Report fi _ fFFi. "�, 49 �(' SL1 f 5
A , „. .. }`Itiponor
SA", FIRE SAFETY SYSTEMS
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, f AQUASAFET" FLOW TEST
n ^' VERIFICATION
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AcfuaSAFETM Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: , completed form.Failure to do so nullifies the
V, �} system warranty.E-mail or fax completed form
Company Name:
�'f to the Uponor Fire Safety Design Department
Contact: ��✓i p cl\A. 4#001e 4 e at technicai.services@uponor,com or 952.997.1731.
3✓ �19 2 , 3 t� �� For questions,contact Uponor"Technical Services at
Phone: l7 888.594.7726 or technical.services@uponor,com.
Fax: 'I Color of test orifice used: �/ (r../.1
/n�
Job Name: 11�Ant — Static pressure(not flowing)reading at incomin
Project Numberlat* water supply into home or at main shutoff:
Job Address: IL LSif i cLia t coc,A t 5-1-
� I Residual pressure(flowing)reading at incoming water
City: / 'r/C�[col supply into home or at main shutoff: 7�
State,ZIP: 01
What time of day was the flow test taken? /0,30
For designs not provided by Uponor,complete the
following information. Flow test method used?,Bucket U Flow Meter
Designer's Name: _ Flow test gpm:
•
Company: Now many gallons of water did the design predict
as required? /7
Phone: Did the test meet or exceed design flow? A Yes ❑No
Fax: Which sprinkler did you��//flow?Number:m Pi,
/44Is the warning sign permanently attached close to the Location of head: /"l Gl tom` �I ��
�invvi k main shutoff valve? ❑Yes AI No
S Date left in service with all valves open:
as this system required by code?p Yes 0 No
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Test Witnessed and Verified by:
Na e Si. . ,-_ Occup Date U ` n/
1
0
0
s
Z
k s Additional Explanations and Notes
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i
gi Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
i Apple Valley,MN 55124 USA Web:www.uponor-usa.com
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