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, uponor
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"'� „r ir '' �` FIRE SAFETY SYSTEMS
;t ' Y.j ': r ; • - AQUASAFETM FLOW TEST
• VERIFICATION
1 =.FORM
r ,er 7, :, •
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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: ff f I I}Ael r ' ��lt,,,M 1j i j(; system warranty.E-mail or fax completed form
a` to the Uponor Fire Safety Design Department
Contact: l it41111 laic `` 0 di••‘.,-$ at technical.services@uponor.com or 952.997.1731.
c- y�� For questions,contact Uponor Technical Services at
Phone: , 03 / , ;2? Z. t 3
13238.594.772E or tachnical.services@uponor.com.
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Fax: — Color of test orifice used: 15(C:4)t)
Job Name: r — Static.pressure(not flowing)reading at incoming,,
Project Number: 3c4/F tip'7 /I water supply into home or at main shutoff: °aC e.:,
Job Address: got, 09 .S(.✓ OtC44/le,,`..•�
,, , ®i Residual pressure(flowing)reading at incoming water
City: / a�G•l supply into home or at main shutoff: .J' ,
State,ZIP: 51 7 2"2 ---
What time of day was the flow test taken? 1
For designs not provided by Uponor, complete the
following information. Flow test methodoused? 'Bucket CIFlow Meter
Flow test gp
Designers Name: m:J 7
Company: How many gallons of water did the design predict
Phone:
t --- as required? /7
—'� Did the test meet or exceed design flow? Gj Yes ❑No
Fax: Which sprinkler'did you flow?Number: 1 Off C
Ylva($\ - Is the warning sign permanently attached dose to the Location of head: a r d ct 3
main shutoff valve? 0 Yes ❑No
Date left in service with all valves open:
g Was this system required by code?ales ❑No
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Test Witnessed and Verified :
Name f Signature___ Occupatio Date-
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Additional Explanations and Notes
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g Uponor,Inc. Tel:800.321.4739
t 5925148th Street West Fax:952.997.1731
i; Apple Valley,MN 55124 USA Web:www.upanor-usa.com
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