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' t ' �` FIRE SAFETY SYSTEMS
' 1, ' k t - AQUASAFETM FLOW TEST
} t VERIFICATION
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AquaSAFETM Flow Test Verification Form
Alliance Important Installing contractor must submit this
Member ID: J / completed form. Failure to do so nullifies the
Company Name: di(Jt AnrY. '��t,,yy r system warranty.E-mail or fax completed form
,/ to the Uponor Fire Safety Design Department
Contact: //A III 11 Lou `"/ 1f1,.e,.-S, _ at technical.services@uponor.com or 952.997.1731.
Phone: C).�- `f ;,..?� For questions,contact Uponor Technical Services at
-- 888.594.7726 or technical.services@uponor.com.
Fax: — Color of test orifice used: Cr;fy
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Job Name ( Static.pressure(not flowing)reading at incpmin
Project Number: 35e9 Doc e>o 7 water supply into home or at main shutoff: Ye.....)
Job Address: t tot. It 'Q
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I Residual pressure(flowing) reading at incoming water
City: f I j�l* -' supply into home or at main shutoff: f.76
State,ZIP: 'Y 7":" * 3' —
What time of day was the flow test taken? I g'�a
For designs not provided by Uponor, complete the };,.
following information. Flow test method:.used? rl'I�8ucket 0 Flow Meter
Designer's Name: _ Flow test gpm: \
Company: How many gallons of water did the design predict
•i — as required?
Phone:
- Did the test meet or exceed design flow? Cll Yes ❑No
Fax:
Which sprinkler did you flow?Number: 1/ (
OP Is the warning sign permanently attached close to the ` (.�v, ,. `�_/
k el main shutoff valve? 0 Yes ❑No Location of head:_ "; _ �Glr..
Date left in service with all valves open:
g Was this system required by code? Yes 0 No
61
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. Test Witnessed and Verified :
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Name Signature cu a oq Date
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Additional Explanations and Notes
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Uponor,Inc. Tel:800.321.4739 /
5925 148th Street West Fax:952.997.1731
i Apple Valley,MN 55124 USA Web:www.uponor-usa.com