Report (12) — • — ipi
a
u, 4
FIRE SAFETY SYSTEMS
rI AQUASAFET"' FLOW TEST
VERIFICATION
r• FORM
AquaSAFETM Flow Test Verification Form
Alliance ........: ........
Important.Installing contractor must submit this
Member ID: // completed form.Failure to do so nullifies the
Company Name, l(x ; _ ' system warranty.E-mail or fax completed form
"' to the Uponor Fire Safety Design Department
Contact: ig.ln trvt'..+r" at technicatsetvieeseupornor.com or 952.997.1731.
Phone; . For questions,contact Uponor Technical Services at
a 888.599.7726 or technicaiservicesudmrar cam.
Fax:
Color of test orifice used:
Job Name. (Ztt,l t+L.!' �.�.,.�t`s:.[ .+�.�'..
(��� Static pressure(not flowing)reading at incoming
Project Number: 1�3 , '1 water supply into home or at main shutoff:
Job Address: /37#1/4 r 4. .X- je.r 4,
City. •�"j' } Residual pressure(flowing)reading at incoming water
+� supply into home or at mainshutoff:
State,ZIP: %477
For designs not provided by ttpvnar,complete the What time of day was the flow test taken?
following information. Flow test method used?,, °Bucket J Flow Meter
Designer's Name. /4e'/, ,.ifivieliew 19d4,116,9 Flow test gprn: _r► {
Company; How many gallons of water did the design predict
as required? /12
Phone: ! "
Did the test meet or exceed design flow? kiilYes D No
Fax:
Which sprinkler did you flow?Number: -,j/..;
Is the warning sign permanently attached close to the location of head:
{ t"h main shutoff valve? Li Yes puo '
in service with all valves open:Was this system required by code? Yes Na Date left --It - "",
av. ......... ......... ....
Test Witnessed and Verified by:
NO.1114
Si nature
/ `r! (444r a C .. Occup ion Date
Additional Explanations and Notes_
Uponor,Inc.
Tel:
592514Fax 8th Street West x X1 952,997.173132 A 3
Apple Valley,MN 55124 USA Web:warwuponor-usa.com