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FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
t z VERIFICATION
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FORM
.Aqua.S ETM Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
.� system warranty.E-mail or fax completed form
Company Name: %k ? �tis �iDi°� Sc,„‹
p to the Uponor Fire Safety Design Department
Contact:c �`u g -'�Z ' t4 i-- at technical.services@uponor.com or 952.997.1731.
Phone:
.a ,cI _9 C i- For questions,contact Uponor Technical Services at
888.594.7726 or technical.services@uponor.com.
Fax:
Color of test orifice used:
Job Name: Static pressure(not flowing) reading at incoming e
Project Number: �R � water supply into home or at main shutoff: G"
Job Address: 141 2.y aul a MILO 44. 110.
e Residual pressure(flowing) reading at incoming water
City: supply into home or at main shutoff: 41
State,ZIP: De.
What time of day was the flow test taken? 4411
For designs not provided by Uponor, complete the
following information. Flow test method used? Bucket 0 Flow Meter
Flow test gpm:
Designer's Name:
Company: How many gallons of water di.L4,e. design predict
as required? r
Phone: Did the test meet or exceed design flow? `i]Yes J No
Fax: Which sprinkler did you flow? Number:
Is the warning sign permanently attached close to the Location of head:
O-- ftkS t1 -==' main shutoff valve? ❑Yes '0 No
Date left in service with all valves open:
Was this system required by code?0 Yes ❑No
Test Witnessed and Verified by:
Name Sig ture 14444 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
Apple Valley,MN 55124 USA Web:wwnw.uponor-usa.com
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