Report (16) ono,„:„ ,
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� FIRE SAFETY SYSTEMS�, Fq
p - AQUASAFETM FLOW TEST
�:.` QST Otb- 00Illb VERIFICATION
FORM
AquaSAFETM Flow Test Verification Form
•
Alliance •
Member ID: G( Important Installing contractor mug submit this
completed form.Failure to do so nullifies the
Company Name: 6.1,-.4.,c4-,j9(1.44,44-0--,c) em warranty.E-mail or fax completed form
Li Ito the Uponor Fire Safety Design Department
Contact: Terr, t-tttrt..�L,..Q at technicoLsendcesau
ponorcam or 952.997.1731.
Phone: fj �-(�{ -i1't . For questions,contact Uponor Tedmeical Services at
888.594.7725 or tedmical.services@uponorcom.
Fax: 4111-ZESC).
' -S p
+t Color of test orifice used: g t t'
Job Name: �l;,.vy&��"'k t ts7
Static pressure(not flowing)reading at incoming ,
Project Number: ___1_5420.1_116 -, A 11 water supply into home or at main shutoff: '"](
Job Address: Qi'7 �,,y tN/ (A)ni►a.ui1 0".
City: Residual pressure(flowing)reading at incoming water
supply into home or at main shutoff:
State,ZIP: 19 72 y
For designs not provided b UWhat time of day was the flow test taken?
y ponor,complel e the
following information. Flow test method used? Cl Bucket t Flow Meter
Designer's Name: (c-" Flow test gpm: 1-1 Q
Coma �` �
Company: How many gallons of water did the design predict
Phone: as required? V 1 5 e 6"^
Did the test meet or exceeidesign flow? Yes U No
Fax:
Is the warning sign permanently attached do a to the Which sprinkler did you flow?Number: �_�.
C010n of head:
main shutoff valve? U Yes U Nor`7 '�ypyh Z
Was this system required by code?U Yes U Na Date left in servos with all valves open: 8-5-le
Test Witnessed and Verified by:
Name t�{ • . ature , n Occu 'on
a r4 �f
.c__ ( , f,� ( pDate
Additional Explanations and Notes
Up
592548tInc.
Street West Te&L CO.321.4739
Apple Valley,MN 55124 USAWeb. wwwww.Fax: 731
p
uponor-usa.can