Report (2) •
uponor
FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
VERIFICATION
FORM
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AquaSAFETM Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: y!4 '1 completed form.Failure to do so nullifies the
J� j system warranty.E-mail or fax completed form
Company Name: I t M..[t? f 1G(is+17%,.., to the Uponor Fire Safety Design Department
Contact: 'A(/ '(,t tJ pvtets at technical.services@uponor.com or 952.997.1731.
x, For questions,contact Uponor Technical Services at
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Phone: 5 — J 77 0S 7 888.594.7726 or technical.serviices@uponor.com.
Fax: Color of test orifice used: IC[A
Job Name: �.�t� Pi((ri Static pressure(not flowing)reading at incoming
Project Number: 206s Ic �f water supply into home or at main shutoff: 7.C"
Job Address: (2.1171 Ski
Residual pressure(flowing)reading at incoming water
City: supply into home or at main shutoff: 6
State,ZIP:
What time of day was the flow test taken? (d "4n
For designs not provided by Uponor,complete the
following information. Flow test method used? Bucket ❑Flow Meter
Flow test gpm: I
Designer's Name: t`J
Company: How many gallons of water did the design predict
as required? 1 -7
Phone: Did the test meet or exceed design flow? 19 Yes ❑No
Fax: Which sprinkler did you flow? Number:
Is the warning sign permanently attached close to the Location of head: e,t rev c-y� ?—
main shutoff valve? ❑Yes ❑No
Date left in service with all valves open:
Was this system required by code?*Yes ❑No
Test Witnessed and Verified by:
Name Signature Occupation Date
Additional Explanations and Notes 1)
LLI
Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com