Report • 111,57 g,016 - co
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FIRE SAFETY SYSTEMS
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AQUASAFElm FLOW TEST
VERIFICATION
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FORM
AquaSAFETM Flow Test Verification Form
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Alliance
Important:Installing contractor must submit this
Member ID-
completed form.Failure to dose nullifies the
system warranty.E-mail or fax completed form
Company Name: W .7P--------1,1,..401,1e1!0.--.
'''- ---- to the Uponor Fire Safety Design Department
Contact: `1"..g. ,___.,,,,,rl. at terka•teummtem or 9S2.997.1731.
Phone. 'ece....,-,,•N For questions,contact Uponor Technical Services at
" 8883943726 or Ulflailfdtmicesgummalm•
Fax:
----------------- Color of test orifice used: 115... ...
Job Name: 12.4Aileerradirktiae.._tx 1 .. Static pressure(not flowing)reading at incoming
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Project Number: 4")11..... kit..)T / ..> water supply into home or at main shutoff
Job Address: i 7 4, (.*- - .k x A.
*esidual pressure(flowing)reading at incorni,water
City: esi,......_ ____-. supply into home or at main shutoff: 5
State,ZIP: .....XZ.A.4Z.Z____________ ---
What time of day was the flow test taken? 7:%3C-::
For designs not provided by Uponor,complete the
followininformation. Flow test method used?48/Bucket '-.1 Flow Meter
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Designer's Name: Flow test gpm.
Company: if-2
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How many gallons of water did the design predict
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tA.t.)C4-1.4r
as required' if t?
Phone: ..91,5:2,.r_29 7...r.„5:34*-36___ Did the test meet or exceed design flow?,4,2 Yes i Na
Fax Which sprinkler did you flow?Number:
44 yr Is the warning sign permanently attached dose to the Location of head: 44 4 I 4
main shutoff valve? LlYes,,417No
Date left in service with all valves open: 2,..-6-
Was this system required by code?iiKes :3 No
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Test Witnessed and Verified by:
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Signature OCCIJ ' n Date
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Additional Explanations and Notes__ _ ___—_______
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Uponor,Inc TeL 800,3214739
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5925 148th Street West Fax 952,9971731
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Apple Valley,MN 55124 USA Web:vwvw.uponor-usa.com
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