Report (11) ( Si ;..016 - 00a3 /
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Uponor
FIRE SAFETY SYSTEMS
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AQUASAFETm FLOW TEST
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VERIFICATION
FORM
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AquaSAFE'm Flow Test Verification Form
.........................„......................................_________............................._...,................_..”...
Alliance
Important Installing contractor must submit this
Member ID:
completed form.Failure to do so nullifies the
4 OW itilim_ system warranty.E-mail or fax completed form
Company Name;
to the Uponor Fire Safety Design Department
Contact: ..i.ZCAQzfrt at fechigfatsglykesemantstm or 9S2.997.1731.
Phone. For questions,contact Uponor Technical Services at
888.594.7726 or terhgcmjermesemnimmata.
Fax:
Color of test orifice used:
Job Name: .12.1jAiLaegfrini1/4,-LC______. tic pressure(not flowing)readnig at incoming
Project Numbectaffr watstaer supply into home or at main shutoff: '7____,,k,_42L
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—
Job Address: - • . ..,,„ t..)i 18,41 4 4 ' —
City: supplyResidinto Residual homepressure(
owing)reading at incoming water
or at main' shutoff;
State,ZIP: ..9_Z22,3______—_--- ---"--------:----T ..„...• —
What time of day was the flow test taken? ,•-•„_ - e ___,*:t.
For designs not provided by Uponor„complete the
llowing information. Flow test method used?4Bucket i...1 Flow Meter
fo
Flow test gpm; LcC____—___.____
Designer%Name: -:”
Jadj_ALetricexiz_
_
Company: How many gallons of water did the design predict
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Phone: ....9....S72 --.. "1-7 —45:336 ,
* Did the test meet or exceed design flow?etiNes U No
Fax: ----------- Which sprinkler did you flow?Number. 111 9
fuyi.;, Is the warning sign permanently attached close to the location of head: 61.41/6/ Z eid
Ha .....)p main shutoff valve? U Yeseltsilo
Date left in service with all valves open: 0---e---(,
Was this system required by code?iiKes J No
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Test Witnessed and Verified by:
Namit
crri
tvm iiActa I 1.1t,tiup0 Di ___Ie >
Signature Occuoatizn
K.
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7.a.
____,_
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Additional Explanations and Notes
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Uponor,Inc. Tel-800321.4739
f 5925 148th Street West Fax-952.997.1731
Apple Valley,MN 55124 USA Web:www.upartor-usa,com
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