Report (4) ,
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Hil.. AFETY r-;YSTEMS
AQUASAFElm FLOW TEST
VERIFICATION
FORM
All UZISA- 1141E" Flow Test
Verification Form
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Member la ___15:3S4— Important: Installing contractor must submit this
_____ completed form. Failure to do so nullifies the
Company Name: _Li dais p) 10: __,.... system warranty.Email or fax completed form
(. 1+ A,K., ,... .
to the Uponor Fire Safety Design Department
Contact: 611-X ,--gc/‘,4""--4-',-.' ____ at technical.servites@uponor.com or 952.997,1731,
Isf) Phone .s(.3 6,60 ) oil For questions,contact Uponor Technical Services at
\.., 888.594.7726 or technical.services@uponor.com.
‘. -- Fax Color of test orifice used:
'CI Job Name: s),,,4 ...
Static pressure(not flowing)reading at incominq
Project Number: I cAS"7 C/4- i 1 e( water supply into home or at main shutoff. 41 c-...- _
ON\
•,, Job Address: ft/30i ..‘4.-1 /6 9
0 Residual pressure(flowing)reading at incoming water
'NI City. 7,-'6"100 supply into home or at main shutoff: 3/
k... State, ZIP: 0 ie
What time of day was the flow test taken? ii.,5 30
4.-- For designs not provided by Uponor, complete the
follovv;rig information. Flow test method used? :_,I Bucket Yr17:AN Meter
Flow test gpm: i3
Designer's Name: _I .6!"-~e .13e^d
How many gallons of water did the design predictCompany.
Company: Pd/Ni as required? 1 3
Phone: A,(t______---9*- —Y___22:c24. Did the test meet or exceed design flow? 11 U i^o
Fax _ .,f__I___;1.-____.__ _ ,.__ _2...31-------- Which sprinkler did you flow?Numbercj _ 3
Is the warning sign permanently attached close to the Location of head-.3ri.) Airbe- ce;440'1
main shutoff valve? 1...1 Yes 0 No e," Date lett in service with all valves open. ,),?-4.
Was this system required by code? leYes LI No
„., .....--........................_
Test Witnessed and Verified by: ,
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"-De' tii ocartatiop , Date
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Additional Explanations and Notes __ _ ___ ___
Id.ki00.321.iii,,)
Uponor,Inc. 1 ox.q)2 Usii I/ I
5925 148th Street West
www.uponor-usa.rom
Apple Valley, MN 55124 li')A Web:
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