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AQUASAFETM FLOW TEST
;,� _ VERIFICATION
; FORM
AquaSAFE`M Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: c/ completed form.Failure to do so nullifies the
system warranty.E mail or fax completed form
Company Name: get(
l►dv� _ �/vita^►� totheUponorFireSafetyDesign DepartmentContact: r 1 ji Ple t Q� at technical.services@uoonor.com or 952.997.1731.
_5 6 s3s' For questions,contact Uponor Technical Services at
Phone: 888.594.7726 or technical.services@uoonor.com.
Fax: Color of test orifice used: _ /.�
Job Name: a;Jeer0414( ( fldat c 3'°91 G)C7 waterStatic spur into not homeowing)or at mainreaing shutofinf:oming 7�
Project Number:
Job Address: (1! I SL.) � V d,.:
Residual pressure(flowing)reading at incoming water
City: supply into home or at main shutoff: S�
State,ZIP:
What time of day was the flow test taken? /eh g1
For designs not provided by Uponor,complete the
following information. Flow test method used? S$.Bucket U Flow Meter
Designer's Name:
Flow test gpm: 1
Company:
How many gallons of water did the design predict
as required? t "i
Phone: Did the test meet or exceed design flow? kYes U No
Fax: Which sprinkler did you flow? Number: �"
Is the warning sign permanently attached close to the Location of head: jt'�r�, C�..
main shutoff valve? U Yes U No
Date left in service with all valves open:
to Was this system required by code?Ayes U No
Test Witnessed and Verified by:
Name _ SignatureOccupation Date
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Additional Explanations and Notes ,J)_ / 1�.. �t4 Lt N
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3 Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
j. Apple Valley,MN 55124 USA Web:www.uponor-usa.com