Report (3) uponof
FIRE SAFETY SYSTEMS
AQUASAFETm FLOW TEST
VERIFICATION
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ApaSAFE" Flow Test Verification. Form
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Alliance Important:Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
Company Name: 41
FC_k!t. , 4 �'— system warranty.E-mail or fax completed form
to the Uponor Fire Safety Design Department
Contact: at technical.services@uoonor.com or 952.997.1731.
Phone: /
¢ —q 2 Z_13 t/ g For questions,contact Uponor Technical Services at
888.594.7726 or technical.services@uoonor.com.
Fax: Color of test orifice used: 12 cam)
Job Name: Static pressure(not flowing)reading at incoming
Project Number: L3 water supply into home or at main shutoff: _
Job Address: _[10 fo lbs -"`J horcy j6c.,1
Residual pressure(flowing)reading at incoming water
City: r °"� supply into home or at main shutoff: l7
State,ZIP: /77-Z-3
What time of day was the flow test taken?
For designs not provided by Uponor,complete the
following information. Flow test method used? 9'6ucket ❑Flow Meter
Flow test gpnt:
Designer's Name:
t'
Company: How many gallons of water did the design predict
as required?
Phone: Did the test meet or exceed design flow? es ❑No
Fax: Which sprinkler did you flow?Number:
Is the warning sign permanently attached close to the Location of head: f
main shutoff valve? Q Yes Ll No
Date left in service with all valves open:
Was this system required by code?0 Yes ❑No
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Test Witnessed and Verified by:
Na e I Sig tur ation �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
Apple Valley,MN 55124 USA Web:www.uponor-usa.com