Report (43) ir..57- 27i6 — 00230
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Uponor
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FIRE SAFETY SYSTEMS
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AQUASAFETM FLOW TEST
4 VERIFICATION
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FORM
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AquaSAFE Flow Test Verification Form
Alliance important Installing contractor must submit this
Member la completed form.Failure to do so nullifies the
Company Name: emzeb.mial INA system warranty.E-mail or fax completed form
,„„, , 1 to the Uponor Fire Safety Design Department
Contact: 14.4-Aager IJ*M4lvt3:41. at tectinkaLsenticeseuporior.com or 952.997.1731.
For questions,contact Uponor Technical Services at
Phone. ece.:,A : 1?2-3,119zY 888.594.7726 or technicaLserviceseuponor,com.
Fax:
Color of test orifice used: 15:*%% .3 )
Job Name: ,, i tA.141# Te..C1C`.‘.0 e..... Static pressure(not flowing)reading at incominni ,,,_
Project Number: '/ 1.43T- is/ water supply into home or at main shutoff: &Co;
Job Address: JI(.Y ,514,..0) 1‘42,114 rvx rtn"- -i-e_
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. , Resi ua pressure(flowing)reading at incoming water
supply into home or at main shutoff: . 5iti
City: . 1 94042S
State,ZIP: 972.z.A
What time of day was the flow test taken? 7:-3c'
For designs not provided by Uponor,complete the
Flow test method used?ialt Bucket ':,1 Flow Meter
following information,
Designer's Name: IAA'fa OAT er/z Flow test gpm: i 7
How many gallons,of water did the design media
Company: irk.f)CrW:r
as required? /0
Phone: 952.,-'? ',2 -..53:31!)„,,
ad the test meet or exceed design flow?etrYes U No
Fax:
Which sprinkler did you flaw?Number:,41, cif
4i -rii_, . Is the warning sign permanently attached dose to the Location of head: 4 6
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lfin .....,main shutoff valve? U YesAINo
Date left in service with all valves open:
Was this system required by code?OlYes 7..3 No
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Test Witnessed and Verified by:
Signature acalPAIP Date
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Additional Explanations and Notes
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,5. Uponor,Inc. Tel 8003214739
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S 5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:vwwv.uportor-usa.corn
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