Report (2) ArAP3144,gb vOlil 46 K
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�' FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
VERIFICATION
` FORM
AquaSAFETM Flow Test Verification Form
Alliance Important:Installing contractor must submit this
I ?Member ID: j'I,- completed form. Failure to do so nullifies the
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system warranty. E-mail or fax completed form
Company Name: c/t n Y ei i."- to the Uponor Fire Safety Design Department
Contact: L f/?4 6.,p fn1 at technical.services@uponor.com or 952.997.1731.
S`G 3 f ]�` For questions,contact Uponor Technical Services at
Phone: 888.594.7726 or technical.services@uponor.com.
Fax: ,) Color of test orifice used: �/4
Job Name: 121S/1A- L. Static pressure(not flowing) reading at incomin
Project Number: 3a5"7S c 06 F water supply into home or at main shutoff: 5
Job Address: /103 7y 5+... Cp609 C.o
Residual pressure(flowing)reading at incoming water
City: 72 t7A?o supply into home or at main shutoff: .3 V
State,ZIP: Va
What time of day was the flow test taken? F'%36 h-A-
For designs not provided by Uponor, complete the
following information. Flow test method used? ❑Bucket 121low Meter
Designer's Name: �"✓1M1 Re��61,c Flow test gpm:
L
Company: fi edNCR__ How many gallons of water did the design predict
as required? / 7
Phone: Crfrk S ?act,
Did the test meet or exceed design flow? ces ❑No
Fax: 9-5-- (,/ 7 17 3/ Which sprinkler did you flow? Number: hi
1'/
Is the warning sign permanently attached close to the Location of head: rns.. /�+r )> rQc,-.—
main shutoff valve? ❑Yes ❑No
,��// Date left in service with all valves open: 7��-91
Was this system required by code?121 es ❑No
Test Witnessed and Verified by:
5.
N e to Occupation Date
e C6 elury I1-ate
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Additional Explanations and Notes
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Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
LT_ Valley,MN 55124 USA Web:www.uponor-usa.com