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°g a y" AQUASAFEFIRESAFETYTM FLOWSYSTEMS TEST
VERIFICAS.
TION
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AquaSAFE' Flow Test Verification Form
Alliance ,, {{ Important Installing contractor must submit this
Member ID: 1"'t tO'-1 completed form.Failure to do so nullifies the
/��'_ i " system warranty,E-mail or fax completed form
Dep
Company Name: (r rcc.0 l"f� V( L( u3 to the ti nor Fire
t^t , at technical senricesf@u Design or 9 2me7t
Contact: ...1 dGL porwrSafetY ,com or 952.997.1731.
Phone: - . `�` 'd:%� 3 For questions,contact Uponor Technical Services at
[, 888.594.7726 or—
r tethnical,servi es@uponor com.
Fax: i 7�-is :..
--
If Color of test orifice used:
Job Name: i,.�VVs°1/1l t a .1
Vi� Static pressure(not(owing)reading at incomin
Project Number: ®� water supply inhome or at main shutoff:, s t
Job Address: I ✓i 0-614441
Residual pressure(flowing)reading at incoming water
City: '1/414'� supply into home or at main shu#off:
State,ZIP: ci Z Z2 U-J
What time of day was the flow test taken?
For designs not provided by Uponor,complete the
following information. Flow test method used? ❑Bucket i Flow Meter
Designer's Name: Flow test gpm: i 1
Company: How many gallons of water did the design predict
as required? 1'•w'
or
Phone: Did the test meet or exceedesi n flow?
Fax: 9IYes U No
Which sprinkler did you flow?Number: 1 V
Is the warning sign permanently attached close to the Location of head: +�G�13`M '3
main shutoff valve? ❑Yes U No
Date left in service with all valves open: Z„�j (�
Was this system required by code?U Yes i]No
Test Witnessed and Verified by:
Name l i '=nature Occupation Date
z -'-t' -1
1
7
I
9
sAdditional Explanations and Notes
d
I
Ulm.Mc Tel:800321.4739
5925148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:wu�nnt upawr-usa com
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