Report •
. li , 5Lr 5
uponor
%,,, i
r •
{ :i FIRE SAFETY SYSTEMS
, TM'AQUASAFE FLOW TEST
`yx VERIFICATION
` FORM
f , ...•—77:7e '',.7,i ,,,..,:,,'.,:,P:,,,...1-,'" t G
y'av,, rt xdd� ' ' ;�1 .
,A
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: ( ". 4�iL U U1�1 to the Uponor Fire Safety Design Department
Contact: r,0 tI rtkek en+1'4 e at technical.services(uponor.com or 952.997.1731.
�n ��92 - �� G® For questions,contact Uponor Technical Services at
Phone: 888.594.7726 or technical.serviceseuponor,com.
Fax: Color of test orifice used: ' /'y.,SI
/�
Job Name: �\�„a 4k. Static pressure(not flowing)reading at incoming
Project Number lab water supply into home or at main shutoff:
Job Address: l f d 7/ 5 ) Swn jl,dh.t coc ISi—.
Residual pressure(flowing)reading at incoming water
City: ir,tin/el
supply into home or at main shutoff: ./:)
State,ZIP:
What time of day was the flow test taken? /Q. 3D
For designs not provided by Uponor,complete the
following information, Flow test method used?,Bucket LI Flow Meter
Flow test gpm:
Designer's Name:
Com an How many gallons of water did the design predict
p y as required? / 7
Phone: Did the test meet or exceed design flow? SIXI LI No
Fax: Which sprinkler did you�, flow?Number: i ,
444 n Is the warning sign permanently attached close to the Location of head: J1 41£" 2
;L►.6 '/,' yt,,A main shutoff valve? O Yes Id No
I Date left in service with all valves open:
c as this system required by code? Yes LI No
Test Witnessed and Verified by:
f.
Na a Si•i--_I. -. 4 Occup.{'•I Date
T. , ,� i ) 64c A \ 1. \o-252 1
a
0
s
tV
0
L
Additional Explanations and Notes
l;
d
S,
gi Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
i Apple Valley,MN 55124 USA Web:www.uponor-usa.com