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FIRE SAFETY SYSTEMS
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AQUASAFETM FLOW TEST
s , VERIFICATION
f FORM
AquaSAFETM Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: k completed form. Failure to do so nullifies the
Company Name: lid " Pk—,d system warranty. E-mail or fax completed form
�yJ /� r� to the Uponor Fire Safety Design Department
Contact: C/.=CT YJ .1-+A"-' at technical.services@uponor.com or 952.997.1731.
�, For questions,contact Uponor Technical Services at
Phone: SO 1 / 888.594.7726 or technicalservices@uuponor.com.
Fax: ��' _LI Color of test orifice used: l ta_.
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Job Name: �"— Static pressure(not flowing)reading at incoming
Project Number: water supply into home or at main shutoff: 7Cc
Job Address: IYii70 St.) (nail Residual pressure(flowing)reading at incoming water
City: .76A400 supply into home or at main shutoff: 3.5--
State,ZIP: 01C
What time of day was the flow test taken? /0=36
For designs not provided by Uponor, complete the Flow test method used? ❑Bucket C enFlow Meter
following information.
Designer's Name: ArJ 30„..,u),ci Flow test gpm: C3
Company: tl'PQ"'a i 2_ How many gallons of water did the design predict '
as required? 0
Phone: ff -S-`7iz/ 770 + Did the test meet or exceed design flow? Ires U No
Fax: yc- - ?f? /73i
Which sprinkler did you flow?// Number: 1i•� g
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Is the warning sign permanently attached close to the Location of head: rJ 1'Zc. sn
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main shutoff valve? 0 Yes 0 No s _�`
Date left in service with all valves open:
Was this system required by code?O Yes 0 No
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Test Witnessed and Verified by:
gn.i Are Occupation Date
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s Additional Explanations and Notes
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a Uponor,Inc. Tel:800.321.4739
= 5925 148th Street West Fax:952.997.1731
g Apple Valley,MN 55124 USA Web:www.uponor-usa.com
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