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uponor
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FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
,r VERIFICATION
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'? 1 FORM
AquaSAFETM Flow Test Verification Form
Alliance 1 I Important:Installing contractor must submit this
!
Member ID: 1-4 completed form.Failure to do so nullifies the
system warranty.E-mail or fax completed form
Company Name:Ai i/���dct./.L �a -.A1�` to the Uponor Fire Safety Design Department
Contact: t7^J V4 Thin Hnms at technical.services@uponor.com or 952.997.1731.
For questions,contact Uponor Technical Services at
Phone: 888.594.7726 or technical.senricel@uponor.com.
Fax: Color of test orifice used: Y�-Lf/�
Job Name: P*4'5'LArf/k. Static pressure(not flowing)reading at incoming
Project Number: jQ 6- 3E,F 60 water supply into home or at main shutoff:
Job Address: V 660 kJ Zovoi5a e sT
Residual pressure(flowing)reading at incoming water
City: - supply into home or at main shutoff: ZCl
State,ZIP:
What time of day was the flow test taken? /o it an
For designs not provided by Uponor,complete the Flow test method used?14flucket ❑Flow Meter
following information. l
Flow test gpm: 7
Designer's Name:
How many gallons of water did the design predict
Company: _ as required? 1 7
Phone. Did the test meet or exceed design flow? @Yes ❑No
Fax: Which sprinkler did you flow? Nu ber: bitit/
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Is the warning sign permanently attached close to the Location of head: >t_ !ees/rI il
main shutoff valve? ❑Yes ❑No
Date left in service with all valves open:
Was this system required by coded Yes ❑No
Test Witnessed and Verified by:
Name , Sign ture Occupation Date
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k Additional Explanations and Notes
Owe j ' 4 7 al- -rtaer r'
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€ Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
1 Apple Valley,MN 55124 USA Web:www.uponor-usa.com
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