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mST o16- 0033 ' li ft, up' ' "1t ` . . . . . ,. .'74 *J VMS FIRE S m`FETY SYSTEMS AQUASA ETm FLOW TEST VE . FICATION y ; ':. FORM „ Apia .AFET Flow Test Verification Es Alliance Important:installing,contract must submit this Member ID: completed form.Failure to do`-i nulifies the Company Name: it:irate- e systemwarranty.E-mail or f r compi form to the Uponor Fire Safety , :n Department Contact: 1.4‘414- V lirm r, at technical servicesarponor,'= or 952.997.173i. For tee/ unease questions,contact . . ethnical Vices at Phone: Cy , - �i ' - Wil I.. ., or.cont. m8.5941726tee/uneaseF< Fax: , >` Color of test orifice used: ' rt Job Name: bye/ ?efl Static pressure(not flowing)r .ing at incoming Project Number: � 'r' water supply into home or at .- shutoff: 6 Job Address: 1'7634 Stj 5't w 1141:L.Cd. Residual pressure(flowing)read,g at incoming water City: "Tlartrral supply into home or at main sh .ff: Or State,ZIP: lam. f 4/7 What time of day was the flow L,1 taken? 7.10 For designs not provided by Uponor,complete the following ixfaririatlon. Flow test method used? i�HuI Flow Meter Designer's Name: f?troaokFlow test gpm 40 Company: _ �IOWi� How many gallons of water did e design predict as required? 10 a Phone: r Did the test meet or exceed des Q�ri flow? el`Yes ;;1 No Fax: Which sprinkler did you flow?N tuber:_ , ` A4/ is the warning sign permanently a ached close to the Location of head: 'LAW- , `ter, Aver "10" main shutoff valve? ©Yes ; Nor Date left in service with all vale open: , 'f~J'i'-) t Was this system required by code?`!f Yes l No el Test finessed and Verified b . . Name Signature O upati€:tr Date y i' Additional Explanations and Notes s t t3ponor,Inc. Tel.800.321.4739 f„. 5925148th Street West Fax:952:S97.1731 Apple Valley,MN 55124 USA Web:www uponorwna.cam I