Report ,.-or,,_.4:„!,: ''.....- :,-„---T,i, - upotlor
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FIRE SAFETY SYSTEMS
a *, r � � AQUASAFET". FLOW TESTf VERIFICATION
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AquaSAFE' Flow Test Verification Form
Alliance g i s, Important:',stoatscontractor must this
Member ID: 6 ci " csunpit ted form.Farre to do so nubs tie
Company Name: � sf it ,. �,tc the UPaner Fire SafetY aior fmc cpiet fay
Contact �r -r' tt 1 Ito Design
.com or 9szis .1737.
Phone: Cr `,'°3 0 -UZ For ,contact Uponor Tectmitai services at
.7126 or techtdcal.sendceseoponor com.
Fax ti re i-' . Coles of test orifice used:
Job Name: i;�'t+�+�iA �f' � �
'� Static pressure(not flowing)reading at incomin
Project Number: fq t)7 b R i water supply into home or at main shutoff: k .
Job Address: ,-0'1 0 (7 U.) 4ri_ Jn
�' Residual pressure(flowing)reading at Incoming water
City: i `` f 1] supply into home or at main shutoff
State,ZIP: Q 7?
'j P
What time of day was the flow test taken?
For designs not provided by Uponor,complete the
following information. Flaw test method used? ®Bucket 4Flow Meter
Designer's Name: Flow test gpm: 1-15?""''
company: How many gallons of water did the design predict
as required? ri- ( e%
Phone:
Did the test meet or exceetrdesign flow? l Yes la No
Fax: t r
Which sprinkler did you flow?Number: /f
is the warning sign permanently attached close to the Location of head: e,ea(r } £-t.
.4 "
main shutoff valve? ®Yes ❑No
Was this system required by code?Q Yes CI No Date left in service with all valves open: #•1 Tl
Test Witnessed and Verifkd by:
Name
7,2s-v.„eckko..evl. C-L.tNACS-, 474-ur1L:1-163":(2'. D
(3ccur—PC.cisov— 77-184-ti
Additional Explanations and Notes
Uporior,Inc. Tel:8170.321.4739
5925 148th Street West Fax 952.997.1731
Apple Valley,MN 55124 USA Web:www.0 cart