Report 5C
k
ono
i v.
FIRE SAFETY SYSTEMS
t: LI AQUASAFETM FLOW TEST
VERIFICATION
FORM
AquaSAFF' Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: I2$Z completed form.Failure to do so nullifies the
Company Name: wc'CD' bath in, system warranty.E-mail or fax completed form
to the Uponor Fire Safety Design Department
Contact: C1i 61. nh at technicai.services@uponor.com or 952.997.1731.
1 Phone: W SD3 o7 `170i For questions,contact Uponor Technical Services at
/(„vv W1.594.7726 or technical,senr'ices@tponor.com.
�� Fax: Color of test orifice used:
Job Name: 6CX*4i On
fie artCe Static pressure(not flowing)reading at incomin e
Project Numbeii 3 t4(,1� sun it.2 water supply into home or at main shutoff:T +
Job Address: I &f3 SW Cd of
,ro
Residual pressure(flowing)reading at inco -.• er
City '`�r(�� supply into home or at main shutoff: I.,
State,ZIP: (914e8010 Is c6.
What time of day was the flow test taken? 4�
For designs not provided by Uponor;complete the Flow test method used? CI Bucket 0 �
Flow Meter 0o�following information. I"1
Designer's Name:
Flow test gpm:
Company: How many gallons of water did the design predict
as required? i I
Phone: Did the test meet or exceed design flow? tai Yes 0 No
Fa Which sprinkler did you flow?Number H•
Is the warning sign permanently attached close to the Location of head:
main shutoff valve? 0 Yes D No 'LZ�•
Date left in service with all valves open: -1
Was this system required by code?0 Yes 0 No
5 Test Witnessed and Veiifred by: c
a Ala Occupation Date
1Ck (ilb '� C J '' 121,ornbQ•t 1-22 3
a
a
n
a Additional Explanations and Notes
J
g Uponor,Inc. Tel:800.321 A739
5925 148th Street West Fax:952.997.1731
1 Apple Valley,MN 55124 USA Web:wwwuponor-usa.com