Report (3) . "..5i,i: ,,,:. 459 kiL(' 5-L“ 5
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ii,. ~ , FIRE SAFETY SYSTEMS
AQUASAFE'rm FLOW TEST
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, VERIFICATION
FORM
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AquaS.A.FETM Flow Test Verification Form
Affiance Important:Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
Company Name: 4. 1 G✓/(�L (�Nt�y system warranty.E-•mall or fax completed form
to the Uponor Fire Safety Design Department
Contact: P,tg1 IN clkek end` G€ at technical.services@uponor,com or 952.997.1731.
For questions,contact Uponor'Fechnical Services at
Phone: So 3- a/2 -3 tl 90 888.594.T/26 or technical.services@uponor.com.
Fax: \ Color of test orifice used: . (r..s2 �_
�7 _
Job Name: ��ne"g L Static pressure(not flowing)reading at incomin
Project Number water supply into home or at main shutoff: — e
Job Address: 16L'Z$L SvVLSL11► . (r7c.41. 5 f i
RResidua pressure(flowing)reading at incoming water
City: "ir f�(�� supply into home or at main shutoff: '70
State,ZIP: ilvii
/
What time of day was the flaw test taken? /0' 30
For designs not provided by Uponor,complete the
following information. Flow test method used?Al Bucket O Flow Meter
Designer's Name: Flow test gpm:
Company: How many gallons of water did the design predict
as required? / 7
Phone: Did the test meet or exceed design flow? Al
Yes ❑No
Fax: Which sprinkler did you flow?Number:be i ,
O„ Is the warning sign permanently attached close to the Location of head: /I'�Cs1 rf1
74-1- 1 wick main shutoff valve? 0 Yes Sf No
S Date left in service with all valves open:
as this system required by code?53 Yes ❑No
8
Test Witnessed and Verified by:
Nae Si e _ Occup. Date
1 it I )uCtc44.ar-u ` `� 10 25-721
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Additional Explanations and Notes
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gj Uponor,Inc. Tel:800.321.4739
' 5925 148th Street West Fax:952.997.1731
1 Apple Valley,MN 55124 USA Web:www.uponor-usa.com