson ControlsF61MB-1CF6261-MAH0.90.9UUT1 / UUT2 / UUT3 / UUT4 /UUT5 / UUT-A1R / 0.20.20.20.2UUT3 / UUT4 / UUT5INTUUT1 / UUT2UUT-A1R / UUT-A1S / UUT-A2SAquatrolAquatrolSpraying SystemsD1DX70C1DX706815G-3/4-HSS-30021.40.6UUT3 / UUT4 / UUT5/UUT-A1R / UUT-A1S / UUT-A2SINTUUT1 / UUT2Solenoid Valve 1"AscoSolenoid Valve 1"Solenoid Valve Solenoid Valve 1-1/2"Solenoid Valve 2"Series 600 Check Valve 1"Series 600 Check Valve 552.640.61Series 600 Check Valve 1-1/2"Series 600 Check Valve 0.4Johnson ControlsP2661Flow SwitchFlow SwitchDESCRIPTION/RATINGMax. WEIGHT (kg)BASISLIQUID FLUID LEVEL INDICATORLiquid Level SwitchLiquid Level SwitchLiquid Level SwitchLiquid Level SwitchPRESSURE RELIEF BYPASS VALVESeries 69 Pressure Relief ValveSeries 69 Pressure Relief ValvePressure Relief ValveSeries 69 1-1/4", 35-100 PSISeries 69 1", 35-100 PSI3/4", 300 PSIANTI-BACKFLOW KIT2UUT1 / UUT2INTINTUUT3 / UUT4/UUT-A1R / UUT-A1S / UUT-A2SUUT5UUT1, UUT2INTUUT3/UUT4/UUT-A1R / UUT-A1S / UUT-A2SUUT5CONTROLLERControllerControllerCondenser Fan Speed ControlNotes1.2.3.UUT1 / UUT2 / UUT3 / UUT4 / UUT5/ UUT-A1R /UUT-A1S / UUT-A2SUUT1 / UUT2 / UUT3 / UUT4UUT1 / UUT2 / UUT3 / UUT4 / UUT5/ UUT-A1R / UUT-A1S / UUT-A2SBASIS: UUT#: Indicates that a test specimen matching these characteristics was tested as part of this testing program. INT (Interpolate/Extrapolate): indicates a model that was not specifically tested, and by which seismic certification is established through evaluation of testing of other, similarmodels in the product line.Certification in this table is limited subcomponents identified when installed as part of a complete assembly of the equipment defined in Table 1.Table excludes all Electrical Controllers, Switches, Transformers, Circuit Breakers and Fuses up to 10 lbs. or 10 amperes, except as noted.08/10/2016OSP-0169-10Phone (909) 606-7622 OSP@EaseCo.comPage 6 of 11

