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y� FIRE SAFETY SYSTEMS
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:� ti° x _ AQUASAFET"' FLOW TEST
, 7 .0? 4 VERIFICATION
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} ' �`� ' ,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
Company Name: I,,///All d 4-1 -i•' la r _ system warranty.E-mail or fax completed form
to the Uponor Fire Safety Design Department
Contact: /L N 1?ito.. '7 0 Vie,.-S at technical.services@uponor.com or 952.997.1731.
Phone: L) `� ` '" > For questions,contact Uponor Technical Services at
—' �s ., 888.594.7726 or technical.services@uponor.com.
Fax:
Color of test orifice used: �.3 rf'i;' `'>
Job Name £ it)7 Static.pressure(not flowing) reading at incoming
Project Number: 34 4/ Y oa 7 water supply into home or at main shutoff: a�c'Z..)
Job Address: CG 25� ; ...�� e.,.® /�� i
/ , —T" Residual pressure(flowing)reading at incoming water
City: / 1 2:' ,.
f _ _ supply into home or at main shutoff: '76
State,ZIP: ' 7-7 ?' —
What time of day was the flow test taken? �,���
For designs not provided by Uponor, complete the
following information. Flow test method used? Bucket ❑Flow Meter
Designers Name: _ Flow test gpm )7 ♦ _ \
Company: How many gallons of water did the design predict
,i' �— as required? j 7
Phone:
Did the test meet or exceed design flow? Q Yes ❑No
Fax: d'
Which sprinkler did you flow?Number: delf
Is the warning sign permanently attached close to the ` 3
4 Location of head:_ _ rj'°e�.raw,rv,
5 L main shutoff valve? C]Yes ❑No
r Date left in service with all valves open:
N
Was this system required by code?C�''es 0 N.o
s Test Witnessed and Verified :
Name Signature Occupation Date
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Additional Explanations and Notes
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Uponor,Inc. Tel:800.321.4739
5925 148th Street West c 7
Fax:952.9J 173 i
r Apple Valley,MN 55124 USA Web:www.upanor-usa.com