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: ,.. Vit ' �' l .: FIRE SAFETY SYSTEMS
ilt::,..i3::','1 AQUASAFETM FLOW TEST
VERIFICATION
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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
Pt U Mb tIY'i system warranty.E-mail or fax completed form
Company Name: ,glt,e,�f a cj to the Uponor Fire Safety Design Department
Contact: ts.tq{'_ at technical.services@uponor.com or 952.997.1731.
For questions,contact Uponor Technical Services at
Phone: 888.594.7726 or technical.services@uponor.com.
Fax: Color of test orifice used: �(-GS r'+
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Job Name: Static pressure(not flowing) reading at incomin
Project Number: I-AT I I76 water supply into home or at main shutoff:
Job Address: /Y yO fe 5w g511't 4dg
,,, � Residual pressure(flowing)reading at incoming water
City: L7C-ctler4-0r1 supply into home or at main shutoff: 70
State,ZIP:
What time of day was the flow test taken? tt ,4-M
For designs not provided by Uponor, complete the �
following information. Flow test method used? U Bucket ❑Flow Meter
Designer's Name: Flow test gpm: 11
Company: How many gallons of water did the design predict
as required? 1`l
Phone: Did the test meet or exceed design flow? tices ❑No
Fax: Which sprinkler did you flow? Number: H. Li
ak' _Is the warning sign permanently attached close to the Location of head: -6ctrtm 3
(in%51") main shutoff valve? ❑Yes ❑No
Date left in service with all valves open:
c Was this system required by code?i Yes ❑No
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Test Witnessed and Verified by:
s 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 Fax:952.997.1731
1 Apple Valley,MN 55124 USA Web:www.uponor-usa.com