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fik 11 UfOflO1 � FIRE SAFETY SYSTEMS 4 -i -i ::.; AQUASAFETM FLOW TEST v VERIFICATION � R t. ,i4s( ZZ- 003s0 FORM AquaSAFF7 Flow Test Verification Form Alliance . Important Installing contractor must submit this Member ID: 12� completed form.Failure to do so nullifies the Company blame: Woler 'f 'aornb i"25 system warranty.E-mail or fax completed form to the Uponor Fire Safety Design Department Contact: Ci i fe 'Boo tAaYl at technical.services@uponor.com or 952 997.1731. Phone: 1►�v �Jv� 4J_-1,` ?e For questions,contact Uponor Technical Services at 888 594 7726 or technicalseeo onor corn. Fax: (j Color of test orifice used: Job Name: ft‘ �`"`/4/�s' JQ Static pressure(not flowing)reading at info, mii Project Number: q3y b3 P 003 � main shutoff. water supply into home or at ma shutoff:-- Job Address: l 6653 64) COIIO(ad o C d 'N } Residual pressure(flowing)reading at incgrrlipg w 4 City: 1 supply into home or at main shutoff: `'I State,ZIP: © ~ What time of day was the flow test taken? For designs not provided by Uponor,complete the following information.. Flow test method used? Iiii Bucket Q Flow Meter Designer's Name: Flow test gpm: i� Company: How many gallons of ter did the design predict as required? f Phone: Did the test meet or exceed design flow? kes Q No Fa : Which sprinkler did you flow?Number I"#' i Is the warning sign permanently attached close to the Location of head: main shutoff valve? Q Yes Q No l �- Date left in service with all valves open: Was this system required by code?Q Yes Q No a 21 Test Witnessed Verified by:s Na> GIbesc 1nur 9 Date Om �r2 2 -z3 ti g a n 6 a Additional Explanations and Notes Vmm SI a Uponor,Inc. Tel:800.321.4739 `T 5925 148th Street West Fax:952.997.1731 1 Apple Valley,MN 55124 USA Web:www.uponor-usa.com