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� � `" ` FIRE SAFETY SYSTEMS
a AQUASAFETM FLOW TEST
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VERIFICAT10N
tl. FORM
AquaSAFE' Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: completed form. Failure to do so nullifies the
Company Name: L k_4,1 Ptu~�' J system warranty.E-mail or fax completed form
/�r� to the Uponor Fire Safety Design Department
Contact: C4,j2: &:-v;...4"-- at technical.services@uponor.com or 952.997.1737,
��� For questions,contact Uponor Technical Services at
Phone: S�'3 �0 888.594.7726 or technical.services@uponor.com.
Fax: Color of test orifice used: NM-4‘"
Job Name: r;Sk/vit. Static pressure(not flowing)reading at incoming
Project Number: 3a "Zr—f' 00 3 water supply into home or at main shutoff: yy
V 1 Job Address: P i D-29- J /lo �'
N ^ Residual pressure(flowing)reading at incoming water
m City: I P'61./VgC/ supply into home or at main shutoff: 3'
0 State,ZIP: i�i
What time of day was the flow test taken? 3 CO= p...n.
I For designs not provided by Uponor,complete the �.
G~ following information. Flow test method used? 0 Bucket L" low Meter
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Designer's Name: ('A.cA€/ 62 u,y,)crS._. . Flow test gpm: t 3
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\-, Company: Ue0^�a✓�, How many gallons of water did the design predict
Phone: �i'S� J/7 d? / as required? l 3
Did the test meet or exceed design flow?
jj''aces ❑No
Fax' Which sprinkler did you flow?Number: r .3
Is the warning sign permanently attached close to the Location of head: 5 3 J 4'/t,c"L.
main shutoff valve? ❑Yes ❑No 9`_
Date left in service with all valves open:
Was this system required by code?L Yes ❑No
9
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Test Witnessed and Verified by:
5Si re Occupation Date
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i Additional Explanations and Notes
88
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fi Uponor,Inc. Tel:80(3.321.4739
5925 148th Street West Fax:952.997.1731
iApple Valley,MN 55124 USA Web:www.uponor-aasa.com