Report (3) 6/.57 ;'O 1 6oigrlf
uponor
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FIRE SAFETY SYSTEMS
,.. AQUASAFETM FLOW TEST
_,- VERIFICATION
1 FORM
S �' r
AquaSAFETM Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: X(6 L completed form.Failure to do so nullifies the
system warranty.E-mail or fax completed form
Company Name: 1(t' -G€,_ 4 p G .t�
`J to the Uponor Fire Safety Design Department
Contact: &AA IV.. -P“4.4,...-114' at technical.services@uponor.com or 952.997.1731.
`�5 For questions,contact Uponor Technical Services at
Phone: . 888.594.7726 or technical.serviices_@I uponor.com.
Fax: Color of test orifice used: IMC.�1
Job Name: Static pressure(not flowing)reading at incoming
Project Number �TJB tep 00( water supply into home or at main shutoff: 20 ,7
Job Address: 1707/ S✓w Fl";41ati7
Residual pressure(flowing)reading at incoming wat r
City: C14044k.r supply into home or at main shutoff: psi
State,ZIP: Y,
What time of day was the flow test taken? I/tl¢(,.,t
For designs not provided by Uponor,complete the
following information. Flow test method used? Bucket ❑Flow Meter
Flow test gpm: i$
Designer's Name:
How many gallons of water did the design predict
Company:
I as required? t7
Phone: Did the test meet or exceed design flow? %LYes ❑No
Fax: Which sprinkler did you flow? Number: el
Is the warning sign permanently attached close to the Location of head: ✓ 1140--e" r G�/ Can"
main shutoff valve? ❑Yes Ll No
Date left in service with all valves open:
Was this system required by code?❑Yes ❑No
Test Witnessed and Verified by:
Name Signatu e Occupation Date
Additional Explanations and Notes (j U+M;4— .`-1
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01
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Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
s Apple Valley,MN 55124 USA Web:www.uponor-usa.com