Report (2) MSC -00i54
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FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
VERIFICATION
FORM
AquaSAFETM 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 7UlcuH Plu•✓64
f� �/ to the Uponor Fire Safety Design Department
Contact: d..-1 c�,C1WM/t-^--1 at technical.services@uponor.com or 952.997.1731.
��� ��� For questions,contact Uponor Technical Services at
c0 Phone: 3 I888.594.7726 or technical.serrviices@/uponor.com.
Fax: Color of test orifice used: IYA G�--
Job Name: le0s11- Static pressure(not flowing)reading at incoming
Project Number: 3.457, .f cJU 3 / water supply into home or at main shutoff: Li S�
Job Address: I y Y,, 541 6u0(0sLS!'-
Residual pressure(flowing) reading at incoming water
City: 7/�/y� supply into home or at main shutoff: 3�
State, ZIP: 0 IL
What time of day was the flow test taken? 10.00
For designs not provided by Uponor, complete the
following information. Flow test method used? ❑Bucket [8 F ow Meter
Designer's Name: fhrj �•�J. Flow test gpm: t
Company: (JP00..)0(Z- How many gallons of water did the design predict
as required? /3 -.
Phone: Erre-eri _S s y 7 7.3C0 Did the test meet or exceed design flow? (ryes ❑No
Fax: C/S� 99 7 <73/ Which sprinkler did you flow? Number: l +0 a--
Is the warning sign permanently attached close to the Location of head: Zrrj-i'L<vv w...S
main shutoff valve? ❑Yes ❑No
Date left in service with all valves open: .S'C.z'''.4l
Was this system required by code?❑Yes ❑No
Test Witnessed and Verified by:
kTa • Occupation Date
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Additional Explanations and Notes
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Uponor,Inc. Tel:800.321.4739
5925148th Street West Fax:952.997.1731
Apple Valley, MN 55124 USA Web:www.uponor-usa.com
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