Report (5) f t r
uponor
FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
VERIFICATION
71Itvrt.:,
FORM
A.quaSAFETM Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: completed form. Failure to do so nullifies the
system warranty. E-mail or fax completed form
Company Name: L-..)6/writ- (74,,"-v to the Uponor Fire Safety Design Department
Contact: C47-41 attchnical,seMces@uponor.com or 952.997.1731.
For questions,contact Uponor Technical Services at
Phone: 6-6 3 - c-1 888.594.7726 or technical.services@uponor.com.
Fax: Color of test orifice used:
Job Name: 4 k Static pressure(not flowing) reading at incoming
N Project Number: 3 s7 5-I- water supply into home or at main shutoff:
0
Job Address: /41, .93 .5t—.) 9 k
City: T.;tvvel0 Residual pressure (flowing)reading at incoming water
supply into home or at main shutoff: 3
State,ZIP: OW—
...,
What time of day was the flow test taken? d;30
N For designs not provided by Uponor, complete the
Flow test method used? CI Bucket Cit‹-ow Meter
following information.
C
Flow test gpm: /3
Designer's Name: re/4c---0
Company:
How many gallons of water did the design predict
CJr‘i/JO(Z._
as required? I 3
Phone: 9 ? 1 73/
Did the test meet or exceed design flow? C:i< 11-1 No
Fax: Which sprinkler did you flow?Number: 3
Is the warning sign permanently attached close to the Location of head:
main shutoff valve? 0 Yes Cl No
Date left in service with all valves open:
Was this system required by code?@IK:s No
Test Witnessed and Verified by:
Sig e Occupatioy Date
-)2,1c, -0
Dc)
a
Additional Explanations and Notes
F, Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952 997.1731
Apple Valley,MN 55124 USA Web:vvvwv,uponor-usa.corn