Report (33) `,.,, /,,,, '' ' ,,::,,,
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,11 FIRE SAFETY SYSTEMS
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4 �',il� a AQUASAFET"' FLOW TEST
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. . 131i0 S ) VERIFICATION
Itle�� t
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AquaSAFETM Flow Test Verification Form
Alliance -j 114
i important Installing contractor must submit this
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Member ID: 1 `4 4 �� completed form.Failure to do so nullifies the
Company Name: C 1 i t, LL( mem warranty.E-mail or fax completed farm
p y 6%tru11 " 31 to the Uponor Fire Safety Design Department
Contact: 171-en, 0 - at technicai.servicesituponor.com or 952.997.1731.
For questions,contact Uponor Technical Senvices at
Phone: S03-AC1.0 `LZ 1 888.594.7726 or t echnical.services@uponor.com.
Fax: 9 i(-7-I -7)Bo Color of test orifice used: tom`1�
Job Name: 5'. AAA 1 c i k 1 63 Static pressure(not flowing)reading at incomin
Project Number: l'1v t 0 F EIU water supply into home or at main shutoff: c
Job Address: 1314Q.5,,, c.c k Qattkui Sr
Residual pressure(flowing)reading at incoming water
City: 7
%634 supply into home or at main shutoff:
State,ZIP: nil t 'i 1'2 L
What time of day was the flow test taken?
For designs not provided by Uponor,complete the
following information. Flow test method used? 0 Bucket SFlow Meter
Designer's Name: Flow test gpm: 1-1 5 1
How many gallons of water did the design predict
Company:
as required.? `l,i e ,n
Phone: Did the test meet or exceed design flow? CYYes U No
Fax: Which sprinkler did you flow?Number: I I
Is the warning sign permanently attached close to the Location of head: 4
main shutoff valve? U Yes U No p _,
Date left in service with all valves open:
Was this system required by code?U Yes U No
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Test Witnessed and Verified by:
.s Name . ature Occupation Date
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f Additional Explanations and Notes
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i Uponor,Inc. Tel:800.321.4739
i' 5925 148th Street West Fax 952.997.1731
I Apple Valley,MN 55124 USA Web:vwiwr.uponor-usa.com
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