Report (30) r 1114 07) ST aa16 - 0003 ,
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FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
VERIFICATION
FORM
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AquaSAFETM Flow Test Verification Form
Alliance Important Installing contractor must submit this
Member ID: 1964 completed form.Failure to do so nullifies the
Company Name: Gravity Plumbing system warranty.E-mail or fax completed form
to the Uponor Fire Safety Design Department
Contact: Jon Hinkle at tedmisaLssodssatumnimem or 952.997.1731.
Phone: 503-490-0763 For questions,contact Uponor Technical Services at
888594.7726 or technical.servicesauponor.com.
Fax: 971-250-3808 Color of test orifice used: Black
Job Name: Summit Ridge -I ys—
Static pressure(not flowing)reading at incoming
Project Number: 19070 F 00( water supply into home or at main shutoff: 78psi
Job Address: [3(16,9,.. VocAP tan
�' Residual pressure(flowing)reading at incoming water
City: T► supply into home or at main shutoff:
State,ZIP- De
1Z22_4
What time of day was the flow test taken? 3fe..
For designs not provided by Uponor,complete the
following information. Flow test method used? U Bucket I3 Flow Meter
Designer's Name: Patrick Brown Flow test gpm: (11 rein
Company: Uponor How many gallons of water did the design predict
as required?179pm
Phone: 888-594-7726
Did the test meet or exceed design flow? 0 Yes 0 No
Fax: 952-997-1731
Which sprinkler did you flow?Number: l D
Is the warning sign permanently attached close to the Location of head: 134.41rubs, 3
main shutoff valve? Yes U No
Date left in service with all valves open: 2-1-n
Was this system required by code?0 Yes U No
Test Witnessed and Verified by:
Name -�+ natur �cupatiorl Date
C
sAdditional Explanations and Notes
Uponor,Inc. Tel:800.321.4739
5925148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com