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4 � �� f erARE SAFETY SYSTEMS
44.-,4 ..‘
� y AQUASAFE"m FLOW TEST
' � VERIFICATION
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A a. F' Flow Test Verification Form
Alliance 1l i important must stdavdt this
Member ID: Fenn.F to do se the
Design Depeihnent Company Name: �t. i, 4► tt
Contact: To-r. ic,.e- atIL*theFireSafetY xmn or .l73l.
Phone: c01-'Aci 0 -C-;(2 Technical
7726 sttt or.com.
Fax tiii$•z tom. -sbo l dt ".:reused: c,r V
Job Name: q AAA e, 114Static pressure(not flowing)reading at incomin
Project Number: . !07 b ( // tY into home or at main shutoff:
Job Address: i ( 13 .7 rr*r S
Residual pressure(flowing)reading at incoming water
City: .7----,((--� �-i`...-� / supply into home or at main shttfiaff;
State,ZIP: /912 "'d L 2 2-c I
What time of day was the flow test taken?
For designs not provided by Uponor,complete the flow tem method used? L7 Bucket l Fera Meter
following information_
Designer's Name: How test gpm_
How many gallons of water did the design predict
Company: as required? 1 jt
i mow'
Phone:
Did the test mowdesign flow? es aNo
fax Which sprinkler did youflow?Number:
is the warning sign permanently attached close to the of head: <fi/
main shutoff value? G�Yes U Na i
Date left in service math all valves open- t.,2
Was this system required by code?U Yes ID No
Test Witnessed and Verified
N-at�Tie
LQ
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tiJts�na"� attire p D/7-23-1t,
Explanations and Notes
Lvener,Inc. Tel:800.321.4739
5925 148th Street West Fax 952.997.1731
Apple Valley,MN 55124 USA Wek VAVW.143anix4sammn