Report (2) p
151V uponor
FIRE SAFETY SYSTEMS
r- AQUASAFETM FLOW TEST
VERIFICATION
FORM
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AquaSAFETM Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: /.I CC( completed form.Failure to do so nullifies the
system warranty.E-mail or fax completed form
Company Name: 14 l 11 u.ricc..- �cjylylrr•t��
/ to the Uponor Fire Safety Design Department
Contact: Chi fit.. "1.AICAAstj at technical.services@uponor.com or 952.997.1731.
Phone: c 77 —E S`3S For questions,contact Uponor Technical Services at
888.594.7726 or technical.services@uponor.com.
Fax: Color of test orifice used:
Job Name: x< Ief fi•t, ... Static pressure(not flowing)reading at incoming
Project Number 366 /Me water supply into home or at main shutoff:—7C
Job Address: IUP7 11lsck
Residual pressure(flowing)reading at incoming water
City: supply into home or at main shutoff: E',S-
State,ZIP:
What time of day was the flow test taken? Co
For designs not provided by Uponor,complete the
following information. Flow test method used? tBucket ❑Flow Meter
Flow test gpm:
Designer's Name:
Company: How many gallons of water did the design predict
as required? t 7
Phone: Did the test meet or exceed design flow? *Yes ❑No
Fax: Which sprinkler did you flow?Number: —1
Is the warning sign permanently attached close to the Location of head: I/4A, 1-Er eat{`rc+r/.n
main shutoff valve? ❑Yes ❑No
Date left in service with all valves open:
Was this system required by code?tAYes ❑No
Test Witnessed and Verified by:
Name Signatur��i Occupation Date
Additional Explanations and Notes g� i,.,
r 1
§l
Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com