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uponor
'1'` #..t \ o• FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
VERIFICATION
,,,. :. ; FORM
AquaSAFETM Flow Test Verification Form
Alliance Important Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
Company Name: l I G N Z,G �'(.c Wt b,h system warranty.E-mail or fax completed form
g to the Uponor Fire Safety Design Department
Contact: 44 in A Let. lOr2 4-5 at technical.services@uponor.com or 952.997.1731.
3 r For questions,contact Uponor Technical Services at
Phone: 50 _44 u 888.594.7726 or technicalservices@uponor.com.
Fax: Color of test orifice used: "516.53
Job Name: \`-�j 4:3I IS Static.pressure(not flowing)reading at incoming
i
Project Number: water supply into home or at main shutoff:
Job Address: 1 4 q t1 5 1oL (IUt'c -
- -
Residual pressure(flowing)reading at incoming water
City: 1 /9 L4 supply into home or at main shutoff: ?e5
State,ZIP: 9++'7Z?3
What time of day was the flow test taken? 1
For designs not provided by Uponor,complete the
Flow test method,used? ''f:ucket Li Flow Meter
following information.
Flow test gpm:
Designer's Name:
Company: How many gallons of water did the design predict
i' as required? 0 7
Phone: --- Did the test meet or exceed design flow?AINes No
Fax: — Which sprinkler did you flow?Number: - / /
Is the warning sign permanently attached close to the Location of head: I;e,,t!rn.r.., arWe,5,fa't'
main shutoff valve? 0 Yes ❑No
Date left in service with all valves open:
Was this system required by code?®Yes ❑N,o
Test Witnessed and Verified y:
E Name Signatu Occupation Date
` i JA./ L G( c l 1 ®4. - 'J.-P
a 0 3 2�
N
3
0
Additional Explanations and Notes
Uponor,Inc. Tel:800.321.4739 /
z v 5925 148th Street West Fax:952.997.1731
1 Apple Valley,MN 55124 USA Web:www.uponor-usa.com
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