Report (2) 2tvr( r_ •
<r P').5 F, 1 .I6 .. vol 26
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uponor
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FIRE SAFETY SYSTEMS
+r `: AQUASAFET" FLOW TEST
r ` # VERIFICATION
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AquaSAFE ` Flow Test Verification Form
Alliance Impotent:Installing contractor must submit this
Member ID: 11Q 9 tt completed form.Failure to do so nullifies the
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Company Name: �-L c 1�L+41rt(• system E-mai or fax completed form
to the Uponor Fine Safety Design Deportment
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Contact: ttt4.-I(..(. Q at ifidlilialLififitinfiNgeggram or 962.997.1731.
Phone: cD3-`iq 0 -0.1 to 2 For questions,contact Uponor Tedndal Services at
6e1s942726 or tedithainediiiihatagram-
Fax: 9 1-2 ie . Color of test Orifice used: 131
Job Name: G :.a.'N ++.- I3'3 Static pressure(not flowing)reading at incomin
Project Number � C) t) & 0 water supply into home or at main shutoff: p•,
( 1 �
Job Address: 13 t2 S1; Ode l y►
Residual pressure(flowing)reading at incoming water
ydrAsupply into home or at main shutoff:
State,ZIP: 0e- 'IZZy
What time of day was the flow test taken?
For designs not provided by Uponor,complete the
following information_ Flow test method used? 0 Bucket Flow Meter
Designer's Name: Flow test gpm: lDvw
Company: How many gallons of water did the design predict
as required? V-1fon.
Did the test meet or exceeddesign flow? AYes D No
Fax
Which sprinkler did you flow Number: 2
Is the warning sign permanently attached dose to the Location of Tread: ('U� 2
main shutoff valve? D Yes D No ii�d�"�'��!`""'��` 12 ---2-1-1.0 2� f/
Date left in service with all valves open: l (
Was this system required by code?D Yes D No
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1
f Teat Wltrre sed and Verified by:
Name `i
-rL�va ture• � on Date
Additional Explanations and Notes
tips'.Nrc. Tel:800321.4739
5925148th Street West Fax 952.997.1731
Apple Valley,MN 55124 USA Web: