Report (3) Uponof
FIRE SAFETY SYSTEMS
} AQUASAFEym FLOW TEST
5, z� �00gqo VERIFICATION
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AcquaSAFE" Flow Test Verification Form.
...............................................................................................................................................
Alliance Important:Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
Company Name: —,4system warranty.E-mail or fax completed form
I to the Uponor Fire Safety Design Department
Contact: duo N h S_b,.0 cor at technical.services@uponar.com or 452.997.1731.
For questions,contact Uponor Technical Services at
Phone: ��� — Z' N�1?5 888.594.7726 or technical.sendces@uponor.com.
Fax: Color of test orifice used: 2—ce.g�
Job Name: Static pressure(not flowing)reading at incoming
Project Number: water supply into home or at main shutoff: _
Job Address: I L 19qj�Y SC�t /
Residual pressure(flowing)reading at incoming water
City: ! �k supply into home or at main shutoff:
State,ZIP: 4�?2Z-..-7
What time of day was the flow test taken?
For designs not provided by Uponor,complete the
following information, Flow test method used? ucket 0 Flow Meter
Designer's Name: Flow test gpm: 1 -71,
Company: How many gallons of water did the design predict
as required?
Phone: Did the test meet or exceed design flow? Utes6 No
Fax: Which sprinkler did you flow?Number:
Is the warning sign permanently attached close to the Location of head:L1-1-9--_zeyl P�
main shutoff valve? ❑Yes Q No
Date left in service with all valves open:
Was this system required by code?O Yes ❑No
Test Witnessed and Verified by:
Namme',1►-1� Si atur 0 patio Date
e .
0
0
a
Additional Explanations and Notes
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Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com