Report (21) ,
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FIRES, ETY SYSTEMS
AQUASA ;En+ FLOW TEST
VE ' FICA" ION
,
-,-/ ac''
.AquaSAFE Flow Test Verification E F. m
Alliance important Inswing comet .• must submit this
Member ID: completed form.failure to do ,• nullifies the
Company Mame: _ ' -i° , -. system warranty.E-mail or ,E =mpleted form
to the Uponor Fire Safety r n Department
Contact: toSttF Dict vA at technical.senr)cessuponor.; , or 952.9997,1731.
Phone: °l R °l(9 For ons,contact echn#�"Servicesat
8885943726 or_.7 Jai.-i , s,'.s-,� ...�.1>3_ t=i=It.
Fax: Color of test orifice used: j S
Job Mame: 40e Tettate- Static pressure(not flowing)re ing at incoming
to
Project Number: /• water supply into home or at m. shutoff:
Job Address: _t'ID1 S'.) # o.•y.1.imsC,.tt .
Residual pressure(flowing)read g at incomiip eater
City supply into home or at main sh .ff: )
State,ZIP: -► 1Z1
What time of day was the flow =t taken? ''0
For designs not provided by Uponor,complete the
following information_ Flow test method used? Bac t Flow Meter
Designer's Name: I 244.14 Flow test gpm;
me= 1-4til How many gallons of water did e design predict
t as required? ,D `.
Phone: , `' 7 Did the test meet or exceed des:n flow? ti
Which
Yes l No
Fax: Which sprinkler did you flaws?lY� n tier:
f i
liT+'� Is the warning sign permanently ached close to the Location of head: A tr+ "` re- cc
I('1tM 7 main shutoff valve? U Yes
Date left in service with all vale:',open: ' ' )./7
Was this system required by code?iries a Na
Test Witnessed and Verified by
Name Si nature Q a Date
Additional Explanations and Notes
Uponor,Inc. Tel 800.321.4739
5925 148th Street West Fart;952.9973731
Apple Valley,MN 55124 USA Web:weiwuponorusa,com