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Report ,.-or,,_.4:„!,: ''.....- :,-„---T,i, - upotlor ,,./4„,;--,„:„ , k : . . f �` FIRE SAFETY SYSTEMS a *, r � � AQUASAFET". FLOW TESTf VERIFICATION A ,YHa � . sn FOPM 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