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FIRE SAFETY SYSTEMS
€ AQUASAFETM FLOW TEST
VERIFICATION
FORM
AquaSAFE'M Flow Test Verification Form
Alliance 0,1 Important:Installing contractor must submit this
Member ID: /4 41 completed form.Failure to do so nullifies the
Company Name: //(A L( . Vtk. system warranty.E-mail or fax completed form
to the Uponor Fire Safety Design Department
Contact: 6041:AA, at technical.services@uponor.com or 952.997.1731.
` For questions,contact Uponor Technical Services at
Phone: 3 —S 7 7`—b S 888.594.7726 or technical.services@uponor.com.
Fax: Color of test orifice used: gezi
Job Name. + er 6.fi G. Static pressure(not flowing)reading at incoming
Project Number 3, (c POtexf water supply into home or at main shutoff: f
Job Address: i7.o 4q .s_r zLs
f Residual pressure(flowing)reading at incoming water
City: supply into home or at main shutoff: b ' l
State,ZIP:
What time of day was the flow test taken? ffiftiA
For designs not provided by Uponor,complete the
following information. Flow test method used? ,Bucket U Flow Meter
Flow test gpm: /
Designer's Name:
How many gallons of water did the design predict
Company:
as required? j 7
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: v11dl-4-/` 11.414 s..
main shutoff valve? ❑Yes U No
Date left in service with all valves open:
Was this system required by code?U Yes ❑No
Test Witnessed and Verified by:
Name Signature Occupation Date
Additional Explanations and Notes ("2C0 (911 (— ,
Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax 952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com