Report (2)i ,. ,...„„, ., . L,r,7 .r
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� a t, or / 77 . UpOf101a
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� ,i s FIRE SAFETY SYSTEMS
4 f.•, ` . AQUASAFETM FLOW TEST
a _ y- � , VERIFICATION
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. FORM
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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: stem warranty.E-mail or fax completed form
P (I1P.tr �ltAIMl.dw
/ 'Al to the Uponor Fire Safety Design Department
Contact: jl Gn n Liz._ "!OYkfrS at technical.services@uponor.com or 952.997.1731.
Phone: �Sb�- �'l -3 G✓�a _ For questions,contact Uponor Technical Services-at
888.594.7726 or technical.servjces@uponor.com.
Fax: n - — Color of test orifice used: CC--S 5
Job Name: (CtC77.5 / A,Static.pressure(not flowing)reading at incoming
Project Number: 1`y C�,l/b Se/ /j c 43 water supply into home or at main shutoff:
Job Address: 1-i f-A� _ '
_. Residual pressure(flowing)reading at incoming water
City: supply into home or at main shutoff: 76
p
State,ZIP: / 72 23 / ,�1.644
What time of day was the flow test taken?
For designs not provided by Uponor, complete the
following information. Flow test methocdused?plaucket ❑Flow Meter
Designer's Name: Flow test gpm:_
Company: _—� How many gallons of water did the design predict
as required?� 1 7
Phone: ----- Did the test meet or exceed design flow? aoYes ❑No
Fax: Which sprinkler did you flow?Number: i - 3
Is the warning sign permanently attached close to the Location of head: 3 ree, 2--
main shutoff valve? ❑Yes ❑No
Date left in service with all valves open:
g Was this system required by code?❑Yes ❑No
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Test Witnessed and Verified.
Name, G rr Occupa ' n Date
a Name.
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Additional Explanations and Notes ,
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Uponor,Inc. Tel:800.321.4739 I
ti 5925148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.conr '