Report (59) r 't'i eiST !6,- `
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��,,.,„ .,. ‘ : �� FIRE SAFETY SYSTEMS
s. i yn k) e, R AQUASAFETM FLOW TEST
VERIFICATION
I ,,!-.. , ',.,' ?bin 5 c- r-fo 'Al
-re c r FORM
AquaSAFETM Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
system warranty.E-mail or fax completed form
Company Name: 411,;coC! ?,..,.,,,., :.1 5 to the Uponor Fire Safety Design Department
RContact: C'�c3 ) 1`I‘51n Mu\ at technical.services@uponor.com or 952.997.1731.
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For questions,contact Uponor Technical Services at
Phone: . - )3-449'Z-3`'��' 888.594.7726 or technical.services@uponor.com.
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Fax:
Color of test orifice used: ,1 S`¢....SS
Job Name: R.i.JYo'Lr i et rtV-p Static pressure(not flowing)reading at incoming
Project Number: water supply into home or at main shutoff: -.S S'
Job Address: p 3`/72.1 ZIN*- k,vin i
✓i- Residual pressure(flowing)reading at incoming water
City: I j?c fc' supply into home or at main shutoff:
State,ZIP: O . ?722_,
0 Wel
What time of day was the flow test taken?
For designs not provided by Uponor,complete the
following information. Flow test method used? tff Bucket U Flow Meter
nn Flow test gpm:
Designer's Name: �etil j t,,,Crus:Ii C .2
Company: econc- How many gallons of water did the design predict
as required? (f
Phone: cf 5 2- 99 7_ 53"3 0 Did the test meet or exceed design flow?'yd Yes U No
Fax: Which sprinkler did you flow?Number: 1.4 - I 0
Is the warning sign permanently attached close to the Location of head: PI ce)te.f '(3r.A. A I'Erxh
main shutoff valve? erePYes O No /
Date left in service with all valves open: II- I
Was this system required by code? Yes U No
5
Test Witnessed and Verified by:
Name Signature Occupation Date
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R Additional Explanations and Notes
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g Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com