Report (3) ( ik)i
1101
t " }3 24 A s i f 1,r1,t l "if i.
x# . #dia 3l f f I4y 3 i ( 3
i.
f l3� f �{a�l4 {t 3 i{ SRd I
e t'y i d $ yF a ti tat i3 at r f ',Alf-
1r( t �.,J� .(. PAS
�.
4Tiro Zi i"a r t �t t4 a $ft# o f it1 ` I I f). 7/t r' bO t J i F M:3
�r4 ���, sf x y�s�� ay g
" �sifi� 6 t 1st # rt 2 a+ bli i(rt a ': i E i
,tt l x z ti�,t ,t �f4rpsrrc`li ,i +�v4 z ` s<r'if � ,t AQUASAFE'"' FLOW TEST
� r a i ` > , r'" VERIFICATION
i"� ; e ir. fis 4t-Ni 7 f . � fi j, i "ig; 1f fi
b i«,IP`fE,r t1iri 7aam a, ' f. },?tilt
FORM
d o.sofrt.y.pv n p ,qf.:,t p�f i }if r,^a. a ala aP +v..i a.. . i t sa .
ri uua . 1�,1,,NI 1a1.OW rfe,s� t Verification Form
Alliance Important:Installing contractor must submit this
N Meml e r l:? 1 D -._ ._._.MM._ completed form. Failure to do so nullifies the
system warranty.E-mail or fax completed form
(`^ rrfaan�"Namr �yrw „_-. i,!'= ! ____ to the Uponor Fire Safety Design Department
. Contact: </.`' I.:tpi,,f./'"..t4x"`-' at technical.servi_c_o@gponor.com or 952.997,1731.
For questions,contact Uponor Technical Services at
Phcme. _."Cc.M 7 ,+ ------- 888.594.T726 or technical.sservices@ugonor.com.
__,Fax __ -___ ._..-_ --..--. Color of test orifice used: 01ACil._
fob Name: _.__ . �"►AI'L Static pressure(not flowing)reading at incoming
V �� water supply into home or at main shutoff: 4'3
1 roject Number: 3. ..3__ _ t
Job Address: •. _ /�^�' �`"+�� �5� Residual pressure(flowing)reading at incoming water
City: .J t-ij1 r', ,! supply into home or at main shutoff: 3)--
4- State,ZIP: �., __...
What time of day was the flow test taken? 3O 4.-r••
r designs not provided by Uponor,complete the Flow test method used? ,J Bucket _1 t low Meter
flowing information.
7 L Flow test gpm: i 3
.isigner's Name: I.,An., �}C''^ 'r'-� 1�3 I
How many gallons of water did the design predict
Company: t)i2 pti - as required? LI
Phone: __-W$'... 5? ...._. 7 7.(3P Did the test meet or exceed design flow? Sell-es 3 No
Fax: _r.,_...�..sr=._._..f .2----r 7 3/ Which sprinkler did you flow?
Number. sa_-
the warning sign permanently attached cease to the Location of head:.4'') ,I 7 -"r '44.("S.
airl shutoff valve? 3 Yes La No Date left in service with all valves open. ', Ft-
as this system required by code? Yes J No
test Witnessed and Verified by: `>' at: Occupation Date
a fro ""w.-.^ ? te-- .1 ._-7 dj 4-1
_ __ iG�r_ el
idditionai Explanations and Notes
Jponor,inc. !.'; i;fx; ,?1,�1'i'
i`,.),t i 14 f i c tf rat.) '1,"[;.,..1
l a:a ,,,),3')7 I/i I
fipple Valley,i nri' ,I !l,i`», Web:wwrw.uponor-usa.com
*� # V