Report (39) Msiaoi& - 00338
uponor
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``'" AQUASAFErm FLOW TEST
VERIFICATION
}e�x FORM
AquaSAFETM Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
Company Name: ��/jeigI- � to system warranty.E-mail or fax completed form
• I rp`A to the Uponor Fire Safety Design Department
Contact: f nb .r1'—V,skINc,I1. at technical.services@ ponor.com or 952.997.1731.
For questions,contact Uponor Technical Services at
Phone. 4�;. • 192"%k 3/9
888.594.7726 or technical.services@uponor.com.
Fax:
(��� Color of test orifice used: ;:,.,S'
Job Name: 1 V kM4 `-- Pte;0-.
Static pressure(not flowing)reading at incoming
Project Number: water supply into home or at main shutoff: L`l v
Job Address: 1 42d .$ SC,)ctis-P�.•l I bbl
"1' f;e,Ttlua
I pressure(flowing)reading at incoming water
City: . ,Car! supply into home or at main shutoff:
PP Y -G
State,ZIP: 97z2_,....
For designs not provided by Uponor,complete the What time of day was the flow test taken? ,7 jC'�
following information. Flow test method used? 4 Bucket U Flow Meter
Designer's Name: ad,-.44 2c.:eL Flow test gpm: ?o
Company: (�(�`• { How many gallons of water did the design predict
` as required? I
Phone ___ '
Did the test meet or exceed design flow? *Yes U No
Fax:
4../Which sprinkler did you flow?Number: 1� 0
Y
At i
Is the warning sign permanently attached close to theL v�.4'1 e
main shutoff valve? V Yese4No Location of head:
Was this system required b code? Date left in service with all valves open: 3 Z C{L{y
Y1 es No
Test Witnessed and Verified by:
)ZkL
i Signature Occu n�..TemNe t at ____ .►Q, Date
Z.
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63
'- Additional Explanations and Notes
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.. Uponor,Inc.
a
5925 148th Street West Fax:952.9 1.4739
i. Apple Valley,MN 55124 USA Web:www7.1731
N www.uponor-usa.com