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-7 ` ,'. FIRE SAFETY SYSTEMS
i AQUASAFETM FLOW TEST
/ i, a r,.. 41' : VERIFICATION
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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
Company Name: ,i� 0 i r.,vi G O(Pfv AIM .d,,.-
system warranty.E-mail or fax completed form
( to the Uponor Fire Safety Design Department
Contact: j)c rr n tet c� '-'i a 04 6.2s at technical.services@uponor.com or 952.997.1731.
Phone: 56 —��'T 'v �,°Ica _ For questions,contact Uponor Technical Services at
8/38.594.7726 or technical.services@uponor.com.
Fax: __ Color of test orifice used: C'c.�5 5
Job Name: to
1 5 Static.pressure(not flowing)reading at incoming
Project Number: r�) Ip , `16p SL) '`Olr4 o of eater supply into home or at main shutoff:
Job Address: d 15 ei>''� _
-. Residual pressure(flowing)reading at incoming water
City: supply into home or at main shutoff: 76
State,ZIP: 9.72?.j — -r
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What time of day was the flow test taken?
For designs not provided by Uponor, complete the
following information. Flow test methodused? Bucket ❑Flow Meter
Designers Name: Flow test gpm:
How many gallons of water did the design predict
Company: — —-- — as required? 1
Phone: Did the test meet or exceed design flow? 21:Yes U No
Fax: 1t
Which sprinkler did you flow?Number: -4
Is the warning sign permanently attached close to the Location of head:_ i j,- .,✓v%
main shutoff valve? 0 Yes ❑No
Date left in service with all valves open:
Was this system required by code?❑Yes ❑No
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Test Witnessed and Verified :
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Name aj,Occup n Date
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Additional Explanations and Notes ,
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Uponor,Inc. Tel:800.321.4739
5925148th Street West Fax:952.997.1731
LiApple Valley,MN 55124 USA Web:www.uponor-usa.com