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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
ff system warranty.E-mail or fax completed form
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Company Name: /4 fI (r.vtLtPttAft.%I..
( to the Uponor Fire Safety Design Department
Contact: f)Un VI is e.. �®yM-G.S at technical.services@uponor.com or 952.997.1731.
Phone: `�j-� -�q�, �� ��Za _ For questions,contact Uponor Technical Services at
888.594.7726 or technicalservices@uponor.com.
Fax: `�-
— Color of test orifice used: �-= t`C.,..5 5
Job Name: ._ Static.pressure(not flowing)reading at incoming
t 1
Project Number: f f water supply into home or at main shutoff:
Job Address: - 1 h b 2/5 Su/ Io1 ntt-e-� '
Residual pressure(flowing)reading at incoming water
City: / I/c 'J_ supply into home or at main shutoff: 76
State,ZIP: 972 2J - 0 ?✓t
What time of day was the flow test taken?
For designs not provided by Uponor,complete the
following information. Flow test methodused?,lucket ❑Flow Meter
Designer's Name:
Flow test gpm:
Company: _ -- How many gallons of water did the design predict
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as required? 1 7
Phone: - Did the test meet or exceed design flow? a,Yes ❑No
Fax: /mot
-•--_---- Which sprinkler did you flow?Number: - ei
Is the warning sign permanently attached close to the Location of head:
main shutoff valve? 0 Yes 0 No
Date left in service with all valves open:
Was this system required by code?0 Yes ❑N,o
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Test Witnessed and Verified by:
Name .Si ur Occupy n Date
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2' Additional Explanations and Notes ,
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E.
Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.173I
1 Apple Valley,MN 55124 USA Web:www.uponor-usa.com
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