Report (27) 41x:
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� FIRE SAFETY SYSTEMS
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,'404-• AQUASAFETrr FLOW TEST
`- IN._ VERIFICATION
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FOP n.1
AquaSAFE' Flow Test Verification Form
Alliance C 1 -,. (f Important Ins ng contractor must submit this
Member ID: �+ I i 10`i completed form.Failure to do so nullifies the
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Company Name: gnec..t)k,4 �t t t.4•c�lt-4C s gem""'rte E-mail or fax completed foray
, {{ j 3 to fire Uponor Fire Safety De%Ign Deptgtment
Contact: Tem 4-tut...1 J at .cam or 952.997.1731.
Phone: t- `-kg 0 -UI k 3 For questions,contact Uponor Technical Services at
888.594.7726 or tedhnical smviceunonor can.
Fax: 911-25c- 3 b c' II '' Color of test orifice used: g t.c
Job Name: Sit..nn AAA I q� Static pressure(not flowing)reading at incomi�nq
Project Number: 161070 (;b water suppy into home or at main shutoff: --7 5 pp a r
1 �
Job Address: (?0t0-1 ,W VOA-s1 L{/I
p Residual pressure(flowing)reading at incoming water
City: TI Gcvu supply into home or at main shutoff:
State,ZIP: n q-77.2-1-1
What time of day was the flow test taken?
For designs not provided by Uponor,complete the
following information. Flow test method used? ❑Bucket 1Flow Meter
Designer's Name: Flow test gpm: fl 5t2
Company: How many gallons of water did the design predict
as required? V'l r ffn
Phone:
Did the test meet or exceeridesign flow? 1 Yes ❑No
Fax: Which sprinkler did you flow?Number:
Is the warning sign permanently attached dose to the Location of head: M1t� sv to
main shutoff valve? Cl Yes ID No
/
Was this system required by code?Cl Yes ❑No Date left in service with all valves open: I I`Js I I(J
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Test Witnessed and Verified by:
Name t + ture 9
�ss�' �hh. � �'�Ov- Dll'( ;�((,
Additional Explanations and Notes
Vhono+",Inc. TeL 800.321.4739
5925 148th Street West Fax 952.997.1731
Apple Valley,MN 55124 USA Web;ww of ,cnm yu