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uponor
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FIRE SAFETY SYSTEMS
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AQUASAFETM FLOW TEST
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VERIFICATION
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AquaSAFT 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. Lim_
Ailiciet,..__21Liten .`
„..........., , to the Uponor Fire Safety Design Department
Contact: IZOk)42tr 1 3..i6k.(1/1.cArl. at tedmical.serviceseuporior.com or 952.997.1731.
riga.. a j,„. For questions,contact Uponor Technical Services at
Phone' ;S4::1*-5 ' 7 1%4-'311'4.- 988.594.7726 or technical.serviceseuponor.com,
Fax:
Color of test orifice used:
Job Name: Q.;i k t 2" Tex,:,,....., 1,.. ‘....,.tr
Static pressure(not flowing)reading at incoming
Project Number: water supply into home or at main shutoff-
_
Job Address: /37 <St.. 3,‘igito 4 Vcv,6 rierc44,e.
Residual pressure-glowing)reading at incoming water
. . ,
State,ZIP: 972 ZS --- ,
What time of day was the flow test taken? 7:,3r,
For designs not provided by Uponor,complete the
Flow test method used?4Bucket Flow Meter
following information.
Flow test gpm: /7
Designer's Name: „ .7'44 attic'6.712
How many gallons of water did the design predict
Company: jAf).,,caar..___
as required? ilt,
Phone: .95_72„ .-9e1 7 -5-33tA__ Did the test meet or exceed design flow? Yes LI No
Far
Which sprinkler did you flow?Number. W. if
44 -ri,, Is the warning sign permanently attached close to the Location of head: 1 Ati....„ . ...
1 6'1 .,„,„jp main shutoff valve? LI Yes4PNo
Date left in service with all valves open: Z--g.-/Y'
Was this system required by code?Nles :".1 No
1.,, .........................................„....,,..............•................„.....-......-......... ,.._.-.. ...-.-.....--..... .
Test Witnessed and Verified by:
r. Signature exclit Signature Occu Attoinuti43..,4,,. .ate
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X
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Additional Explanations and Notes
6,
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". 1 Uponor,Inc. Tel.8(X).321.4739
5925 148th Street West Far 952 997.1731
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4 Apple Valley,MN 55124 USA Web:www.uporrorusa.corn
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