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�° '` "" FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
VERIFICATION
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A.quaSAFETM Flow Test Verification Form
Alliance Important Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
Company Name: 'l r system warranty. E-mail or fax completed form
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( to the Uponor Fire Safety Design Department
Contact: I-I Gqii N es, ',Y►zG.S at technical.services@uponor.com or 952.997.1731.
For questions,contact Uponor Technical Services at
Phone: ,) 7 3—q?2_-3 4/2a — ggg S94.7726 or technics!.services@uponor.com.
Fax: ( C.) -- Color of test orifice used: '``m '�'.A >
Job Name: ►2. Static.pressure(not flowing)reading at incoming
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Project Number: water supply into home or at main shutoff: 'S�-,t)
Job Address:
L/q00 5.' It4717
ur " Residual pressure(flowing)reading at incoming water
City: b ,e/1.- supply into home or at main shutoff: 745
State,ZIP: ``;r'7 2 2 "-
What time of day was the flow test taken? r�
For designs no:provided by Uponor, complete the
following information. Flow test method used?dcatucket ❑Flow Meter
Designer's Name: Flow test gprn:� /7
Company: —� Y v How many gallons of water did the design predict
as required? 17
Phone: -------- Did the test meet or exceed design flow? ,'Y/es CI No
Fax: -------- --�-- Which sprinkler did you flow? Number: /�i - 3
n �n is the warning sign perms tly attached close to the Location of head: !, rc� �-
I►tl main shutoff valve? Yes ❑No
/f f ��� Date left in service with all valves open:
Was this system required by code?[y"yes GI No
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Test Witnessed and Verified lam:
id Name I Sin Occupation Date
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Additional Explanations and Notes_____- �._.
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Uponor,Inc. Tel:800.321.4739 v
5925 148th Street West • Fax:952.997.173I
Apple Valley,MN 55124 USA Web:www.uponor-usa.conr
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