Report (3) y)? Si 2b 1 - co/ 6
uponor
4
a FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
VERIFICATION
FORM
AquaSAFETM Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: 2_?dy completed form.Failure to do so nullifies the
system warranty.E-mail or fax completed form
Company Name: 1-t1;tt, .(
�JJ to the Uponor Fire Safety Design Department
Contact: 69-c4/L. " at technical.services@uponor.com or 952.997.1731.
7 For questions,contact Uponor Technical Services at
Phone: b '5— >`7 / � 888.594.7726 or technical.servv�iiyces@uponor.com.
Fax: Color of test orifice used: (/.r'4
Job Name: hi.cr reerr Static pressure(not flowing)reading at incoming
Project Number j¢j$L6 ii. oef water supply into home or at main shutoff: 7a
Job Address: (let f f&4 i✓f _+a.
Residual pressure(flowing)reading at incoming water
City: supply into home or at main shutoff: 60
State,ZIP:
What time of day was the flow test taken? tithe..
For designs not provided by Uponor,complete the
following information. Flow test method used? Bucket ❑Flow Meter
Flow test gpm: /0
Designer's Name:
Company: How many gallons of water did the design predict
as required? 1
Phone. Did the test meet or exceed design flow? ❑Yes ❑No
Fax: Which sprinkler did you flow? Number:
Is the warning sign permanently attached close to the Location of head:1410-likr 06 '
main shutoff valve? ❑Yes ❑No
Date left in service with all valves open
Was this system required by code?❑Yes ❑No
Test Witnessed and Verified by:
Name Sig t re Occupation Date
57
Additional Explanations and Notes f/C i>14-t!f 3 3
LLI
Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com