Report (38) i Y
MST a v t 6 - o O 3 ,40
at r
uponor
FIRE SAFETY SYSTEMS
,:
AQUASAFET"' FLOW TEST
VERIFICATION
FORM
AquaSAFEFM Flow Test Verification Form
Affiance Important:Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
Company Name: frilh41(,/0_2 �„` „�� system warranty.E-mail or fax completed form
'�`'=�- to the Uponor Fire Safety Design Department
Contact: !�''bya,r`'"- .Skflilc arl. at technical.services@Aponor.com or 952.997.1731.
Phone: �' 7�9 -� 1�/f� For questions,contact Uponor Technical Services at
888.594.7726 or technical.services@uponor,com.
Fax:
(��� Color of test orifice used: :-.S!'SJob Name: I V ki1/4.1.,6'.1.9 �,.-L e.... Static pressure(not flowing)reading at incoming�,
Project Number: water supply into home or at main shutoff: LJ O
Job Address: 17091.5
,,)-'-an\bl6 r
j,/' esidual pressure(flowing)reading at incoming water
City: I44 er — supply into home or at main shutoff:
State,ZIP: 97zZ.
What time of day was the flow test taken? 7::-.3c,
For designs not provided by Uponor,complete the
following information, / n Flow test method used?Ai Bucket -1 Flow Meter
Designer's Name: ae, 4 1�.`.. ft:crf,Z Flow test gpm: 1315
Company: How many gallons of water did the design predict
`'`4' �
-
as required? (0
Phone: ._ 7.2._r 7 '53,:_it'___.
Did the test meet or exceed design flow? Ves J No
Fax: ,L
A Which sprinkler did you flow?Number: 1 . 3
11/. Til AA Is the warning sign permanently attached close to the
F Location of head: /44 it, �
�► main shutoff valve? []Yes�No
�j� Date left in service with all valves open: ,3..2Lf`4 7
Was this system required by code?k es J No
Test Witnessed and Verified by:
W N Signature Occu ' n Date
7
x
-
ed
L
7
5. Additional Explanations and Notes
.s,
'.4
4i
u Uponor,Inc. Tel 800.321.4739
,t 5925 148th Street West
Fax 952.997.7731
�t Apple Valley,MN 55124 USA Web:www.uponor-usa.com