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FIRE SAFETY SYSTEMS
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x. AQUASAFETM FLOW TEST
. i.* VERIFICATION
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FORM
AquaSAFETM Flow Test Verification Form
Alliance n Important:Installing contractor must submit this
Member ID: 12 DZ completed form.Failure to do so nullifies the
Company Name:
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system warranty. E-mail or fax completed form
/1 to the Uponor Fire Safety Design Department
Contact: C iI� I!uw/la/l at technical.services@uponor.com or 952.997.1731.
Phone: 5D3 —467 net For questions,contact Uponor Technical Services at
888.594.7726 or technical.services@onor.com.
Fax: /� '( �p Color of test orifice used: �1Pa��,.V.
449
Job Name: �nOJ t� `r `i sa`e Static pressure(not flowing) reading at incoming
Project Number: 434 e3 ,_ 001 ,`Z" water supply into home or at main shutoff: f 5 6
Job Address: Ite8 � alOfQ. O 4,
at Residual pressure(flowing)reading at incoming water
n� City: 11� supply into home or at main shutoff:
-V State,ZIP: Dferrk.
What time of day was the flow test taken? /'� PM
For designs not provided by Uponor, complete the
following information. Flow test method used? Bucket CI Flow Meter
Designer's Name: Flow test gpm: 1�
Company: How many gallons of iter did the design predict
as required?
Phone: Did the test meet or exceed design flow?� Yes 0 No
Fa • Which sprinkler did you flow? Number: ' 1'lYe
Is the warning sign permanently attached close to the Location of head:
main shutoff valve? 0 Yes ❑No G�-�;
Date left in service with all valves open:
23
Was this system required by code?0 Yes ❑No
Test Witnessed and Verified by:
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Additional Explanations and Notes
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E0 Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
LL,
Apple Valley,MN 55124 USA Web:www.uponor-usa.com