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FIRE SAFETY SYSTEMS
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AQUASAFETM FLOW TEST
� i:_ VERIFICATION
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FORM
Aqu.aSr Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: /28 2 completed form.Failure to do so nullifies the
Company Name: Wolcott' Numbing system warranty.E-mail or fax completed form
to the Uponor Fre Safety Design Department
Contact: Gi FF aCt-t)!fin at technical.services@uponor.com or 952.997.1731.
Phone: -o3 47 176, For questions,contact Uponor Technical Services at
JFAR 5947726ortechnical icesfuponor.com.
Fax: Color of test orifice used: it�,..IK,.
Job Name: f 0..)kiN l p A) /leckrQ(e Static pressure(not flowing)reading at incomin
Project Number: 3�b1 �,,, 2 water supply into home or at main shutoff:
i Job Address /j17 SW C C lJO A)
v G T+��tio Residual pressure(flowing)reading at in v g water
" supply into home or at main shutoff: 1
� State,ZIP: D cc do n
What time of day was the flow test taken? /iOO pm
For designs not provided by Uponor,complete the
following information. Flow test method used? Bucket 0 Flow Meter
Designer's Name: Flow test gpm: R
How many gallons of water did the design predict
Company: as required?
Phone: Did the test meet or exceed design flow?*Yes 0 No
Fax: Which sprinkler did you flow?Number: H.I
Is the warning sign permanently attached close to the Location of head:
main shutoff valve? CI Yes CI No b-22 Date left in service with all valves open: -I
Was this system required by code?r
0 Yes CI No
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Test Witnessed and Verified by. ,
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Date Eck Cb � � °?\000O el 2 2-23
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a Additional Explanations and Notes
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LL Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:wwwuponor-usa.com