Report (4) 2L
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FIRE SAFETY SYSTEMS
AQUASAFETm FLOW TEST
Lil-
VERIFICATION
FORM
AquaSAFE' Flow Test Verification Form
Alliance M 2-► a Important Installing contractor must submit this
Member ID: 1 -U7.— completed form.Failure to do so nullifies the
Company Name: WO I toff t]r!! rat system warranty.E-mail or fax completed form
9 to the Uponor Fire Safety Design Department
Contact: CI ire" '30 4.0 man at technical.services@uponor.com or 952.997.1731.
Phone: "(3 3 - (obi -/-1'{3++
For questions,contact Uponor Technical Services at
/�`� J` 1 888.594.7726 or technical.services@uponorcom.
U�/ Fax �7 Color of test orifice used: �GClL
i Job Name: SO1) 1 V�i40( Tt(CAL e Staticpressure(not flowing)reading at incoming
water supplyinto home or at main shutof`r
"�' Project Number. �i lv � R
^p�U' y 5fb3 1- /� , ���
11 Job Address. i�o]vel 51,0 oc 4(Fk �N
1 V -r Residual pressure(flowing)reading at incoming water
City 1 i fd U C supply into home or at main shutoff: � PS.
01/4'11
State,ZIP: Occetyo n , q)2L.2 `qq What time of day was the flow test taken? 31)ri ti4
For designs not provided by Uponor,complete the
following information. Flow test method used? Lli Bucket CI Flow Meter
Designer's Name: Flow test gpm: I 7
Company: How many gallons of water did the design predict
as required?
Phone: Did the test meet or exceed design flow? Et Yes CI Na
Fax: Which sprinkler did you flow? Number.14. 11
Is the warning sign permanently attached close to the Location of head:
main shutoff valve? ❑Yes ❑No -j_�a-13
Date left in service with all valves open:
Was this system required by code?Cl Yes ❑No
N
..
3 Test Witnessed and Verified by: _
s Name Si uOccupati n Date
i -Rini,. &r)b� .1' \ ,414.4., lk0( 7 !D- 23
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Additional Explanations and Notes
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41
g Uponor,Inc Tel:800321.4739
5925148th Street West Fax:952.997.1731
iS Apple Valley,MN 55124 USA Web:www.uponor-usa.com