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uponor
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kyw4FIRE SAFETY SYSTEMS
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. "` N4-°',•> AQUASAFET"' FLOW TEST
�` ' VERIFICATION
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AquaSAFETTM Flow Test Verification Form
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Alliance ,. tt Important Installing contactor,must submit this
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Member ID: ��++ i CI completed form.Failure to do so nuMtfles the
Company Name: lTYrxcJi 4.� tL } to Uponor .
E-mail or fax completed form
i ��L. Fire Safety Design Department
Contact: t-tuaJJ(L.. ! at tedmicaLsavicasehnsonor.com or 952.997.1731.
Phone: U3'+ 0 -GI k 3 For questions contact Uponor Technical Services at
888594.7726 or tednrica servkrn
esOnsonor co .
Fax: 91 l-25c 3�j C Color of test orifice used-
Job Job Name: 5l.av,sun4" ZSCI
cttr
Static pressure(not flowing)reading at incoming
Project Number: 70F 0�11'.,, water supply into home or at main shutoff: s i? c
Job Address: L 3II( S w a t&ct-W cAtAmi 4
Residual pressure(flowing)reading at incoming water
City: Ii supply into home or at main shutoff:
State,ZIP: D q. 122 q
What time of day was the flow test taken?
For designs not provided by Uponor,complete the
following information. Flow test method used? U Bucket Flow Meter
Designer's Name: Flow test gpm: I-1rt,"
Company: How many gallons of water did the design predict
as required? ,1 t ''st"
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Did the test meet or exceed-design flow? i 'Yes O No
Fax: Whichsprinkler did6
you flow?Number:
Is the waming sign permanently attached close to the Location of head: Me,-`7\eV• Rec.ay......,
main shutoff valve? O Yes U No t Z_�`-
Date left in service with all valves open: to
I Was this system required by code?U Yes O No
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Test Witnessed and Verified by:
Name Lire. , Date
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Additional Explanations and Notes
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i Uponor,Inc. Tek 800321.4739
a 5925 148th Street West Fax 952.997.1731
i Apple Valley,MN 55124 USA Web:wrwr.upenor-rsa.com