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t f A UASAFETM FLOW TEST
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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
t ' N �l t.'rM b s h system warranty. E-mail or fax completed form
CAN
Company Name: ® g to the Uponor Fire Safety Design Department
Contact: kits.In A LA. /,(Oft C.-S at technical.services@uponor.com or 952.997.1731.
�— For quest , ct al at
Phone: 49 03 -(1S'2 3�f PLC ) gag 594.7726 ions or
conta technicalUponor.services@upTechniconor.comServices.
Fax:
(� Color of test orifice used: "5(6.SS
Job Name: \ ) ,.'" Static.pressure(not flowing)reading at incoming
Project Number: water supply into home or at main shutoff:
Job Address: f L-�1 5_)1'o hcUcll,.c 54-
PP Residual pressure(flowing) reading at incoming water
City: I 0/ 6-4 supply into home or at main shutoff: —7t5
State,ZIP: Ci.•7y"73
What time of day was the flow test taken? i ertt-•
For designs not provided by Uponor,complete the
following information. Flow test method-:used? ,-f:ucket 0 Flow Meter
Designers Name: Flow test gpm: \
Company: How many gallons of water did the design predict
.. as required? I e
Phone: Did the test meet or exceed design flow?2'es 0 No�
Fax: — Which sprinkler did you flow?Number: / - 4`7/
/_
Is the warning sign permanently attached close to the Location of head: i .e 1ur�,n., is //%�.5Y•',
main shutoff valve? 0 Yes 0 No
Date left in service with all valves open:
Was this system required by code?0 Yes LI No
g
Test Witnessed and Verified :
Name Signati -- Occupation Date
a
0 •
o
70
Additional Explanations and Notes —_ ,
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i' Uponor,Inc. Tel:800.321.4739 r
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com
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