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FIRE SAFETY SYSTEMS
� � 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
Company Name: C system warranty.Email or fax completed form
6 tdA ` °v� : S to the Uponor Fire Safety Design Department
Contact:cTf,u L �u �G at technicalservices@uponor.com or 952.997.1731.
�., , _ , . •L For questions,contact Uponor Technical Services at
Phone: 888.594.7726 or technicalservices@uponor.com.
Fax:
Color of test orifice used:
Job Name: Static pressure(not flowing)reading at incoming
Project Number: !Qp$�1�� water supply into home or at main shutoff:
Job Address: / (7Ii.. c5U' O'�U��l �P
/ j ' Residual pressure(flowing)reading at incoming water
City: r r7 '4 supply into home or at main shutoff: "7 3
State,ZIP: OR -
What time of day was the flow test taken? 161- �
For designs not provided by Uponor, complete the
following information. Flow test method used? Bucket ❑Flow Meter
Flow test gpm:
Designer's Name:
Company: How many gallons of water did the design predict
Phone:
as required?
Did the test meet or exceed design flow? ` I Yes ❑No
Fax: Which sprinkler did you flow? Number:
Is the warning sign permanently attached close to the Location of head:
AkSil l' main shutoff valve? ❑Yes ❑No
Date left in service with all valves open:
Was this system required by code?❑Yes ❑No
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Test Witnessed and Verified by:
Name Sign tore 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
i Apple Valley,MN 55124 USA Web:www.uponor-usa.com
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