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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: ,/� -0- completed form. Failure to do so nullifies the
// system warranty.E-mail or fax completed form
Company Name: LI 0l ca N 1�Lr.rv'6 to the Uponor Fire Safety Design Department
Contact: (I hg L j ."^--' at technical.services@uponor.com or 952.997.1731.
For questions,contact Uponor Technical Services at
Phone: ,5G3 C06 7 r ! / 888.594.7726ortechnicalservices@uponor.com.
Fax: Color of test orifice used: t YAc4-__
Joh Name: (20591-A hpp Static pressure(not flowing)reading at incoming
Project Number: r 5?S--t— csvS water supply into home or at main shutoff: 4'.5
Job Address: /c/el.. ' ,4?4.1 ls1114:2 ee)AS)---
Residual pressure(flowing)reading at incoming water
City: 72*.7J' ''tc J supply into home or at main shutoff: 3S--
State,ZIP: rJ
What time of day was the flow test taken? .11700
For designs not provided by Uponor, complete the
following information. Flow test method used? ❑Bucket mow Meter
N N�),c Flow test gpm: 7
Designer's Name: GVh
Company: OA"ra(2-- How many gallons of water did the design predict
as required? l 7
Phone: � i''( 77d d<es(n Did the test meet or exceed design flow? U ❑No
Fax: 75a. %Y) 17.3/ Which sprinkler did you flow? Number: Akie.A.42 da
Is the warning sign permanently attached close to the Location of head: &J✓w"-, . ..
main shutoff valve? ❑Yes ❑No _al
Date left in service with all valves open: `j
Was this system required by code?O Yes ❑No
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Test Witnessed and Verified by:
e Si Occupation Date
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L. Additional Explanations and Notes
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.51
Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com