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FIRE SAFETY SYSTEMS
1 t AQUASAFETM FLOW TEST
VERIFICATION
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AquaSAFETM Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: IQ&P completed form. Failure to do so nullifies the
�� system warranty.E-mail or fax completed form
Company Name. L34 izII to the Uponor Fire Safety Design Department
Contact: 64b A ,"../4-ti at technical.services@uponor.com or 952.997.1731.
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' For questions,contact Uponor Technical Services at
Phone: S 73 66? I76` 888.594.7726 or technical.services@uponor.com.
Fax: Color of test orifice used: B/' /
Job Name: a Sh1A Static pressure(not flowing)reading at incoming
Project Number: 3=)5 75:11 on I water supply into home or at main shutoff: iS
Job Address: )'I i) .5 -.J 6049 Cam 91—
�/� Residual pressure(flowing)reading at incoming water
'Ti City: Cal/1+ / supply into home or at main shutoff: 3S--
State,ZIP: Q
What time of day was the flow test taken? cl O
For designs not provided by Uponor, complete the
following information. Flow test method used? 0 Bucket arrow Meter
Designer's Name: ciAN er'ecj'c. Flow test gpm: /3
Company: (J(I How many gallons of water did the design predict
as required? :3
Phone: „cf-i" .S' cP 7i Did the test meet or exceed design flow? tomes 0 No
Fax: c c.2, 9V, 03i Which sprinkler did you flow? Number: .L2 a
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Is the warning sign permanently attached close to the Location of head:3r) -ILV- `CAI✓$
main shutoff valve? 0 Yes 0 No Seto _a[
Date left in service with all valves open:
Was this system required by code?❑Yes ❑No
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Test Witnessed and Verified by: 1
Si Occupation Date
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Additional Explanations and Notes
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sUponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com
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