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s , u u onor } ...,. FIRE SAFETY SYSTEMS g!:, --t AQUASAFETM FLOW TEST 'k it VERIFICATION Sri* t ."':, FORM AquaSAFETM Flow Test Verification Form Alliance Important:Installing contractor must submit this Member ID: )0-Er'?" completed form. Failure to do so nullifies the system warranty.E-mail or fax completed form Company Name: U cl cz%/ ei„- / Th to the Uponor Fire Safety Design Department Contact: C1°/t'1 A vi6la4+ s-- at technical.services@uponor.com or 952.997.1731. For questions,contact Uponor Technical Services at Phone: 56S (6 9 i 7Crl 888.594.7726 or technical.services@uponor.com. Fax: k Color of test orifice used: t31,�.G.- /� Job Name: I�0.51*A Static pressure(not flowing)reading at incoming Project Number: 3as'zc-P 005 water supply into home or at main shutoff: ,SO Job Address: 11713S0 Si...) 6 A eeiA>I- Residual pressure(flowing)reading at incoming water City: //.1*�!/t ,j supply into home or at main shutoff: 5 State,ZIP: V 1`. What time of day was the flow test taken? 11%i© A-w For designs not provided by Uponor, complete the following information. Flow test method used? ❑Bucket Flow Meter meoil. 1 Flow test gpm: Designer's Name: �J/41`1 l Company: etlAi How many gallons of water did the design predict as required? 1 7 Phone: ' 77.96Did the test meet or exceed design flow? 27Yes ❑No Fax: 75-X 97 i 73/ Which sprinkler did you flow?r Number: R Is the warning sign permanently attached close to the Location of head: V6,sJ ':.)✓,;; main shutoff valve? ❑Yes ❑No Date left in service with all valves open: l/"aA - �! Was this system required by code?L9 Yes ❑No Test Witnessed and Verified by: e to Occupation Date v r flipsq a` o` 0 a O s 0 t Additional Explanations and Notes v s LLI E Uponor,Inc. Tel:800.321.4739 5925 148th Street West Fax:952.997.1731 Apple Valley,MN 55124 USA Web:www.uponor-usa.com