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M FIRE SAFETY SYSTEMS
' ' AQUASAFETM' FLOW TEST
14,4 VERIFICATION
` • FORM
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a AquaSAFE' Flow Test Verification Form
V-Lq Alliance C� Important:Installing contractor must submit this
-1 Member ID: I _82_ completed form.Failure to do so nullifies the
Company Name: l tjb 1 co it t?i oi,b rrt� hem warranty.E-mail or fax completed form
jLi to the Uponor Fire Safety Design Department
/ 15) Contact: C I fF -ac k.) trio n at technicalservices@uoonor.com or 952.997.173-1.
��� Phone: 6-0 3 - 1. 7 7� chFor questions,contact Uponor Technical Servau:es at
888.594.7726 or tenical.services@uaanor.com.
Fax: 7 Color of test orifice used: • }O1CIC<_
L I Job Name: S h !!ki 30f �e�!e Static pressure(not flowing)reading at incoming
Project Number. 'y 34/63 F 003 e1 water supply into home or at main shutoff. 7'
Job Address: 16677 SiJ rob(A A 1.4
Residual pressure(flowing)reading at incoming water
City: j tt G r Ot supply into home or at main shutoff: (I/v)
State,ZIP: (XPr ( . 1 9 12z4
What time of day was the flow test taken? e
For designs not provided by Uponor,complete the
following information. Flow test method used? 0 Bucket 0 Flow Meter
Designer's Name: Flow test gpm: 7
Company; How many gallons of water did the design predict
as required? / 7
Phone: Did the test meet or exceed design flow? ii Yes Q No
Fax: Which sprinkler did you flow?Number: N. II
Is the warning sign permanently attached dose to the Location of head:
main shutoff valve? ❑Yes 0 No
Date left in service with all valves open: 7-A0-23
Was this system required by code?I]Yes ❑No
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.t Test Witnessed and Verified by: r
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s Name Si ` u ,, �OccruJpa micna rDate
T,ck &‘1bb-T 1 10- 23
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pAdditional Explanations and Notes
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i Uponor,Inc Tel 800321.4739
5925 148th Street West Fax:952.997.1731
I Apple Valley,MN 55124 USA Web:www.uponor-usa.com