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°- FIRE SAFETY SYSTEMS
�: � AQUASAFE' FLOW TEST
VERIFICATION
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FORM
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AquaSAFETM Flow Test Verification Form
Alliance Important Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
I`' system warranty.E-mail or fax completed form
Company Name: { )G,r4L� u d„ �►^' to the Uponor Fire Safety Design Department
Contact: /if
✓t iren % 004.11j at technical.services@uponor.com or 952.997.1731.
/ For questions,contact Uponor'Fechnical Services at
S C Phone: , '7
- 9 Z -3 V cb 888.594.7726 or technicalservices@uponor.com.
Fax: Color of test orifice used: Or%..6j
Job Name: LL Static pressure(not flowing)reading at incoming
Project Number: Lirf S S water supply into home or at main shutoff: 4
Job Address: I ye, 5 ) Su, I,4N., /��.f fi 4-/
_ Residual pressure(flowing)reading at incoming water
City: 9[-f a supply into home or at main shutoff: ,b
State,ZIP: fsr
What time of day was the flow test taken? Jo;5 `a
For designs not provided by Uponor,complete the
following information. Flow test method used?9 Bucket ❑Flow Meter
Designer's Name: Flow test gpm:
Company: How many gallons of w er did the design predict
as required? /i
Phone: Did the test meet or exceed design flow? 0 es ❑ o
Fax: Which sprinkler did you flow? umber: H-
Is the warning sign permanently attached close to the Location of head: 4 / e.J.__
main shutoff valve? ❑Yes 0 No
Date left in service with all valves open:
Was this system required by code?0 Yes 0 No
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Test Witnessed and Verified by:
NT�`e� 'l't
Sign ure Occupation Date
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gi Uponor,Inc. Tel 800.321,4739
t 5925 148th Street West Fax:952.997.1731
1 Apple Valley,MN 55124 USA Web:www.uponor-usa.com
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