Report (65) Ac r 1 �-- 17
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t . FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
a VERIFICATION
$ f ,� � . �. FORM
AquaSAFETM Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: l t 4 completed form.Failure to do so nullifies the
Company Name: ( Y� 1C Pt t+° system warranty.E-mail or fax completed form
.r , ,_ { to the Uponor Fire Safety Design Department
Contact: Jt) V1-1. at technical.services@uoonor,com or 952.997.1731.
C _ For questions,contact Uponor Technical Services at
Phone: r 888 594.7726 or technical,services@uponor.com.
Fax: Ci 1(. �ctb°i2Color of test orifice used: 6) Co.L
Job Name: �..0 4 t'.ti c 1„la'"161 Static pressure(not flowing)reading at incoming ,
Project Number: 0 F Mai._
water supply into home or at main shutoff: 1e re,...
Job Address: ! I+( 5 o i
M1 at._ti Lit,
Residual pressure(flowing)reading at incoming water
City: I t G� a�c r ( supply into home or at main shutoff:
State,ZIP: 6112-2-q
What time of day was the flow test taken?
For designs not provided by Uponor,complete the
following information. Flow test method used? Li Bucket S Flow Meter
Designer's Name: Flow test gpm !
: I l t P
Company: How many gallons of water did the design predict
as required? 11
Phone: Did the test meet or exceed design flow? iit Yes U No
Fax: Which sprinkler did you flow? Number: 10
Is the warning sign permanently attached close to the Location of head: g..e. ir' =v"
main shutoff valve? U Yes U No
Date left in service with all valves open: �'(�/i
Was this system required by code?U Yes U No
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Test Witnessed and Verified by:
e Ign4ure Occupation Date
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T Additional Explanations and Notes
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,eUponor,Inc. Tel:800.321.4739
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5925148th Street West Fax:952.997.1731
1 Apple Valley,MN 55124 USA Web:www.uponor-usa.oan
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