EASEEQUIPMENT ANCHORAGE& SEISMIC ENGINEERINGATTACHMENT 2: TEST SPECIMEN SUMMARYATTACHMENT PAGE 1 OF 5UUT- 13 Ton Chiller / Rigid BaseMANUFACTURER:Dimplex Thermal TION:Single Refrigeration Circuit & Single Fluid CircuitCompliant with UL1995 standardsController:Carel PCOxsCompressor :(1) Sanyo C-SBN263H8A 3 TonPump :(1) Walrus TPHK4T5-5S 2.0 kWFan Motor:(1) ½ HP Marathon 048A170F1HFan Blade:(1) 18-in Lau 61142601Heat Exchanger:(1) Kaori K095x20Condenser:(1) 3-6 Ton Keeprite 1104615Refrigerant:407cEnclosure:Stainless steel enclosure by DimplexControl Cabinet:Stainless steel NEMA 4 electrical enclosure by SaginawControl & EngineeringTank:40 gallon, Stainless Steel, Sealed w/ air ventAnti-backflow kit, pressure relief bypass valve, flow switch, & low fluid tank levelindicator. Unit full of contents during test.MOUNTING:Rigid Base mount w/ (4)-½” dia. Grade 5 boltsPROPERTIES:DIMENSIONS (in.)Weight (lb.)LOWEST RESONANT FREQUENCY (Hz.)WidthDepthHeightDry / 560.75685 / 11005.83.310.82.8SHAKE TABLE TEST PARAMETERSCODETEST CRITERIASDS (g)z/hIPAFLX-H (g)ARIG-H (g)AFLX-V (g)ARIG-V (g)CBC 2016ICC-ES AC1562.111.53.362.521.410.57Unit maintained structural integrity and remained functional per manufacturer requirementUUT- 23 Ton Chiller / Spring IsolatorMANUFACTURER:Dimplex Thermal TION:Single Refrigeration Circuit & Single Fluid CircuitCompliant with UL1995 standardsController:Carel PCOxsCompressor :(1) Sanyo C-SBN263H8A 3 TonPump :(1) Walrus TPHK4T5-5S 2.0 kWFan Motor:(1) ½ HP Marathon 048A170F1HFan Blade:(1) 18-in Lau 61142601Heat Exchanger:(1) Kaori K095x20Condenser:(1) 3-6 Ton Keeprite 1104615Refrigerant:407cEnclosure:Stainless steel enclosure by DimplexControl Cabinet:Stainless steel NEMA 4 electrical enclosure by SaginawControl & EngineeringTank:40 gallon, Stainless Steel, Sealed w/ air ventAnti-backflow kit, pressure relief bypass valve, flow switch, & low fluid tank levelindicator. Unit full of contents during test.MOUNTING:SPRING ISOLATED: (4)-Sundown Model No. VMSSM1 (1”deflection). Each isolator anchored w/ ½” dia. Grade 5 bolts to UUTand (2)-½” dia. Grade 5 bolts to steel table extension. (Isolatorsmanufactured by Vimco Part No. SSMA-1-127)PROPERTIES:DIMENSIONS (in.)Weight (lb.)LOWEST RESONANT FREQUENCY (Hz.)WidthDepthHeightDry / 560.75685 / 11001.81.75.61.6SHAKE TABLE TEST PARAMETERSCODETEST CRITERIASDS (g)z/hIPAFLX-H (g)ARIG-H (g)AFLX-V (g)ARIG-V (g)CBC 2016ICC-ES AC1562.111.53.362.521.410.57Unit maintained structural integrity and remained functional per manufacturer requirement08/10/2016OSP-0169-10Phone (909) 606-7622 OSP@EaseCo.comPage 7 of 11

EASEEQUIPMENT ANCHORAGE& SEISMIC ENGINEERINGATTACHMENT 2: TEST SPECIMEN SUMMARYATTACHMENT PAGE 2 OF 5UUT- 315 Ton Chiller / Rigid BaseMANUFACTURER:Dimplex Thermal CRIPTION:Dual, Independent Refrigeration Circuit; Dual, Redundant Fluid CircuitCompliant with UL1995 standardsController:Carel PCOxsCompressor :(2) 7.5 Ton Sanyo C-SCN603H8KPump :(2) 2.0 kW Walrus TPHK4T5-5SFan Motor:(4) ½ HP Marathon 048A170F1HFan Blade:(4) 18-in Lau 61142601Heat Exchanger: (2) Kaori K105x40BCondenser:(2) 7.5-10 Ton Keeprite d steel enclosure by DimplexGalvanized steel NEMA 4 electrical enclosure, site glass/filltube by Saginaw Control & EngineeringTank:72 gallon, stainless steel, sealed w/ air vent tank.Anti-backflow kit, pressure relief bypass valve, flow switch, & low fluidtank level indicator. Unit full of contents during test.MOUNTING:RIGID BASE: (8)-½” Dia. Grade 5 bolts (2 lines of 4 bolts ea.).PROPERTIES:DIMENSIONS (in.)Width109OperatingDepth34.4LOWEST RESONANT FREQUENCY (Hz.)HeightWeight 76.2530005.55.310.2SHAKE TABLE TEST PARAMETERSCODECBC 2016TEST CRITERIASDS (g)z/hICC-ES AC1562.02.51.00.0IPAFLX-H (g)ARIG-H (g)AFLX-V (g)ARIG-V (g)1.53.22.52.41.041.341.680.540.68Unit maintained structural integrity and remained functional per manufacturer requirement.UUT- 415 Ton Chiller / Spring IsolatorMANUFACTURER:Dimplex Thermal CRIPTION:Dual, Independent Refrigeration Circuit; Dual, Redundant Fluid CircuitCompliant with UL1995 standardsController:Carel PCOxsCompressor :(2) 7.5 Ton Sanyo C-SCN603H8KPump :(2) 2.0 kW Walrus TPHK4T5-5SFan Motor:(4) ½ HP Marathon 048A170F1HFan Blade:(4) 18-in Lau 61142601Heat Exchanger: (2) Kaori K105x40BCondenser:(2) 7.5-10 Ton Keeprite d steel enclosure by DimplexGalvanized steel NEMA 4 electrical enclosure, site glass/filltube by Saginaw Control & EngineeringTank:72 gallon, stainless steel, sealed w/ air vent tank.Anti-backflow kit, pressure relief bypass valve, flow switch, & low fluidtank level indicator. Unit full of contents during test.MOUNTING:SPRING ISOLATED: (8) Mason SLRSO – B – 750 spring isolators [2lines of 4 isolators along length of UUT] w/ (4) ½” Grade 5 bolts at top &bottom of each isolator.PROPERTIES:DIMENSIONS (in.)Width109Depth34.4OperatingLOWEST RESONANT FREQUENCY (Hz.)HeightWeight 76.2530002.42.85.7SHAKE TABLE TEST PARAMETERSCODETEST CRITERIASDS (g)z/hIPAFLX-H (g)ARIG-H (g)AFLX-V (g)ARIG-V (g)CBC 2016ICC-ES nit maintained structural integrity and remained functional per manufacturer requirement08/10/2016OSP-0169-10Phone (909) 606-7622 OSP@EaseCo.comPage 8 of 11

