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i, A FIRE SAFETY SYSTEMS
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- _ AQUASAFET"i FLOW TEST
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VERIFICATION
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AcpiaSAFE' Flow Test Verification Form
Alliance important:installing contractor must submit this
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Member ID: {{ completed form.Failure to do so nullifies the
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Company Name: "rc 4.3i'Taj ?(t.--4it..t(4. system+" Y.E-snail or fax cain{deted form
i 1 to the Uponor Eire Safety Design Department
Contact: _�-," # v.,-4.t Le at technica ponor.com or 952.997.1731.
t- For questions,contact Uponor Technical Services at
Phone: `�v t�� 883.594.7726 or teclmical.servics uponor.corn
Fax: 91 -2. C'. 't O .a Color of test orifice used: i ..0 Y,
Job Name: 5i;,.ays Ott &Are Static pressure(not flowing)reading at income
Project Number. f9C'7 G i: CO i ' water supply into home or at main shutoff: t
Job Address: 13i3/ BL .U.ilt t
Residual pressure(flowing)reading at incoming water
City: C1 L.Arti supply into home or at main shutoff:
State,ZIP: () Cl 12 Z 7
What time of day was the flow test taken?
For designs not provided by Uponor,complete the
following information. Flow test method used? ®Bucket at Flow Meter
Designers Name: Flow test gpm: ��
How many gallons of water did the design predict
Comiaaray: as required?
Phone:
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Did the test meet or exce a
design flow? Yes Ca No
Fax: Which sprinkler did you flow?Number: 2..
Is the warning sign pe anently attached close to the Location of head: °d e r.e .ir✓t 2_
main shutoff valve? &Yes ®No
Date left in service with all valves open: !-I -I (::s
Was this system required by code?ErYes U No
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I Test Witnessed and Verified by:
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Additional Explanations and Notes
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Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax 952.997.1731
Apple Valley,MN 55124 USA Wok v u uponer-usa.com