Report (2) �.' ''' i , II, Mir20747°.00110q
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FIRE SAFETY SYSTEMS
A UASAFETM FLOW TEST
-- : VERIFICATION
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FORM
AquaSAFETM Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: /, i . / ►�1u�4. / '•- completed form. Failure to do so nullifies the
Company Name: t..J / cY7 system warranty. E-mail or fax completed form
/� 3 to the Uponor Fire Safety Design Department
Contact: c i!,`C 641.JA.—I\1 -1 at technical.services@uponor.com or 952.997.1731.
For questions,contact Uponor Technical Services at
Phone: SO L / 7S1 888.594.7726ortechnicalservices@uponor.com.
Fax: Color of test orifice used: 13/Ac-t
Job Name: r)51//.Lk Static pressure(not flowing)reading at incoming
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Project Number: 3, ):-F OQ 9 water supply into home or at main shutoff: S7)
Job Address: /Y370 1.,J elliii 0 ton 5"
,/') Residual pressure(flowing)reading at incoming water
�City: 7'�AIr supply into home or at main shutoff: 4(
State,ZIP: 012..
What time of day was the flow test taken? 16O0 Pn".
For designs not provided by Uponor, complete the
following information. Flow test method used? ❑ Bucket U' Flow Meter
/ 7
Designer's Name: cJ'Ar) ,/g�c�',✓t61o4-T' Flow test gpm:
Com an Q6�G 1 How many gallons of water did the design predict
p y as required? / 7 Phone: WK �j�Y 7 2.16) Did the test meet or exceed design flow? ®'Yes/'
❑No
Fax: 94-D- ?7 2 / 231 Which sprinkler did you flow? Number: it `1
Is the warning sign permanently attached close to the Location of head: t �rrck,/4-1- ,—
main shutoff valve? ❑Yes ❑No Y�� 4� Date left in service with all valves open:
Was this system required by code?1111 s ❑No
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Test Witnessed and Verified by:
tne e Occupation Date
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Additional Explanations and Notes
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E Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
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Apple Valley,MN 55124 USA Web:www.uponor-usa.com