Loading...
Report (2) 1.i Kos '' r _ .,g ¢3 p r 5 „-,,,,,.. , ii UpOf101 ¢ �� FIRE SAFETY SYSTEMS . AQUASAFETM FLOW TEST 4 VERIFICATION FORM 4Y 4€ AquaSAFETM Flow Test Verification Form Alliance Important:Installing contractor must submit this Member ID: completed form.Failure to do so nullifies the ill. rDL ,*( b),� system warranty.E-mail or fax completed form Company Name: /l to the Uponor Fire Safety Design Department Contact: C�� �G Icy at technical.services@uponor.com or 952.997.1731. 'Z3 G[w For questions,contact Uponor Technical Services at Phone: 97 — S J!�" ggg,594.7726 or technical.services@uponor.com. / Fax: Color of test orifice used: (�af` Job Name:S/G`�`"/F'� n / ��r�� Static pressure(not flowing)reading at incomm Project Number: -I 33 16 —c 46.7 R2t r water supply into home or at main shutoff: 65 s 11 . mai Job Address: b *' � o 0 W �. Residual pressure(flowing)reading at incomi water ^Q City: /'.7`"' supply into home or at main shutoff: _. _ V State,ZIP: 0� d� What time of day was the flow test taken? 8i sap /9 For designs not provided by Uponor,complete the following information. Flow test method used? [8'Bucket ❑Flow Meter Designer's Name: Flow test gpm: /7 Company: How many gallons bof water did the design predict as required. 0 1 Phone: Did the test meet or exceed design flow? J�Yes ❑No Fax: _ Which sprinkler didp�you flow?Number: Is the warning sign permanently attached close to the Location of head: 17' ' main shutoff valve? ❑Yes ❑No Date left in service with all valves open: /O .. Was this system required by code?CI Yes ❑No =y Test Witnessed and Verified by: Name ` Signature Occupation Date ra( Alef.°3m Oaf P1 t's%1 /Q�/C 'J 0 © t. Additional Explanations and Notes 5 0 1 Uponor,Inc. Tel:800.321.4739 5925 148th Street MN West Fax:952.997.1731 Apple Valley, 55124 USA Web:www.uponor-usa.com