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FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
VERIFICATION
FORM
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: ig It wt r�qtt A,M L d I.( to the Uponor Fire Safety Design Department
Contact: if-)c.-vt v{(a,¢,. '®✓>7 6.- at technical.services@uponor.com or 952.997.1731.
, e� For questions,contact Uponor Technical Services at
Phone: S f7 3,`f !. 3 2z> 888.594.7726 or technicalservices@uponor.com.
Fax: `` Color of test orifice used: .rE CC..S S
Job Name: nn 1�.3 Static.pressure(not flowing)reading at incoming
Project Number: 1`V 34hIf S(.✓IG544,4 water supply into home or at main shutoff: Sit,
Job Address:
/r,c•,-d.-- _
_ Residual pressure(flowing)reading at incoming water
City: supply into home or at main shutoff: 76
�y
State,ZIP: / 7 2-2.3 I ��
What time of day was the flow test taken?
For designs no provided by Uponor, complete the Flow test method,used?Atucket ❑Flow Meter
following information.
Designers Name:
Flow test gpm:
How many gallons of water did the design predict
Company: as required?
Phone: Did the test meet or exceed design flow? IAYes ❑No
Fax: 6
-- —_� Which sprinkler did you flow?Number: -`3
Is the warning sign permanently attached close to the Location of head:_ 13 gent rti 2.-
main shutoff valve? U Yes ❑No
Date left in service with all valves open:
c Was this system required by code?❑Yes ClNo
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Test Witnessed and Verified y:
_s Name Occupa n Date
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Additional Explanations and Notes ,
Uponor,Inc. Tel:800.321.4739 ,
5925 148th Street West Fax:952.997.1731
-A Apple Valley,MN 55124 USA Web:www.uponor-usa.com
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