Report (48) s
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FIRE SAFETY SYSTEMS
` AQUASAFErm FLOW TEST
VERIFICATION
FORM
AquaSAFE M Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
Al _. _ _ system warranty.E-mail or fax completed form
Company Name: 1e:44 t
I,�,i t ►-i .A_ to the Uponor Fire Safety Design Department
Contact: ?\.2eYi -V,S‘,lfkc'n. at technical.services@uponor.comor 952.997.1731.
;�q � For questions,contact Uponor Technical Services at
Phone: S c:,-. 888.594.7726 or technical.services@uponor.com.
Fax: Color of test orifice used: ::,.S 7
Job Name: (kA.1 'TeX:* L t Static pressure(not flowing)reading at incoming
Project Number: water supply into home or at main shutoff: t' COI
Job Address: no
..�* 'dual pressure(flowing)reading at incoming water
City: , f .."f supply into home or at main shutoff:
fre
State,ZIP: 972 Z-1
What time of day was the flow test taken? .7
For designs not provided by Uponor,complete the
following information, Flow test method used?usBucket ]Flow Meter
Designer's Name: aaa`JI4 P ;t'.c�2 Flow test ypm:!'C J
Company: <` 'lfif How many gallons of water did the design predict
as required? \to
Phone: 95,.... +.._:. Z L__..
Did the test meet or exceed design flow? Yes U No
Fax: Which sprinkler did you flow?Number: hL r
Is the warning sign permanently attached dose to the Location of head:____Ltat20,4m.1/4____ _
f T T main shutoff valve? Li YesA(1No
Date left in service with all valves open: —2 Y.4>
Was this system required by code? 'es J No
Test Witnessed and Verified by:
Narne,Mt 144, 6legvkcat Signature Occu n Date
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P. Additional Explanations and Notes
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Uponor,Inc. Tel.800.321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponorusa.com