Report iltS Zazi-O77/
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'_ FIRE SAFETY SYSTEMS
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AQUASAFETM' FLOW TEST
VERIFICATION
r �.: FORM
AquaSAFETM Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
` system warranty.E-mail or fax completed form
Company Name: l i t4)/ Li 0,30 %
�f to the Uponor Fire Safety Design Department
Contact: ' c y1 ink —/ ?,bin6j at terhnicai.serviceseuponor.com or 952.997.1731.
For questions,contact Uponor Technical Services at
Phone: S b,. -y 9 2 `...3 if b 888.594.7726 or technicai.services@uoonar,com.
Fax: Color of test orifice used: ec,Sj
Job Name: ` S Static pressure(not flowing)reading at incoming
Project Number 4b`f . . water supply into home or at main shutoff: gv 4
Job Address: Iloro,73 Sy.) Sl.►n for Cac.,r a-,Residual pressure(flowing)reading at incoming water
City: 1 C `l( supply into home or at main shutoff: -25
State,ZIP:
What time of day was the flow test taken? o:3 o
For designs not provided by Uponor,complete the
following information, Flow test method used?` Bucket ❑Flow Meter
Designer's Name: Flow test gpm:
Company: How many gallons of w er did the design predict
as required? //
Phone: Did the test meet or exceed design flow? es Clo
Fax: Which sprinkler did you flow? umber: /'
Is the warning sign permanently attached close to the Location of head: e4f / e,cf
main shutoff valve? ❑Yes ❑No
Date left in service with all valves open:
Was this system required by code?❑Yes ❑No
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3
Test Witnessed and Verified by:
Na e •1Lt Sign u_re Occupation Date
0
Additional Explanations and Notes
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gj Uponor,Inc. Tel:800.321.4739
I 5925 148th Street West Fax:952.997.1731
ri Apple Valley,MN 55124 USA Web:wuwv.uponor-usa.com