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FIRE SAFETY SYSTEMS
;£ AQUASAFETM FLOW TEST
s VERIFICATION
s FORM
AquaSAFFr`t Flow Test Verification Form
�� Alliance ^G� Important Installing contractor must submit this
V Member ID: I� _ completed form.Failure to do so nullifies the
system warranty.E-mail or fax completed form
Company Name: WO I car t�f 001 b rst'� to the Uponor Fire Safety Design Department
/�/ Contact: C l ire 30 &e a YI at technicaLservices@uponor.com or 952.997.1731.
^l!' For questions,contact Uponor Technical Services at
/IV1,! Phone: S) 3 - (O 61 -1781 888.594.7726 or technical.services@uponor.com.
e` Far. r� Color of test orifice used: - b1aC.K
Job Name: SOS)t4% "`3pr 1 tte, Static pressure(not flowing)reading at incoming
Project Number: 43'II 3 F 002 at water supply into home or at main shutoff: 4 75"
Job Address: Ib6 83 Sw Co/orud o GO
Residual pressure(flowing)reading at incoming water
City —1-y G t C' supply into home or at main shutoff: it
State,ZIP: C)cedo r 9 ]224
(/ What time of day was the flow test taken? 7 A A h
For designs not provided by Uponor,complete the Flow test method used? Ai Bucket ❑Flow Meter
following information.
Designer's Name: Flow test gpm: /7
How many gallons of water did t�f e design predict
Company. as required? 1
Phone: Did the test meet or exceed design flow? C!Yes ❑No
Fax: Which sprinkler did you flow? Number: ill•11
Is the warning sign permanently attached dose to the Location of head:
main shutoff valve? ❑Yes ❑No �� 2 3
Date left in service with all valves open:
Was this system required by code?❑Yes ❑No
41,
Test Witnessed and Verified by. ,
s Name Si t (}1 I Occupati n Date
1?.ick 6,Ibacc. \ 11om 1 10-23
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' Additional Explanations and Notes
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d Uponor,Inc Tel:800321.4739
5925 148th Street West Fax:952.997.1731
iApple Valley,MN 55124 USA Web:www.uponor-usa.com
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