Report (42) A .-r IG 'X*t_-
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FIRE SAFETY SYSTEMS
AQUASAFE— FLOW TEST
VERIFICATION
AquaSAFE"' Flow Test Verification Form
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Alliance Important:Installing contractor must submit this
Member ID: j completed form. Failure to do so nullifies the
Company Name ---- system warranty.E-mail or fax completed form
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- to the Uponor Fire Safety Design Department
Contact: at gchnical.setvicesCuoonor.com or 952.997.1731.
y c For questions,contact Uponor Technical Services at
r' r_
Psione: J } 1 7� 7y 888.594.7726 or _
— t.,�,chnicalsery s@uponor.com.
Fax: S �' f "i :- 7 1 _— Colar of test orifice used: iyal
Job Name: 'L�e c�`f s Static pressure(not flowing) reading at incoming
Project Number: ,2 ��� 1� t"`c'y water supply into home or at main shutoff: _—7
Job Address: /., S 3 Ga _5
- ,.. zjt% _ L 1v'_---
Residuai pressure Cfiowing)reading at mcot-iinrg Ovate'
City: Z2"t)_rb supply into Dome or at main shutoff:
State, ZIP: t vley nJ `Z z .;
Vvfhat time Of day was the flow test taken?
For designs not provided by Upono;, complete the
Floe.test n:etl�od used? bucket J Floe. !Meter
folk,,%%;ng information,
Designer's Name: Flow test gpm:
Company: Flow maoy gallons oftvater did the design predict
as required? j l
Phone: Did the test meet or exceed design flo,? A Yes J No
Fax ----
Which sprinkler did you floe.')Number
Is the ue!arning sign permanently attached cl ase to thF Location of head:
main shutoff valve? Yes J No ,, ,,
Date left in seri=icc with all valves open _td'I ,
1Vas this system regu?red by c_-de?J Yes J No
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Test Witnessed and Verified by:
Name ,_Signatur Occupation Date
tiY
Additional Explanations and Notes
T
Uponor,Inc. le! &':Yj.321.473'1
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99?S 1481h Street I.Vest Fay 952 997 1731
Apple Valley,kiN 5512-'U5A Web:www.uponor-usa.com