Report (3) `, MST2o,2/ - Q o 1 i7
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FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
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'; VERIFICATION
FORM
AquaSAFETM Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: 17 e n completed form.Failure to do so nullifies the
Company Name: All ,eA 4 CC l"I U M 61 system warranty.E-mail or fax completed form
to the Uponor Fire Safety Design Department
Contact: Nocte at technical.services@uponor.com or 952.997.1731.
For questions,contact Uponor Technical Services at
Phone: 888.594.7726 or technical.seervices@uponor.com.
Fax: Color of test orifice used: 6rA55
Job Name: Static pressure(not flowing)reading at incoming
Project Number: L.of- a17 awater supply into home or at main shutoff: "5O
Job Address: IYyO A 5w (65 ,kJr
/ Residual pressure(flowing)reading at incoming water
City: �Pet-ter r. supply into home or at main shutoff: 10
State,ZIP:
What time of day was the flow test taken? I I A Jh
For designs not provided by Uponor, complete the
following information. Flow test method used? 01 Bucket ❑Flow Meter
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Designers Name: Flow test gpm: �1
How many gallons of water did the design predict
Company:
as required? ri
Phone: Did the test meet or exceed design flow? AO Yes ❑No
Fax: Which sprinkler did you flow? Number: µ. 1
Is the warning sign permanently attached close to the Location of head: "idrM 2.
a_(`,r,.sSes, main shutoff valve? ❑Yes ❑No
Date left in service with all valves open:
Was this system required by code? Yes ❑No
Test Witnessed and Verified by:
Name Signature
Occupation Date
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Additional Explanations and Notes
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q. Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
s Apple Valley,MN 55124 USA Web:www.uponor-usa.com