Report (42) /11 5 / poi(r- o 0 ,L-i ,
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uponor
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FIRE SAFETY SYSTEMS
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,, ,..„„ -E--(v• I.+ 10 AQUASAFE114 FLOW TEST
VERIFICATION
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FORM
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AquaSAFEFlow Test Verification Form
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Alliance
important Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
system warranty.E-mail or fax completed forrn
Company Name. it 11;e% t.Q i p' %
to the Uponor Fire Safety Design Department
Contact: eke.iiISINAk."
D at technical.senriceseuponortom or 952.997.1731.
Phone: 503. - Lii).- -Y44./er For questions,contact Uponor Tedmical Services at
888.594,7726 or technicatsegiceseuponor.com.
Fax.
Color of test orifice used: Drox
Job Name: ile(' 142./Prit.11 Static pressure(not flowing)reading at incoming 60
Project Number: E.1 i LA+ ici tat 3 water supply into home or at main shutoff:
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Job Address: I 7670
Residual pressure(flowing)reading at incoming water
City: --nlem- supply into home or at main shutoff: ct/
States ZIP' 417a):4
What time of day was the flow test taken?
For designs not provided by Uponor,complete the
following information. Flow test method used? aBucket J Flow Meter
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Designerlitt
's Name: e-tl5Flow test gpm: ,14'rk
How many gallons of water did the design predict
Company: tidysk,,,01"'
as required? jet_
Phone: (IC?.alli- 33‘:2
Did the test meet or exceed design flow? Cir res LI No
Fax:
Which sprinkler did you flow?Number: ii-1119
/4 6Is the warning sign permanently apched close to the Location of head: f194404e.yirs 4
A'T 1 at '...L. main shutoff valve? LI Yes IAN()
Date left in service with all valves open:
Was this system required by code?Xs :-.1 No
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Test Witnessed and Verified by:
Name Signature Occupation Date
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64,"'"4.-- 1,104.4-4,-A- -47120.....j._ ArrnAifiti rig.44,/ A ii.-ri
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Additional Explanations and Notes
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Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952,9971731
Apple Valley,MN 55124 USA Web:www.uponopusa.com
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