Report (7) qc'
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FIRE SAFETY SYSTEMS
i
t AQUASAFETM FLOW TEST t
ZOZZ-00 g VERIFICATION
f - FORM
AquaS E Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: a2$2. completed form.Failure to do so nullifies the
Company Name: WO IGO tt 11.r,(10 1 R 1 system warranty.E-mail or fax completed form
to the Uponor Fire Safety Design Department
Contact: cliff Bowman at technicafseruices@uponor.com or 952.9973731.
Phone: .SO3 - Li -17% For questions,contact Uponor Technical Services at
MR 594.7725 or technicaLservic� n
es@u or coin.
vi
Fax. Color of test orifice used: D'1q
Job Name: 5(304'v1 (k);d e( Tut'ctc e, Static pressure(not flowing)reading at incomin <.
Project Number: y3y b F oc I 72_ water supply into home or at main shutoff:
Job Address f(p St4 CC iotttJO I ij
Residual pressure(flowing)reading at incgrpiag water
City. If RM) supply into home or at main shutoff: yJ 46
State,ZIP: Q c 01J ,
What time of day was the flow test taken? ':op Pm
For designs not provided by Uponor,complete the
following information Flow test method used? Iti Bucket CI Flow Meter
Designer's Name:-
ame: Flow test gpm: ��
Company How many gallons afwater did the design predict
as required r 7
Phone:
Did the test meet or exceed design flow? Ves 0 No
Fa Which sprinkler did you flow?Number: /4'(0
is the warning sign permanently attached close to the Location of head:
main shutoff valve? 0 Yes ❑No ' _
Date left in service with all valves open: Y
c Was this system required by code?0 Yes 0 No
ri
r Test Witnessed and Verified by:
P.s. Na ma lTi1�t A11( r Jj( �I "t Occupation Date
Oa�e�_23
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... Additional Explanations and Notes
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I. Uponor,Inc Tel:8fl0.32i.4739
5925 148th Street West Fax:952.997.1731
1 Apple Valley,MN 55124 USA Web:www.uponor-usa.com