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2 . . . FIRE SAFETY SYSTEMS
( r - AQUASAFETM FLOW TEST
'* ' /it- ..,14, P ' VERIFICATION
FORM
AquaSAFETM Flow Test Verification Form
Alliance Important:Installing contractor must submit this
i
Member ID: 2,S Z completed form.Failure to do so nullifies the
o1c®`, C J��1 0 system warranty.E-mail or fax completed form
Company Name: to the Uponor Fire Safety Design Department
Contact: Gaff ' 0`Z)t"LC11 at technical.services@uponor.com or 952.997.1731.
b3 ��' For questions,contact Uponor Technical Services at
Phone: 888.594.7726 or technical.services@uponor.com.
Fax: � GC.1�
"..?..,der Color of test orifice used: 1
Job Name: {JQ 3'W' �*-SC4C? Static pressure(not flowing)reading at incoming
Project Number: L/3 -I t F 005 �' water supply into home or at main shutoff: S l P�
Job Address: 16191 SW Cobra c0 Lid
,,� Residual pressure(flowing)reading at incoming water
City: {Ig0.cA supply into home or at main shutoff: 9� p,
State,ZIP: (J • '��/
I What time of day was the flow test taken? rb'3D OM
For designs not provided by Uponor,complete the
following information. Flow test method used? 1 Bucket ❑Flow Meter
Designer's Name:
Flow test gpm: 11
Company:
Phone:
How many gallons water did the design predict
as required? il
Did the test meet or exceed design flow? Yes ❑No
Fax
zWhich sprinkler did you flow?Number: /////} i
Is the warning sign permanently attached close to the Location of head:
main shutoff valve? ❑Yes ❑No o 'Li
Date left in service with all valves open: ) -23
Was this system required by code?0 Yes ❑No
Test Witnea.ssed and Verified by:
Name / Ik— i n a
re Oation Date 23
-
0
Additional Explanations and Notes
LLI
Uponor,Inc. Tel:800.321.4739
t, 5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com