Report (3) 10
Ponof
AQUASAFE" FLOW TEST
VERIFICATION
FORM
utaSA.1-11-4-1 Ftow- Telst Verification Form.
. ' —.--------.—.-----.----------.-- - —' --- ------ '
^0mm v Important:Installing contractor must submit this
mn'oe, |C ��� completed form. Failure mdomnullifies the
/� .~/ - system warranty. H fa
x form
�
`-' ~` tu the Upvn",Fire Safety Design Department
w����me����o�ur��.���,�|� �
,
For questions,contact Upnnv,Technical Scmice at �
888I947726^,�u�bNcu!
\ raw. Color of test orifice used
. -
Job Name, - -- Static pressure(not flowing)reading atincoming
��,rmp�yinmhomcv,�� sh
utoff: *V
�zNvmbe': "
u»Address Residual pressure(flmwn9)reading ot incoming water
-
' - O�y� _- svpp�inmhome o,atmainshuu`�i ���
| \ ����p�
---- -- What time of day was the flow test taken?,
��
esigns not provided by�nonor. comP|�cthe Flow'e�method ued7 []Bucket �f|^wMe'c'
�ngix�om`adon R �
` Flow _3
na^sName� _�-��"---�~�- How many gd|un�of water did the duig«p'cdi�
Company. � ---' asequ/�d7_1��
��
Ph»"eL Did the test me�nr exceed deign flow? o�,es []No
Fax `�_-����« -- Vvhichsp,ink|u,diJynvf{nw?Numbec '
^��gnpr,man*od attached ion e �ocam ~g
wemo
"�'-uff~'|/u7 0Yes 0 No Date left in service,with all vdve^*pcm
| j`is 'cquiied bymdc/16�15 0N«
`
t Witnessed and Verified by: OCCU Date
b}mma� f:xo|anodwns and Notes___-__.... ....................
________
!J PO)
nor Inc.
|4Ni.\uem �'o ^m` oy\ We�vmw��opvmv,�su/
,Vdk� �w