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,, '1'.:.:1,.. ii'� _ UOflO1 Iy:, '� cn§YdM1 FIRE ASAFFE SATMS AQUASAFETM Y FLOW TEST : VERIFICATION FORM � f , w °°z/...-Gwadie AquaSAFETM Flow Test Verification Form Alliance ^� Important:Installing contractor must submit this Member ID: r+6'1 completed form.Failure to do so nullifies the I Ili c_c_ . + __ system warranty.E-mail or fax completed form Company Name: ' ��^'� to the Uponor Fire Safety Design Department Contact: G ct(�+U 1�cs N.�rcS _ at technicalservices@uponor.com or 9i52.997.1731. , 3 S 7? `6 For questions,contact Uponor Technical Services at Phone: /t 888.594.7726 or technical.s(e?rvices@uponor.com. Fax: Color of test orifice used: iLG� Job Name: 1,vi 1F Ce1C� Static pressure(not flowing)reading at incoming Project Number 6'� CO water supply into home or at main shutoff: `7S Job Address: ill S7 5•.! 0410d. ,v' k 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? !a ��h For designs not provided by Uponor,complete the following information. Flow test method used? 'Li Bucket ❑Flow Meter Designer's Name: Flow test gpm: '6 Com an How many gallons of water the design predict Comp an as required? 17 Did the test meet or exceed did design flow? Kl Yes U No Phone: Fax: Which sprinkler did you flow?Number:+ .� Is the warning sign permanently attached close to the Location of head: .1/')Ot-+n main shutoff valve? ❑Yes ❑No Date left in service with all valves open: Was this system required by code?'�Yes ❑No I Test Witnessed and Verified by: Name Signature ccupation Date © J Additional Explanations and Notes .12C,7 I 17'1- I('l(1.�y L/ :I Uponor,Inc. Tel:800.321.4739 5925 148th Street West Fax:952.997.1/31 s Apple Valley,MN 55124 USA Web:www.uponor-usa.com