Report msrao16 - 0033$
' Art U I ! s nor
. . ,
,,,,. , , , , ....„ 4,,.
.. , , A'," -,
FIRE FETY SYSTEMS
/ , ,:'
a" ,/ r- AQUASA En. FLOW TEST
VE ® FICATION
FORMAqua AFET Flow Test Verification Fri
Alliance Important:Installing a • . must stebmit this
Member ID:_ completed form.Failure to do=', nullifies the
Company Name: tt tawle., 110.041.4) system Warranty E-mail or i s completed form
i r is •v> tot Uponor Fire Safety ,,'n Department
Contact: I� at tectinical servi gor. , or 952.9971731.
Phone: ' ) " afi p?-. )190 For questions,contact LI-, . < ethnical Services at
888.594:7726 or tethplattse ` tr»cant;.
Fax: Color of test orifice used: ,
Job Name: ` .'J Static pressure(not flowing)r...;.Mg at incomings
Project Number Lk 0/.4./ water suppply into home or at in.in shutoff;
Job Address: 1fi1J' .@. gilt.td, ;
}
Residual pressure(flowing)rear:g at inca in water
City: wt^ supply into home or at main :.ff: 5 `
State.ZIP: Ott.t � el�
Why time of day vias the flow t taken? 7:10
For designs not provided by Uponor,complete the
following information.
flow test method used? l Iuc;=- U Flow Meter
Designer's Name t A+* k.4.0.10.,
Flow test Spm A. i
Company: How many gallons of water did e design predict
as required? it
Phone: .' 3�. �/
W Did the test meet or exceed desk;n flow? �JYes No
Fax: Which sprinkler did you flow?N tuber: tt`&
Is the warning sign permanently attached close to the Location of head: frit ') *; rm.^
tri pot* main shutoff valve? Ci Yes Ko
Date left in service with all vale`<open: 7'17./
c Was this system required by cede?( Yes 3 No
r
fiest tNtirtessed and Verified by ,:int
Nam Signature Occupation , Date
> iE ' . _ 9'/74
0
Additional Explanations and Notes
d
Uponer,Inc. Tel:800.321,4739
5925148th Street West Fax:952.997.1731 :`
Apple Valley,MN 55124 LISA Web:tiwvw.uponor*usa,com
,