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$� AQUASAFETM FLOW TEST
VERIFICATION
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AquaSAFETM Flow Test Verification Form
Alliance Important Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
Company Name: il 1/ I CA-N 1.1.- / t'1 tot►M b r In 0 system warranty.E-mail or fax completed form
( ) to the Uponor Fire Safety Design Department
Contact: ��l C4.In A Lci. lOM2 4-5 at technical.services@uponor.com or 952.997.1731.
,� - For questions,contact Uponor Technical Services at
Phone: .103 -4�l q - 3 4{ q.Q 888.594.7726 or technicalservices@uponor.com.
Fax: Color of test orifice used: i(G-S S
Job Name: 1' 13 Static.pressure(not flowing)reading at incoming
Project Number: water supply into home or at main shutoff:
1
Job Address: 't S24/ SC.) i i't.Vv'W L �O
f J Residual pressure(flowing)reading at incoming water
City: 1 g e- 1. supply into home or at main shutoff: 7e,
State,ZIP: q?Z-.)3
What time of day was the flow test taken? 1 trt‘k-
For designs not provided by Uponor,complete the
following information. Flow test methodkised? 0euckef 0 Flow Meter
Designers Name: Flow test gpm: (le
Company: How many gallons of water did the design predict
•i'-• as required? i ?
Phone: Did the test meet or exceed design flow?ANes ❑No
Fax: Which sprinkler did you flow?Number: f^r - c1
/ "C �,,� Is the warning sign permanently attached close to the Location of head: eel vrx.,ri .a
./\C\�' main shutoff valve? 0 Yes Callo
// Date left in service with all valves open:
Was this system required by code? Yes ❑No
f
Test Witnessed and Verified y:
Name l /�U� Signatu Occupation Date
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2 Additional Explanations and Notes
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Uponor,Inc. Tel:800.321.4739 of
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5925 148th Street West Fax:952.997,1731
1 Apple Valley,MN 55124 USA Web:www.uponor-usa.com