EASEEQUIPMENT ANCHORAGE& SEISMIC ENGINEERINGATTACHMENT 2: TEST SPECIMEN SUMMARYATTACHMENT PAGE 3 OF 5UUT- 530 Ton Chiller / Rigid BaseMANUFACTURER:Dimplex Thermal SCRIPTION:Dual, Independent Refrigeration Circuit with tandem comps;Dual, Redundant Fluid CircuitCompliant with UL1995 standardsController:Carel PCOxsCompressor :(4) 7.5 Ton Sanyo C-SCN603H8KPump :(2) 3.9 kW Walrus TPHK8T6-5SFan Motor:(8) ½ HP Marathon 048A170F1HFan Blade:(8) 16-in Lau 61142601Heat Exchanger:(2) Kaori K205x40CCondenser:(2) 20 Ton Keeprite 1104618Refrigerant:407cEnclosure:Galvanized steel enclosure by DimplexCabinet:Galvanized, NEMA 4 electrical enclosure, site glass/filltube, V-coil cabinet configuration by Saginaw Control &EngineeringTank:100 gallon, stainless steel, sealed with air-ventAnti-backflow kit, pressure relief bypass valve, flow switch, & low fluid tank levelindicator. Unit full of contents during test.MOUNTING:RIGID BASE: (8) - ½” Grade 5 bolts (2 lines of 4 bolts ea).PROPERTIES:DIMENSIONS (in.)WidthDepth13541.5LOWEST RESONANT FREQUENCY (Hz.)HeightWeight (lb.)Front-AxisSide-AxisVert-Axis88.53926 (Dry)5.83.07.5SHAKE TABLE TEST PARAMETERSCODECBC 2016TEST CRITERIASDS (g)z/hICC-ES AC1562.02.51.00.0IPAFLX-H (g)ARIG-H (g)AFLX-V (g)ARIG-V (g)1.53.22.52.41.041.341.680.540.68Unit maintained structural integrity and remained functional per manufacturer requirementUUT- 6Carel pGD Remote DisplayMANUFACTURER:Philips HealthcareIDENTIFICATION:pGDDESCRIPTION:Optional interface panel to for remote display &programming of chillers.MOUNTING:WALL MOUNTED: (2) mfr-supplied machine screws into (2)layers 5/8” Gyp BdPROPERTIES:DIMENSIONS (in.)WidthDepth6.11.2LOWEST RESONANT FREQUENCY (Hz.)HeightWeight 3.2 1---------SHAKE TABLE TEST PARAMETERSCODETEST CRITERIASDS (g)z/hIPAFLX-H (g)ARIG-H (g)AFLX-V (g)ARIG-V (g)CBC 2016ICC-ES AC1562.01.01.53.22.41.340.54Unit maintained structural integrity and remained functional per manufacturer requirement08/10/2016OSP-0169-10Phone (909) 606-7622 OSP@EaseCo.comPage 9 of 11

EASEEQUIPMENT ANCHORAGE& SEISMIC ENGINEERINGATTACHMENT 2: TEST SPECIMEN SUMMARYATTACHMENT PAGE 4 OF 5UUT- A1R20 Ton Chiller / Rigid BaseManufacturer:Dimplex Thermal escription:Dual, Independent Refrigeration Circuit; Dual, Redundant Fluid CircuitCo

Brazed Plate Heat Exchanger Kaori K095x20 7.5 UUT1 / UUT2 Brazed Plate Heat Exchanger Kaori K095x30B 9.7 INT Brazed Plate Heat Exchanger Kaori K105x40B 13.1 UUT3 / UUT4 Brazed Plate Heat Exchanger Kaori K105x50B 15.5

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