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FIRE SAFETY SYSTEMS
AQUASAFETu FLOW TEST
VERIFICATION
5
AquaSAFE' Flow Test Verification Forte.
Alliance I "Contractor muss:Submit this
Member 113: compleW form.F&Wre to do$ir num the
system .E-mail or fart completed ft=Company Narrie Hca i t � t+-�� to the Uponor Fire Safety Design Department
Contact: j.,% " at or9SZ.907.1731.
Phone iJ a'' 0 � For 9�contact Uponor T Services at
:7726 or techni orceeaa.
Fax: Ti t-zsc' M Color of test orifice used:
Job Name: ;+A
Static pressure(not flowing)reading at iricomin
Project Number: IA water supply into home or at main shutoff:
Job Address: 2-1�0% ¢xYl
Residual pressure(flowing)reading at incoming water
Citysupply into home or at main shutoff:
State,ZIP: Ce q-1-Z?-4
What time of day was the flow test taken?
For designs not provided by Uponor,complete the Row test method used? ®Bucket I How Meter
following Irifciiimaticin.
Flow test
Designer's Naive:
gpm: i pion
Coma Flow many gallons of water did the design predict
Company: as required?--.--.-. Elegvyel
Did the test meet or exc design flow? Yes ®No
FaxWhich sprinkler did you ?Number:
Is the warning sign permanently attached close to the Location of head:ALL V- QYVZIN�
main shutoff valve? Q Yes ®No
Bate teff in servile with all valves open:
Was this system required by code?Q Yes Q No
i
` Test Wftessed and Verified by.
Name � � a#ore� e� � � Occup ion Date
A&Wm
i
al ExplamAlons and Notes
tipow,hm Tel:SM321.4739
5925148th Street West Fax 952.997.1731
Apple Valley,MN 55124 USA Web:www exinr
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IL