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a= �g � ;' FIRE SAFETY SYSTEMS
�'t• � � > ' Q 1ASAFETm' FLOW TEST
� MS-r �.o1�-do Its A
,� '� � s �� VERIFICATION
FORM
A.quaSA.FF' Flow Test Verification Form.
•
Alliance Important:Instating contractor must sub t this
Member ll): corn eted farm.Fal ure to do sa nudes tine
Company Name t,1`T1P,(1.44.4.10-4.c) the warranty.E MA fax f
Contact: en, #-tit t k..Le at safetytomer phe on
.canr�95i2.997.1'7�i.
Phone: 5[? `� t ~U-I j
.7726 or tedFor questions,contact ilponorTeclrroohcatoeMces at
888594 �rrical unona�r aoni
Fax: 91 t- 3Sc Color of test office used:
g 10,C VN
5
Job Name: t 1-10 Static pressure(not flowing)reading at inc.
Project Number: t'I CSO 1" water supply into home or at main shutoff: kti .
Job Address: 1 015 S., V-04?-10 1-0,41-k
Residual pressure(flowing)reading at incoming water
City: -11, f t.1
supply into home or at main shutoff:
State,ZIP: 1-72,7 q
For designs not provided by Uponor,complete the What time of day was the flow test taken?
following information. Flow test method used? C]Bucket a Flow Meter
Designer's Name: Flow test gpm: 5iNvx
Company: How many gallons of water did.the design predict
as required? V'1 Cie
Phone:
Did the test meet or excee design flow? Yes C3 No
Fax:
Which sprinkler did you flow?Number: 2.
is the warning sign permanently attached close to the location of head: g 3
main shutoff valve? D Yes 0 No
Was this system required by code?Cl Yes 0 Na Date left in service with ail valves open: 11-10-1k
o
Test Witnessedand Vetted by:
Name ure �, Date
1
al ExplanatIons and Notes
Inc. lel 800.321 4739 roar,
5925148th Street West Fax 952.997.1731
Apple Valley,MN 55124 USA Web:ww&