Report (2) 7, t {^
41 r uponor
, . 14:,:;,,,,,
.--, t t Z FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
VERIFICATION
,
d 7 > 01: FORM
AquaSAFETM Flow Test Verification Form
Alliance Important Installing contractor must submit this
Member ID: /j /�/ completed form.Failure to do so nullifies the
/
Company Name: f?!/I t e n It- `f 1/,,h i system warranty.E-mail or fax completed form
to the Uponor Fire Safety Design Department
Contact: lh at l?to, 'la 1•46.-S at technical.services@uponor.com or 952.997.1731.
S0 3- G/�? y 9 . For questions,contact Uponor Technical Services at
Phone: -- 888.594.7726 or technical.services@uponor.com.
Fax: ^ — Color of test orifice used: 13 d' S3
Job Name: ()LOTS Static.pressure(not flowing)reading at incoming
l
Project Number: water supply into home or at main shutoff: c(O
Job Address: I18 4L 5(1 I b )1V
/ Residual pressure(flowing)reading at incoming water
City: I�1'�l�/aG supply into home or at main shutoff: `7Z`-)
State,ZIP: 9'7 7 2,3 "t,ti
What time of day was the flow test taken? I
For designs not provided by Uponor,complete the �j
following information. Flow test method used? Bucket ❑Flow Meter
Designer's Name: Flow test gpm:—
How many gallons of water did the design predict
Company:
t ., as required?
Phone: --- Did the test meet or exceed design flow? ®Yes 0 No
Fax: — Which sprinkler did you flow?Number: / " //
Is the warning sign permanently attached dose to the Location of head: 'f&1.ape.vti.. 2
main shutoff valve? 0 Yes ❑No
Date left in service with all valves open:
g Was this system required by code?0 Yes CI ND
Test Witnessed and Verified by:
Naome� g� Sign-ture _ Occupaji Date
I
z
o
Additional Explanations and Notes
0
"I
LL Uponor,Inc. Tel:800.321.4739 e
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com
LL