Report (5) ..; '.' ' ., 41.
uponor
...,
.,
,
,,,,,,
, , .
FIRE SAFETY SYSTEMS
:,,,1•i! of4+i-,„.....- . -.. ' . .'::: ",, •..
.,..s. ...1'.. 4,.-F.Y•-.,;:,;, .. . , .....';'-:-:- - .•
-••,, ..,,ii--0-....,,i,,dt',,,--3 - ,--•.%'. : ..,..,:i,,,l' AQUASAFETM FLOW TEST
:f','-.,- .:-.4:.:,',••1,.,,,.i4p.',,,,:c •.,rf. • :.,--,.-.*:•,','4'A',. ' VERIFICATION
FORM - - -
--
?i.4,;;•:'‘‘..<.-11:1:.4 ::.;::-:::11:4'-''
AquaSAFETM Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
Company Name:6.7..t--.1'i V il./i„%a9i,ek.ii —I- 4:-—4.: system warranty. E-mail or fax completed form
,i t to the Uponor Fire Safety Design Department
Contact:e..)-1-rc'kit -11-Z,;',06.t<ui--- at technical.services@uponor.com or 952.997.1731.
Phone: ,.I;: ;?:.'3--,-‘4,i=1::' -i LA i—1 For questions,contact Uponor Technical Services at
888.594.7726 or technicalservices@uponor.com.
--i ,
Fax: t fit"5,5
Color of test orifice used:
Job Name: ebs-A,,..1( Static pressure(not flowing)reading at incoming
Project Number: /4p1 30 cSIA) 17040 Al t—Itater supply into home or at main shutoff: 0 C.
Job Address:
, .0-1—• teed Residual pressure(flowing) reading at incoming water
City: /II supply into home or at main shutoff: -)t.
State, ZIP: ,e)r
What time of day was the flow test taken?
For designs not provided by Uponor, complete the
following information. Flow test method used? LN Bucket L.1 Flow Meter
Designers Name: Flow test gpm: i-1
'
How many gallons of water diclie design predict
Company:
as required?
Phone:
Did the test meet or exceed design flow? lei Yes Li No
Fax:
Which sprinkler did you flow?Number:
Is the warning sign permanently attached close to the Location of head:
main shutoff valve? CI Yes D No
Date left in service with all valves open:
Was this system required by code?J Yes CI No
Ir..,
iv,„..°..
Test Witnessed and Verified by:
Name Sign ure 41.440( Occupation Date
.
\\ _,. .._
"C:1-1-e ?' -i'i,-i t:.(2_ ri-
-----k-t-.......k;
(?...- --kz..
0
N'
(V)
Additional Explanations and Notes
e,-
.-.,
fC,
t
Uponor,Inc. Tel:800.321.4739
.'s
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com
LLI