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FIRE SAFETY SYSTEMS
.� � AQUASAFETM FLOW TEST
'` '' VERIFICATION
,`a a
FORM
AquaSAFETM Flow Test Verification Form
Alliance C Important:Installing contractor must submit this
Member ID: ��p c%'" completed form. Failure to do so nullifies the
system warranty. E-mail or fax completed form
Company Name: U 0/Ciet
to the Uponor Fire Safety Design Department
Contact: Clf. l' at technical.services@uponor.com or 952.997.1731.
For questions,contact Uponor Technical Services at
Phone: 50 G('? /7S1 888.594.7726 or technical.services@uponor.com.
Fax: Color of test orifice used: g1n-41
Job Name: (20S11- - Static pressure(not flowing)reading at incoming
Project Number: 3.257c-f o o 7 water supply into home or at main shutoff: S C)
Job Address: Pi 9' . i 6a419 c'Qir$1
-�^ Residual pressure(flowing) reading at incoming water
!City: itnArl19 supply into home or at main shutoff: 4/4)
State,ZIP:
What time of day was the flow test taken? '-A.) ,A. .-
For designs not provided by Uponor, complete the
following information. Flow test method used? ❑Bucket CM F ow Meter
Designer's Name: fv.",-/ d3eeeJt,I - Flow test gpm: 1
How many gallons Q water did the design predict
Company: 0fO nI p/L
as required? /
Phone: 1 7?act:, Did the test meet or exceed design flow? s ❑No
Fax: f ff /7 J?/ Which sprinkler did you flow? Number I
Is the warning sign permanently attached close to the Location of head: Vez S 'di 011
main shutoff valve? ❑Yes ❑No
Date left in service with all valves open: (f—c-g--0/
Was this system required by code?BCes ❑No
Test Witnessed and Verified by:
04 j e /'Ly ✓ig ure Occatign Date �1
O
Additional Explanations and Notes
EI
LL Uponor,Inc. Tel:800.321.4739
5925148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com