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fltl T 24-1- ©fIc,, • UOflO1 * # FIRE SAFETY SYSTEMS ' ` AQUASAFETM FLOW TEST I „` VERIFICATION �.� 1 � k FORM '4 1 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}c n ��t,,h�j i system warranty. E-mail or fax completed form to the Uponor Fire Safety Design Department Contact: PIG,Yl h ta. O Y4AS at technical.services@uponor.com or 952.997.1731. io3- Gl y 9tj For questions.contact Uponor Technical Services at Phone: 888.594.7726 or technical.services@uponor.com. Fax: n ^ Color of test orifice used: 1,3 f S�j Job Name: i i{JTS Static.pressure(not flowing)reading at incomingr^ Project Number: 0I , d, water supply into home or at main shutoff: X,C.7 Job Address: I`I`%D.— 5LJ i it 3 ",4 Residual pressure(flowing)reading at incoming water City: 11.,J' Alci-- supply into home or at main shutoff: 76 State,ZIP: 9 7 2 7 What time of day was the flow test taken? I For designs not provided by Uponor, complete the following information. Flow test methocbused? ,t'Bucket ❑Flow Meter Designer's Name: _ Flow test gpm: IT \ Company: How many gallons of water did the design predict •C..; -- as required? /7 Phone: Did the test meet or exceed design flow? G3 Yes 0 No Fax: — Which sprinkler did you flow? Number: (/ " // Is the warning sign permanently attached close to the Location of head: ,1 1-724.0. main shutoff valve? ❑Yes Cl No Date left in service with all valves open: ffi Was this system required by code?0 Yes 0 N,o ex Test Witnessed and Verified : t . Name Signature-— Occupa Date ` 5 2z s zN 0 Additional Explanations and Notes 0 s, g LL Uponor,Inc. Tel:800.321.4739 / •Z" 5925 148th Street West Fax:952.997.1731 Apple Valley,MN 55124 USA Web:www.upanor-usa.com LL