Report :i,_-')i (Y1 S I ) 0 I -- 06-) a, ys
.:1
t,
,i ,','
ti ' ' it t:
2
' 7? I. c <
1
, .„. .
: , ,
FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
VERIFICATION
FORM
AcpiaSAFET lki Flow Test Verification Form
................_..........,-..._______.............................,............_.....
Alliance Important:Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
system warranty.E-mail or fax completed form
Company Name: II • 4-.3 ''
— to the Uponor Fire Safety Design Department
Contact;.0"a I. i, la lib' . .,. 4. at technicgimndatemonorsiun or 952.997.1731.
For questions,contact Uponor Technical Services at
Phone: - ' - c *° ' c 888.59E1.7726 or ,t` '
..... x .,. ... ,.1., .u.
Fax:
Color of test orifice used:
Job Name: a ....., ,..„, ...r,,,. i it" 4 . _ Static pressure(not flowing)reading at incoming
r -..--
water supply into home or at main shutoff: 0
Project Number; 4,,..dc,Lu.. - NLI. „ ax... _______
- .
Job Address: A - . cc C.,t7e_—Tc.---------T—
Residua(pressure(flowing)reading at incoming water
City: e-' supply into home or at main shutoff:
State,ZIP:
What time of day was the flow test taken?
For designs not provided by Uponor,complete the
following information. Flow test method used?ei413ucket CI Flow Meter
" 0'
Designer's Name: 4, .0 VFlow test gpro:ie-A
if
Company: _,uy2c2oof______________ How any gall° s of ater did the d sign predict
Phone: -.o. -
Did the test meet or exceed design flow? es Li No
Fax:
Which sprinkler did you flow?Number: -
1
Aiiiiistf........? mIsatihneswhtltrnfinfg slignve?perrunanyently es art4tached close to the Location of head. ) , ' , '4 A.,...„ '''' • W.47
Date left in service with all valves open: -I-
Was this system required by code Yes J No
..li
Test'Witnessed and Verified by:
Name '. ..
Occu atifi Date
-......avniii
5-
1 ----------------_____ ------------- ------
Additional Explanations and Notes
St
ll
gi
Uponor,Inc, Tel:800.321.4739
‘v,
5925 148th Street West Fax.952.997:1731
Apple Valley,MN 55124 USA Web:www.uponor-usacorn
x7.