Report (4) ---,,,-,-,sii.N-irr-q-. .f:'":1fr'llir-1tIPT?"'.f17''l'::11`;',-40•fl -',110Till
(
up/on'i' crirlY /
'
, ,, , , ,„ , , , , ,
4,..., AQUASAFF' FLOW TEST
VERIFICATION
FORM
1
*\(11SA.1" l,,, hi OW r.I‘CS1, V(...-,ri I)ca.t,i(-)ri .1'()rren
.. .„ . . ........ .. . , " . ,,
.,,t.,,,r 1,-„,„,-,int.:Installing contractor must submit this
I v)'.' ''' -' completed form.Failure to do so nullifies the
L...j(,)/c‘,177 (7// system warranty.E-mail or fax completed form
*/"' ')' -S to the Uponor Fire Safety Design Department
1'14 iSawr"eV.'" at technical,serviresqi1uponot,corn or 9519-97.1231.
\9 For questions,contact Uponor Technical Services at
71-'-/
888.594.1/26 or technical.seryicesouponor,corta
0 ,.. - - - --- --- - Color of trlst mail(r,itt,itti iSkiA,4,44._
it t,N.4tV le (20. -i....,%.it _ ,,,tatic pressui a(not flowing iiiiidin,;iiit -I-no:air,
?5'-f cc 7-
water'apply into home ca ic itialci -iiiilnll 16—
,, iq3z/3 sL., ic.os
Residual pressure(flowing)niii,)aing at.111,
Ni ity :iii6A0 _ supply inio home or at main shutoff 34/
litiatia, Ali 0 1/2---
What 11111e of day was the flow lost L ik /
tql' /0 4,--
'Is ;o-aasatins rid tarot/Aid lay llporioa,romplet-ilia
How twit method used, U H.:, '-, :i
•,iii,-;,i'oil
1 low tol (low. i
:gt.-Aditi
I low 111,1itty kl,1110,1t,° f of tAhlr'l ikt Olt'Llt`t,S,it)(,,t.tditi,
0 11)/4 a-- .1',1 ttitill OW
,,, ,„ gr.try 69y 2 )36 Ltd th,te,,t ine0 or exttaufl desigii tli A
t ax 5,x. 'iitz 7 I 7 3/ who,,,p,WHO' fil,1 343),Ifi.OLAJt Nttintttt it 3
I)
ttlf.313334t3309 t;3911 1)(33133 3 IH;(!, ,I1'ik li,;1(1 I
il',.eifri 1,1, ',j'i 4,11,./0 _...1 '-,..i li ap 1 I. ii. 0.... „... .
11i2.4-.:111.11,vo.ii quip, 1,, .. il../1Y";-1...
. ..........,... ...
. ...„., . . .. ....... . . .
. ... . ..
Test Witnessed arid Verified by:
R,111,,sio,I
Additional Imilanation.,and Notes
Tel ri,00 s)i .1K1
Uporior,Inc. i,,,, ,,,,?:,,i/ iiii
Yll'i I Mil i Stif..et Wesi Web:wtevtitt tipttittit ;Leo et to
PP 'Vallay,MN'a i IP;I it,A