Report (5) •-ti P M9.
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FIRE SAFETY SYSTEMS
fp/ '' AQUASAFETM FLOW TEST
'rt , VERIFICATION
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,, i FORM
FORM
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AquaSAFEI`t Flow Test Verification Form
Alliance -► Important Installing contractor must submit this
Member ID: 1182_ completed form.Failure to do so nullifies the
/� Company Name: Ldo I COLT ?EOM brat system warranty.E-mail or fax completed form
(}4J"�\ -� to the Uponor Fire Safety Design Department
n\v1 Contact: C I ter 3pu7 p1Gt YI at technicaLservices@uoonor.com or 952.9971731.
Phone: �� - (p b'1 7 For questions,contact Uponor Technical Services at
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888.594.7726 or technicai.services@uoonor.com.
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V Fax: !1 Color of test orifice used: - WLGd<
tJob Name: Sl7V 1\�a�( T ccz P_ Static pressure(not flowing)reading at incomin
Project Number. /-` water supply into home or at main shutoff_ 7
Job Address: I(97i3 Sij Col a fah a W
� City:City: �1 1� G C a
Residual pressure(flowing)reading at incoming water
supply into home or at main shutoff: 110
State,ZIP: c)c a f1. , q 722.4
What time of day was the flow test taken? q CO An
For designs not provided by Uponor,complete the
following information. Flow test method used? 9 Bucket Q Flow Meter
Designer's Name: Flow test gpm' .l
Company: How many gallons of water did the design predict
as required? 1
Phone: Did the test meet or exceed design flow? [XYes 0 No
Fax: Which sprinkler did you flow?Number: H, 1 f
Is the warning sign permanently attached dose to the Location of head:
main shutoff valve? ❑Yes 0 No jQ-23
Date left in service with all valves open: 7
Was this system required by code?0 Yes D No
A' Test Witnessed and Verified by:
Name Si atu Occupati n Date
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1k. Additional Explanations and Notes
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Uponor,Inc Tel:800321.4739
5925 148th Street West Fax:952.997.1731
i Apple Valley,MN 55124 USA Web:wwv,uponor-usa.com