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FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
VERIFICATION
FORM
AquaSAFE' Flow Test Verification Form
Alliance -� Q Important Installing contractor must submit this
Member ID: 12 82_ completed form.Failure to do so nullifies the
`Al Company Name: UA)O I CotT k rn bin� system warranty.E-mail or fax completed form
�` to the Uponor Fire Safety Design Department
Contact: (- I t F{ 30L.4) Mot n at techniraiservices@uponor.com or 952.997.1731.
Phone: �'O 3 - (obi -17$ For questions,contact Uponor Technical Services at
_ I 888.594.7726 or technicaLservices@uponor.com.—
Au V Fax: Color of test orifice used: WACJrL
A Job Name: r,SDO I\6P( TECCCICC. Static pressure(not flowing)reading at incoming
//11�J Project Number. 1439 r0 F 00 i (\ water supply into home or at main shutoff: 7��5
{„2 Job Address: Ali5 Su) (oloRado (A
) .�' Residual pressure(flowing)reading at incoming water
�` City 1 1 Qf CA supply into home or at main shutoff: IIo
State,ZIP: C)C90 O. , 9/ZZ4
(/ What time of day was the flow test taken? 7%CO 19M
For designs not provided by Uponor,complete the
fallowing information. Flow test method used? IV Bucket CIFlow Meter
Designer's Name: Flow test gpm: J
Now many gallons of water did the design predict
Company: as required? I7
Phone: Did the test meet or exceed design flow? 10 Yes Cl No
Fax: Which sprinkler did you flow?Number: H.II
Is the warning sign permanently attached dose to the Location of head:
main shutoff valve? CI Yes LI No -��_
Date left in service with all valves open: 2,3
Was this system required by code?CI Yes ❑No
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Test Witnessed and Verified by:
Name Si u ' (1r l v m 1Da (�_Z3
`- tck GPI bast 11
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Additional Explanations and Notes
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gl Uponor,Inc Tel:800.321.4739
e 5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com
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