Report (2) . _
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uponor
#
IRE SAFETY SYSTEMS
1,11,
AQtJASAFETM FLOW TEST
\ 7)-) VERIFICATION
FORM
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4\21/A(ittaSAI' E Flow I est Verification Form,
Alliance Important:Installing contractor must submit this
Mmhber ID ..,....1c)*441 ...„ completed form. Failure to do so nullifies the
nmpany Name P!.4ciL(421.t....fb system warranty. E-mail or fax completed form
_.„ to the Uponor Fire Safety Design Department
Contact cur 20_,,,,4,--, at technical.seryices@?upknor,com or 952.997.1731,
For questions,contact Uponor Technical Services at
Phone. Syl 64,-/ i"el 888.594.7726 or technicatservices@uponor.com.
Fax ___ _ Color of test orifice used ___,EZEIs.,..4-,
Job Name. PcNAA1,r,„ Static pressure(not flowing)reading at incoming
roject Number 3 003
water supply into home or at main shutoff: Li
P . 2),s5 sic
Job Address. iii,a'it St..,/ 6,40
Residual pressure(flowing)reading at incoming water
City 7:-4.1ei,e0 supply into home or at main shutoff: .35-
State,ZIP, OIL — -
What time of day was the flow test taken? 'D ...30
For designs not provided by Liponor, complete the
following information. Flow test method used? "..3 Bucket .1117ow Meter
Flow test gpm. a 3
Designer's Name: .__EN/A..etti ti., 0Aid..‘"—
Company 1.)N&Olt How many gallons of water did the design predict
as required? 13
Phone. "1& .55'Y 72
Did the test meet or exceed design flow? a"<es :l No
Fax 95-,,). 91 i i 7 3/
Which sprinkler did you flow?Number: iltAt3 4'1
is the warning sign permanently attached close to the Location of head: 3") flik,r
main shutoff valve? C.1 Yes L-3 No
Date left in service with all valves openi aL)-30-, t(3
Was this system required by code?0 Yes r--/No
1
t
..F.
Test Witnessed and Verified by:
Occupation Date,
i cichmihivii.,- Jo- . 0-?t-9
a
,,.
a
,
- . .........____......... _
b
.., ...... ......._ ________........
Additional Explanations and Notes A,
_____
_ -..._ _
ul ')'•.])
`,- tiponor,Inc. Tel 800.321.4739
5925 148th Street West
g ...
Apple Valley,MN 55124 USA Fax:952 997.1731
Web:www.uponor-usa.corn i;'