Report I
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FIRE SAFETY SYSTEMS
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+ AQUASAFET"" FLOW TEST
VERIFICATION
1"' FORM
AquaSAFETM Flow Test Verification Form
Alliance Important Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
t system warranty.E-mail or fax completed form
Company Name: 'I P.m C 2 �l 4 AI I.d w`i to the Uponor Fire Safety Design Department
Contact: 0 Gvs i-i L e.. lUVhG. at technical.services@uponor.com or 952.997.1731.
For questions,contact Uponor Technical Services at
Phone: ,56,3-',' -3 4 a _ 888.594.7726 or technical.services@uponor.com.
• Fax: � Color of test orifice used: eE S' 3 5
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Job Name: (�<_5 Static.pressure(not flowing)reading at incoming
i !
Project Number: water supply into home or at main shutoff:
Job Address: c 116S74. SW t ieWCl`' L
Residual pr sure(flowing) reading at incoming water
City: "f15 / supply into home or at main shutoff: `26,
State,ZIP: _ '2•2 _ -
What time of day was the flow test taken? I
For designs not provided by Uponor, complete the
following information. Flow test method•.used? O.13ucket 0 Flow Meter
Flow test gpm: (7 f
Designer's Name:
Company: __ _ _-y How many gallons of water did the design predict
.i,';
as required? 1 ?
Phone: Did the test meet or exceed design flow? Glt'Yes ❑No
Fax: Which sprinkler did you flow? Number: f? - 3
is the warning sign permanently attached close to the Location of head: ec\c—, ev. - .-
/` main shutoff valve? 0 Yes 0 No
`�\�./ Date left in service with all valves open:
Was this system required by code? 0 No
1
Test Witnessed and Verified lam:
L • •
Name A i .Sign-_ r Occupa n Date
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Additional Explanations and Notes ,
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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