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FIRE SAFETY SYSTEMS
` r AQUASAFETM FLOW TEST
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VERIFICATION
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AquaSAFETM Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: pper�,� completed form.Failure to do so nullifies the
Company Name: ea... A 14, system warranty.E-mail or fax completed form
''11 to the Uponor Fire Safety Design Department
Contact: ' at technical.services@uponor.com or 952.997.1731.
Phone: / ry 1 i35 05041
For questions,contact Uponor Technical Services at
888.594.7726 or technical.services@uponor.com.
IFax: (C__ �(�� R Color of test orifice used:
�� Job Name: c3 F/� r`� � Static pressure(not flowing)reading at incom' g t
qq J� Ie /I r 0 water supplySi7
�Z Project Number: k3�/Ce tr W( ���Z1, into home or at main shutoff:
JobAddress:Kr$2'I cokia`c L/)
Residual pressure(flowing)reading at incop�switerr
City: supply into home or at main shutoff: !!.•��
State,ZIP: ZZY
What time of day was the flow test taken? C'.3ve446"
For designs not provided by Uponor,complete the
following information. Flow test method useedd?12 Bucket ❑Flow Meter
Designer's Name: Flow test gpm:
Company: How many gallons gf water did the design predict
as required?
Phone: Did the test meet or exceed design flow?,Yes ❑No
Fax: Which sprinkler did you flow?Number: 1'•'1.4
Is the warning sign permanently attached close to the Location of head:
main shutoff valve? ❑Yes ❑No p —.2Q'�3
Date left in service with all valves open:
Was this system required by code?❑Yes ❑No
Test Witnessed and Verified by:
Nalex Signa re O patio Date
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