Report (23) ryl sr _ a oi‘ - 00 3 5-7
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J.;.,. 1 ' ii A' uponor
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.. . FIRE SAFETY SYSTEMS
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AQUASAFElm FLOW TEST
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VERIFICATION
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FORM
Aqua.SAFETm Flow Test Verification Form
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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: ill 16,01.,- 11401rwri
---r. to the Uponor Fire Safety Design Department
Contact: Reflager''...M5tt.1%.r.Nrt at tedmicalserviceseuponor.com or 952.997.1731.
Phone: ,s6,3 ..4/92..,..34/901:2 For restiorLkorcotn:cahrtnitlposnetvior Technical Services at
R88, lernor.com.
Fax:
Color of test orifice used: 751r1",,,5 S
Job Name: RI iii4"'-r — Static pressure(not flowing)reading at incoming
Project Number: Le ". 11 water supply into home or at main shutoff: VCI
Job Address: 17611 i cui
Residual pressure(flowing)reading at incomiN water
City: . 179444 supply into home or at main shutoff: 5y
State,ZIP: 9722 :3
What time of day was the flow test taken? ,.
/ ,-.44.WIllq't°
For designs not provided by Uponor,complete the
following information.
Flow test method used? Bucket Ll Flow Meter
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Designer's Name: 44 e41 50 gtric CriZ Flow test gpm. af
as required? i
Company:
How many gallons of w
Pho9_,S4er did the design predict
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ti
ne: -2r:2 ,2 -5733ira_
Did the test meet or exceed design flow? Ifrres LI No
Fax:
Which sprinkler ditlyou flyow?Number: ii.,3.
41 •i-.r, Is the warning sign permanently attached close to the Location a h...k. PA ".#4,-tale.-
P m
/414 - sin sfittoff%with, L-.)ye,_________
Date left in service with all valves open. -101)
Was this system required by code? 7Yes :..1 No
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Test Witnessed and Verified by:
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Name, _
accu ' n ate
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LSignature cre,4,,,Acd,t
..._. .
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14
f Additional Explanations and Notes
23 .
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Uponor,Inc. Tel 800.321.4739
5925 148th Street West Fax 952.997.1731
.1.1
Apple Valley,MN 55124 USA Web:www.uponor-usa,com
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