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I 0 1/4..)- T- uponor
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FIRE SAFETY SYSTEMS
r' ;,I ti., AQUASAFETM FLOW TEST
a VERIFICATION
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AquaSAFETM Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
It+ <1i 1 04, system warranty.E-mail or fax completed form
Company Name: l I i I I u tt..
/ to the Uponor Fire Safety Design Department
Contact: / ,,yl ink -I/ at technical.seruices@uponor•com or 952.997.1731.
For questions,contact Uponor Technical Services at
Phone: G��-l'9 Z `3 y 'i:::+ 888 594.7726 or tern.
Fax: Color of test orifice used: r )
Job Name: rr Static pressure(not flowing)reading at incoming
Project Number 44
S•C water supply into home or at main shutoff: b v 4
Job Address: I(ptjri(p $i S(,�ytf kittit �,�7 4-
/ ) "'Rid pressure(flowing)reading at incoming water
City: / I C [-✓a supply into home or at main shutoff: 7tj
State,ZIP: port-
What time of day was the flow test taken? /0.3 6
For designs not provided by Uponor,complete the Flow test method used?9 Bucket O Flow Meter
following information. f
Designer's Name: Flow test gpm:
Company: How many gallons of w er did the design predict
as required? rl
Phone: Did the test meet or exceed design flow? es ❑ o'
Fax: Which sprinkler did you flow? umber: H _
Is the warning sign permanently attached close to the Location of head:_/(C,SJ/ <1
main shutoff valve? ❑Yes 0 No
Date left in service with all valves open:
Was this system required by code?❑Yes 0 No
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Test Witnessed and Verified by:
Na e • Sign ure Occupation Date
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Additional Explanations and Notes
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gi Uponor,Inc. Tel:800.321.4739
I 5925 148th Street West Fax:952.997.1731
iApple Valley, MN 55124 USA Web:www.uponor-usa.com