Report (8) uponor
FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
VERIFICATION
z,,;: s` ,1•,� ,Frf FORM
AquaSAFETM Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: � completed form.Failure to do so nullifies the
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Company Name: Q� r IVW+Wfn system warranty.E-mail or fax completed form
� ,tt to the Uponor Fire Safety Design Department
Contact: Ilan.` 14. at technical.services@uaonor,com or 952.997.1731.
Phone: R11 23S OSo 1 For questions,contact Uponor Technical Services at
888.594.7726 or technical.services@uponor.com.
Fax n ? Color of test orifice used:
Job Name: �(seAL
tit( efr�� Static pressure(not flowing)reading at incomin
Project Number� Ulf f Oat 22 water supply into home or at main shutoff: (05 t
4n3LiN Job Ageri ss� .SW iyo Ln
�5� nn 'V 1 Residual pressure(flowing)reading at incomin water
Z City: lOVI �,/ supply into home or at main shutoff: TZ
State, ZIP: �/ j 322 f
What time of day was the flow test taken? 12•
For designs not provided by Uponor,complete the
following information. Flow test method used? 7013ucket ❑Flow Meter
Designers Name: Flow test gpm: t�
Company: How many gallons of waterdy'd the design predict
as required? I
Phone:
Did the test meet or exceed design flow? JiVes ❑No
Fax: Which sprinkler did you flow?Number 1•1--4s
Is the warning n permanently attached close to the Location of head:
main shutoff valve? ❑Yes ❑No
Date left in service with all valves open: 18
Was this system required by code?❑Yes ❑No
Test Witnessed and Verified by:
Name Si e OLcupation Da e
-41-23
Additional Explanations and Notes
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Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com