Report (43) n?STlCI6 - 003CO
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1D. -" Is Irr SYSTEMS
"` a. , „: .„,„„, AQUASA ;ET° FLOW TEST
' 3fE' FICATION
FORM
Ac uaSAFETM Flow Test Verification F e
Alliance ImportantInstalling contra• :
most submit this
Member ID: completed form.Failure to do o nullifies the
Gam n Marne: rt. system warranty.E-mail or f, ;:completed form
Pay ,( to the Uponor Fire Safety ' ; Department
Contact:_ LSP i- i91S W'N. at ....f a +, .ia . ,°'.tx aG.< A. or952 1,1731.
' For qu ,estionscontact . echrric Services at
Phone: ts"r i " 9190 ss6.594.7726-sx
Fax: t� Color of test orifice used: zau
Joh Name: f4C T YA C Static`pressure(not flowing) .F'ing at incomi
_
Project Numberbeetot /0.3 water supply into home or at lir. shutoff'
Joh Address: 17.0)* 5w 9e4." N.
Residual pressure(flowing)read;g at incomiewater
City: supply into home or at main sit ,ff:
State,ZIP: Oft f 'l3
What time of day was the flow t t taken? �`
For designs not provided by Uponor,complete the
Flow test method used? Y13kluc l-t 'J Flow Meter
following information, .
Designer's Name: € Flow test gpm:
Company: _ + `i�T
How many gallons of water did ae design predict
�j as required? f4' 1
Phone: ' m ltl Did the test meet ori exceed deswn flow? CIYes la No
Fax: Which sprinkler did you flow?N i her: /,,^2
iiti�,,,, Is the warning sign p ntl ed dose to the location of tread: �' D c
,r 11-10%., main shutoff valve? a J�'es °�
Date left in service with all valv.z;open: 1}"/)
c Was this system required by code?l Yes a NoA .
;<
''' Test Witnessed and Verified by
s' Name Signe`e - Occur atiori ,, Date
,
Additional Explanations and Notes
ll
Uponor,Inc. Tel:M0,321.4739
5925 148th Street West Fax:957.997.1731 ''
Apple Valley,MN 55174 USA Web:www.uportor-usa.com '