Report (38) 4
,„ , , •t OC) .‘7, 7
''
. ' upono
I
ii.,
,
... : , , . , .t.„,
FIRE SAFETY SYSTEMS
1
,
,4 IQ '
. .
\..,,,t
AQUASAFETh4 FLOW TEST'. ; ,;,;:i'
VERIFICATION
i Lr
.34-1
,... •.,,,,,,,v r-0 FORM
AcpiaSAF'E' Flow Test Verification Form
. . . . , , , .. , _. „......,,,......................._................,...........................
Affiance
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. 4/4.44t.t( ififryk4'1 '
i .,. ........ . to the Uponor Fire Safety Design Department
Contact: poiewi d);s11,the,rt, at technicatserviceseuponor.coin or 952.997.1731.
Phone: so:3_ 97 -3 /9,eiz_ For.q5uwestnio2n6s,ocrotnetcahcrtacatiptosenontriTechnittvoincies at
Fax.
Color of test orifice used:
Job Name. cZtLAgai"L.A-CCA,C.Z...
Static pressure(not flowing)reading at incoming
Project Number: 1.6.1.-394 2311 4( water supply into home or at main shutoff: 4*0
Job Address: 13 731 Si liA4
rt'l Ael-44mesliqual pressure(flowing)reading at incoming water
City: 11, 64 supply into home or at main shutoff: ,-y
State,ZIP:
What time of day was the flow test taken? 77 3 et
For designs not provided by Uponor,complete the
followininformation, Flow test method used? 'Bucket C.1 Flow Meter
g
Designer's Name: Pio tv rokerez, Flow test gprn.•....._________
ComHow many gallons of water did the design predict
pany: (40C1Yie
as required? ifp—
Phone: 952:9297------436CL---- Did the test meet or exceed design flow?;if Yes CI No
Fax:
Which sprinkler d , a id you flow?Number: a-8.3
1/ 4,i ,,,,,,,..31s tne whatrnif"nfg stign7permanently attached dose to the location of
. LI Yes 54f,No
Date left in service with all valves open: -/
Was this system required by code?ki Yes '....I No
x
zx
•Ei ...................._.................... ..................-........,........... .... . _ .
Z3
Test Witnessed and Verified by:
Na ie i Si. -1.w" Occ .. `,*. ID e
f5
...........__
5,-
1-,
Additional Explanations and Notes
:-.4.
Uponor,Inc. Tel:8003214739
5925 148th Street West Fax:952.997,1731
1, Apple Valley,MN 55124 USA Web:vvww.uponor-usa.corn
ttl'