Report (3) : . 5. T 0 2.2 ) - OO1 I
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uponor
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' it , � i• '" FIRE SAFETY SYSTEMS
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.��� _ AQUASAFETM FLOW TEST
VERIFICATION
r FORM
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AquaSAFETM Flow Test Verification Form
Alliance Important Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
I CA-0a h system warranty.E-mail or fax completed form
Company Name: r �( b 5 to the Uponor Fire Safety Design Department
Contact: la 4 Irt 4� -/ OWL G-S at technical.services@uponor.com or 952.997.1731.
s I For questions,contact Uponor Technical Services at
Phone: �C�3 -"[�? �t— 888.594.7726 or technical.services@uponor.com.
Fax: Color of test orifice used: irbi-erSS
Job Name: \24:3 iS Static.pressure(not flowing)reading at incoming
Project Number: // water supply into home or at main shutoff:
Job Address: '``73 W 1 ,s Y iU. _ `
�'J Residual pressure(flowing)reading at incoming water
City: / 9 e-il supply into home or at main shutoff: le,
State,ZIP: q,727
What time of day was the flow test taken? 1
For designs not provided by Uponor, complete the
Flow test metho&used? krf:ucket CJ Flow Meter
following information. 07i
Designer's Name: Flow test gpm:
How many gallons of water did the design predict
Company: _.
, as required? i1 .;k
Phone: — --- Did the test meet or exceed design flow?Ain'es CI No
Fax: Which sprinkler did you flow?e Number: f'i/ - 9Is the warning sign perman tly attached close to the Location of head: !".d.vrle2" a
Pr1f'i,v main shutoff valve? Yes LI No
Date left in service with all valves open:
Was this system required by code Yes Li No
Test Witnessed and Verified :
Name i 1 Signatu Occupation Date
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0. Additional Explanations and Notes __
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Uponor,Inc. Tel:800.321.4739 of
5925 148th Street West Fax:952.997.1731
g Apple Valley,MN 55124 USA Web:www.uponor-usa.com