Report (17) 1)157AO'6 - 04361
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T_ FIFE S,'FETY SYSTEMS
AQUASA ' Th FLOW TEST
to. VE'1 FtCATION.
t
FORM
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AquaSAFE Flaw Test Verification Fs)
Alliance Important Installing contra* , must submit this
Member 10: completed form.Failure to do , nullifies the
Company Name; /1 t, systemwarranty.E-mail arf,'completed form
to the Uponor Fine Safety r .n Dapartment
Contact: €' Of5fw *v-,. attechnieat.services@upanor a. or 952.997.1731.
I"4147)'3y�6 Far eprestions,contact Upa 1 ectrrtieaA rvlces at
Phone: 8 .59+t.T726 err technical..fit»- er.co .
Fax: Color of test orifice used: s.i++cc
Job Name: , gllitir
e ma►et, Static pressure(not flowing)r-. ing at incoming
/-
Project Number: tiff 16,+ water supply into home or at tn. shutoff: (0100
i
Job Address: t.► Ye,t�.rhr .
_ qq Residual pressure(flowing)rea t, g at incoming water
City: +,A.e'rR supply into home or at main sh .ff: y
State,ZIP: O&, 42/7.4)›,i
What time of day was the flow', taken? 7`'0
For designs not provided by Uponor,complete the
following information. Flow test method used? Bu „et )Flow Meter
Designer's Name‘,
Flow test gpm:
Ccrnparky: /" How many gallons of water did : design predict
as required?i /0
Phone: .q: 7.5330 f ,,��
Did the test meet or exceed d- to flow? C1 Ypes Ci No
Fax: Which sprinkler did you flow?Nrmb/er: +r t7
Is the warning sign permanently����aft shed close to the Location of head: 'S i r
1 main shutoff valve? Cl Yes 'fNo
,,�' Date left in service with all valva. open. -
Was this system required by code?1gYes J No '
1 Nest Witnessed and Verified by
E Nar� Signature Occupation n I " Date
4
a
Additional Explanations and Notes
il
Uponor,Inc. Tel:800321.4739
15925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA www,uponor-usa.com