Report (3) 11101111111111111111111111111111111111101111111110111111111Now
., ..t..'„.
07: ../
topoirior
... ,,,
:, !. .. ....,
, HPF SAE+ FY ':)Y TEM)
AQUASAFE' FLOW TEST
VERIFICATION
,., FORM
r..\\v
r\L..)
%‘..)
6 AquaSAFE'm Flow Test Verification form
r\l/
‘.1
Member ID:, _ 1,,e)44_9 2_.._. _ completed form,
finosrmkallFinagilucroenttoradctoosromnuusitlifsjuebsmthitethis
____
system r warranty.Fir Fire
sa E-mailfetyo rpfeasxign completedpepartnifeonrtm
()
Company Name: 001(ifit--.P.11/^^12- - -- to the Upon
Contact C b(p gt„..,„..,,i____ aFtor ecicuhensitciaoln.sse,
cr-Viocneisa@c:jUP-Q'priTionor Tecohrn9ic5a21.99e9:7):(lic7e3s1;t
Phone: 503 67(41.) ,,. 7S-I--- B88.594.7726 or technical.services@uponor.com.
Fax ____ _ ---- Color of test orifice used: BiACii,
'''...",..,4iNikV0Piiliplie:i.F'''''.t Job Name: _ )20S.kiti"--- Static pressure(not flowing)reading at incoming
Number projec, .
' . 0.s--)5"--74- oc 1 water supply into home or at main shutoff: 9 3
lob Address: ,1Y30(11 Si-,) 6-00 rAYIS4
Residual pressure(flowing)reading at incoming water
-..,., ;',i„,,iki4.'',.,;•!,14X.5'..,,,Oitx,,,1,;!,, ,,,,,'
City. .7.:61/4-40 supply into home or at main shutoff: 3 y
___
State, ZIP: OrZ--
L;; What time of day was the flow test taker? 330
For designs not provided by Uponor,complete the
Flow test method used? 0 Bucket t31"rtow Meter
following information.
, Designer's Name: Flow test gpm:
ikalr-ii Se.f•JdiCA1--
How many gallons of water did the design predict
Company; ()Pe _
as required? 1 3
Phone: f2Ciii *5,• .` 77,)a
Did the test meet or exceed design flow? litT/es 0 No
Fax. c)- 949.7 173/
Which sprinkler did you flow? Number: tie.h,i0 ) 40gtt:=-1C:41.444,1i
is the warning sign permanently attached close to the Location of head: 30r) Pico'v-- 51%eley's
rnairi shutoff valve? Li Yes 0 No , ,
Date left in service with all valves open. /C.1-..)C
VVe..,this system required by code?Li Yes LI No
Test Witnessed and Verified by:
..'
.:, 7' Sitifiat _ ..- Occup-tion Date
LT 14,tp
---
.;,.-
E
2.7 Additional Explanations and Notes
6- A
,A
Uponor,Inc,
Tel:800.321.4739
5925 148tli Street West Fax:952,997,1731
Apple Valley,MN 55124 USA Web:wvwv.uponor-usa.corn