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4 FIRE SAFETY SYSTEMS
aYY,, � "�- P AQUASAFETM FLOW TEST
�" / VERIFICATION
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AquaSAFETM Flow Test Verification Form
Alliance Important Installing contractor must submit this
Member ID: /JJI/ completed form. Failure to do so nullifies the
Company Name: 1f!!1ta✓! ���,,�1p Jo
system warranty.E-mail or fax completed form
to the Uponor Fire Safety Design Department
Contact: /16/0I4 taw //t2 y . at technical.services@uponor.com or 952.997.1731.
Phone: 5o3- L/ 2 ;3 q 94. For questions.contact Uponor Technical Services at
888.594.7726 or technical.services@uponor.com.
Fax: /� — Color of test orifice used: rir., >44
Job Name: f�CJS Static.pressure(not flowing)reading at incoming
Project Number: S water supply into home or at main shutoff: c`-
Job Address: 114 )r a e/ SO -I 15' "411
Residual pressure(flowing) reading at incoming water
Crty: ii,All supply into home or at main shutoff: 76
State,ZIP: 9'7 2:Z 3 ��
What time of day was the flow test taken?
For designs not provided by Uponor, complete the
following information. Flow test method:used? 4Bucket 0 Flow Meter
Flow test m:_ /-7
Designer's Name: 9P
Company: How many gallons of water id the design predict
i — as required?
Phone:
Did the test meet or exceed design flow? ®Yes 0 No
Fax: Which sprinkler did you flow? Number: A/ " //
Is the warning sign permanently attached close to the Location of head:_ 16e-el._(r, ,✓..., 2
main shutoff valve? 0 Yes 0 No
Date left in service with all valves open:
Was this system required by code?U Yes D No
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Test Witnessed and Verified y:
Name i Sign ture,_ Occupa Date
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Additional Explanations and Notes 3
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Uponor,Inc. Tel:800.321.4739 r
5925 148th Street West Fax:952.997.1731
j. Apple Valley,MN 5512.4 USA Web:www.uponor-usa.com