Report (20) 16 - 0 ° 3 I q
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Uponor
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' V FIRE SAFETY SYSTEMS
AQUASAFErm FLOW TEST
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FORM
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AquaSAFE Flow Test Verification Form
kliance Important:Installing contractor must submit this
Member to _.. Completed form.Failure to do so nullifies the
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system watranty.E-mail or fax completed form
Company Name: kn.&
1 to the Uponor Fire Safety Design Department
Contact: )10 . 4tjechnicatxtratttiumxfam or 952.997.1731.
phone. .._. . v9, For questions,contact Uponor Technical Services at
888.594.7726 or • ,1.1.:. . ILL 4.q ....i.. ..m.
Fa)'. -------------------- Color of test orifice used: a;,::::A,,,,.....*::)__• ______
pressure(not flowing)reading et incoming/
Project Number' Staticwater supply Mto home or at main shutoff'____A-1_42____
L313
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Job Address: _4_2/_./1) 5U !,,e4 .Rti,,,,,,e -----------------------
pressure(flowing)reading at incoming wat
City er
_ supply into home or at main Shutoff _____$_q______
State,ZIP:
What time of day was the flow test taken?
For designs not provided by Uponorcomp, lete the
following information.
Flow test method used?.1/Bucket —1 Flow Meter
Designer's Name: F19141 teat
How many gallons of water did the design predict
Company- 1.444:4,..acr______
as required' i 0
Phone: 2,__•::_ .:122--533r1.._
Dci the test meet or exceed design flow? grYes j No
Fax: -----------------__-- Which sprinkler did you flow?Number.
A./ Till Is the warning sign permanently attached close to the Location of head:
I al ...*main shutoff valve? Li. YesdOivo
Date left in service with all valves open
Was th:s system required by cocie4Kes j No
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Test Witnessed and Verified by:
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Signattire _,4pQrOccu ' , Date
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Additional Explanations and Notes'i:,
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Uponor,Inc. Tel 800321.4739
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5925 148th Street West Fax 952.997.1731
App le Valley MN 55124 LISA Web:www.uportor-usa.com
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