Report (4) •' .
UpOf101
„ „„,. ,, ,, .. , :,k",. „.,.... ,,„ 2 s.:____,,... .„.,t.i, , , - •• „,, - .. „ ,
AI ,
, ,,;„,:, .. -, _ 4, , , , . , „ , , • /11.cr,, t.,, 1 - 0 0 ,-4 2'7
FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
VERIFICATION
w
G
FORM
AquaSAFETM Flow Test Verification Form
Alliance Important Installing contractor must submit this
Member ID: f completed form.Failure to do so nullifies the
Company Name: i d 1 I CA-0 Z� /!tA.yvt b r system warranty. E-mail or fax completed form
r 5 to the Uponor Fire Safety Design Department
Contact: (41 G in A itet.. 10p2 G `) at technical.services@uponor.com or 952.997.1731.
J�v� _ r 3 �� For questions,contact Uponor Technical Services at
Phone: 888.594.7726 or technical.services@uponor.com.
Fax: Color of test orifice used: (C,.S3
Job Name: \`- D IS Static.pressure(not flowing) reading at incoming
Project Number: water supply into home or at main shutoff: 6
`Job Address: 1 �IgW S �L1U1r15Jr VIe_54-
�Jc ✓� Residual pressure(flowing)reading at incoming ater
City: 1n J supply into home or at main shutoff:
State,ZIP: `it,727
What time of day was the flow test taken? 1 tr
For designs not provided by Uponor,complete the
following information. Flow test method•:used? f:ucket ❑Flow Meter
Designer's Name: Flow test gpm:
Company: How many gallons of water did the design predict
as required? 4 7
Phone: Did the test meet or exceed design flow?ADYes ❑No
Fax: -- Which sprinkler did you flow? Number: i -/,5 f
Is the warning sign permanently attached close to the Location of head: ,.,1�,�,..., �"/GSf4Y
main shutoff valve? 0 Yes ❑No
Date left in service with all valves open:
Was this system required by code?C3 Yes U No
11
Test Witnessed and Verified y:
2
Name Signatu Occupation Dat^e�
f�` � Cr cr r l��i _27_
o
0
0.
o ,
o
ry
Additional Explanations and Notes ,
0
iUponor,Inc. Tel:800.321.4739 0
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com
LL
I
LL