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FIRE SAFETY SYSTEMS
it ' 7 . AQUASAFETM FLOW TEST
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VERIFICATION
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AquaSAFETM Flow Test Verification Form
Alliance Important Installing contractor must submit this
Member ID: /�i completed form.Failure to do so nullifies the
I I( v1 L L ' P'r µv s i in system warranty.E-mail or fax completed form
Company Name: g to the Uponor Fire Safety Design Department
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Contact: l�rn I t 014w 10149.c-g at technicalservices@unonor,com or 952.997.1731.
For questions,contact Uponor Technical Services at
Phone: J C?3 — [�8 ' ,�7 L, T c'1 888.594.7726 or technical.services@uponor.com.
Fax: Color of test orifice used: �iCYSS
Job Name: \ c 5`" Static.pressure(not flowing)reading at incoming
Project Number: water supply into home or at main shutoff:
Job Address: Iy374/ Sw ft$ y4/
Residual pressure(flowing)reading at incoming water
City: 1 J 9 e-"/C '
supply into home or at main shutoff: 7
State,ZIP: 97273
What time of day was the flow test taken? 1
' For designs not provided by Uponor,complete the caP1,�
Flow test methodsused? ,avBucket 0 Flow Meter
following information.
Flow test gpm:
Designer's Name:
How many gallons of water did the design predict
Company: as required? ! dT
Phone: Did the test meet or exceed design flow? 7(es 0 No
Fax: Which sprinkler did you flow? Number: I/ -
Is the warning sign permanently attached close to the Location of head: 'I rr,,r'•, 3
main shutoff valve? 0 Yes ❑No
Date left in service with all valves open:
Was this system required by code?0 Yes 0 No
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Test Witnessed and Verified by:
"<_ Name i i Signatu Occupation Date
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. Additional Explanations and Notes ,
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g Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
1 Apple Valley,MN 55124 USA Web:www.uponor-usa.com
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