Report (3) iC*t
UpOnor
FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
VERIFICATION
Cr2/
no\ FORM
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,0/AcittaSAFE' 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: _Lap ic,...c/f
to the Uponor Fire Safety Design Department
Contact a '1 at technical.seryices@uponor,com or 952.997.1731.
For questions, contact Uponor Technical Services at
Phone: 50',3 e,26 888.594.7726 or technical.services@uponorcom.
Fax. Color of test orifice used 0/44
Job Name: )2°)"— — Static pressure(not flowing) reading at incoming
Project Number 3 05-?.5.71 ociJ3 water supply into home or at main shutoff. VI
Job Address- 1Y300 i Gynik9 cots 4-
Residual pressure(flowing) reading at incoming water
City supply into home or at main shutoff:
State, ZIP. 012—
What time of day was the flow test taken? 3'Aio
For designs not provided by Uponor,complete the
following information. Flow test method used? CI Bucket lil-Tow Meter
3
Desioners Name Flow test gpm:
Company &A/J(4—
How many gallons of water did the design predict
: 0140 --
as required? 1 3
Phone: lidecr 7-2,16 Did the test meet or exceed design flow? s 7...7.1 No
Fax '*7 173/
Which sprinkler did you flow? Number: /1„,..4
the warning sign permanently attached close to the Location of head: 3rt)
n shotttff valve? U Yes LI No
Date left in service with all valves open JO— 30
Via.it v;torn required by cede?LI Yes U No
Test Witnessed and Verified by:
.4, s Wry /
Occup Date
J 0 30
fold
Additional Explanations and Notes