Report (6) .
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FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST;-.''::' .4.-.!,,1,:.1...• . ,. . .., . .k-7 '
VERIFICATION
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FORM
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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
/.. (....)) it)i-tioytiotc: ..„A.. .. . system warranty. E-mail or fax completed form
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Company Name:k....-
to the Uponor Fire Safety Design Department
Contact:,Sri''c i.i i -$7:)'1/401:j(<it-- at technical.services@uponor.com or 952.997.1731.
Phone: ,:47:1137—,24:2 -l Lin For questions,contact Uponor Technical Services at
888.594.7726 or technical.services@uponor.com.
Fax:
Color of test orifice used:
Job Name: eosit tot t Static pressure(not flowing)reading at incoming
Project Number: water supply into home or at main shutoff:Job Address: 1(01/941 50 DcwithYt Li
Residual pressure(flowing)reading at incoming water
City: eril *1 supply into home or at main shutoff: *it
State,ZIP: e)
What time of day was the flow test taken? "944'1
For designs not provided by Uponor, complete the
following information. Flow test method used? l:11 Bucket CI Flow Meter
Designers Name: Flow test gpm: )1
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How many gallons of water did the design predict
Company:
as required? 1—I
Phone:
Did the test meet or exceed design flow? Va Yes Cl No
Fax:
Which sprinkler did you flow?Number:
Is the warning sign permanently attached close to the Location of head:
rk-t-tiltrkSI'l --11---i. main shutoff valve? CI Yes D No
Date left in service with all valves open:
Was this system required by code?0 Yes 0 No
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Test Witnessed and Verified by:
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Name Sign ure
/ 4Ll Occupation.)<r 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:vwvw.uponor-usa.com
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