Report (9) v 2 _'
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- FIRE SAFETY SYSTEMS
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t ; AQUASAFET"" FLOW TEST
;, VERIFICATION
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3 ''" FORM
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AquaSAFE' Flow Test Verification Form
Alliance -► p Important Installing contractor must submit this
Member ID: ) [_(1_ completed form.Failure to do so nullifies the
4 Company Name: ttl0 wit t�i urn b rrt� system warranty.E-mail or fax completed form
4 to the Uponor Ere Safety Design Department
Contact: C I t({ 3O La Ma n at tedinicalservices@uaonor.com or 952997.1731.
Phone: SU lobs - 7fj For questions,contact Uponor Technical Services at
f + 888.594.7726 or technical.services@uponor.com.
�J Fax: Color of test orifice used: - U(
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VU Job Name: �17UI"A 1 r�\s 3Q( Ttra1(P Static pressure(not flowing)reading at incomin
/ Project Number. 434 L 3 i 00'3 K.( water supply into home or at main shutoff: lb
4\_✓\ Job Address: 1Io721 SOCo1orack / AI
Residual pressure(flowing)reading at incoming water
V�1" City: .1 i Ca f supply into home or at main shutoff: 90
State,ZIP: Oce1c O R r ci i z2.4
V What time of day was the flow test taken? 9!-la Ail
For designs not provided by Uponor,complete the
following information. Flow test method used? 4Bucket El Flow Meter
Designer's Name: Flow test gpm: / 7
Coma How many gallons of water dig the design predict
pmY as required? /
Phone: Did the test meet or exceed design flow? LYes Q No
Fax: Which sprinkler did you flow? Number: (-4• ii
Is the warning sign permanently attached dose to the Location of head:
main shutoff valve? ❑Yes ❑No
Date left in service with all valves open: 7"/0 -23
Was this system required by code?Cl Yes 0 No
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nessed tnessed and Verified by:
Name Si Occupation Date
,u ��( � ���' ik000 1 i0-23
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Additional Explanations and Notes
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Uponor,Inc. Tel:800321.4739
z 5925148th Street West Fax 952.997.1731
1 Apple Valley,MN 55124 USA Web:www.uponor-usa.com