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Report (36) , . .,„..,. :„ ii,. > , . : luponol FIRE SAFETY-SYSTEMS I AQUASAFETM FLOW TEST VERIFICATION FORM AquaSAFETM Flow Test Verification Form Alliance Important:Installing contractor must submit this Member ID: completed form.Failure to do so nullifies the Company Name: 4(bet itice_. viAA c f t _ system warranty.E-mail or fax completed form to the Uponor Fire Safety Design Department Contact: Pi Se. 915(11/4,-x4c• at technical.services@uponor.com or 952.997.1731. Phone: So -y`i'I' y/p For questions,contact Uponor Technical Services at 888.594.7726 or technical.services@uponor.com. Fax: 2 Color of test orifice used: /JPS Job Name: V--C r7 e r(`Ut.e- // Static pressure(not flowing)reading at incoming Project Number: 1-0.-f- 6,.3 t4-7 water supply into home or at main shutoff: S�- Job Address: ())79 (71,JAv t);re —ler, Residual pressure(flowing)reading at incomin water City: r� � � supply into home or at main shutoff: 146 State,ZIP: OPS- 1-7a)-3 For designs not provided by Uponor,complete the What time of day was the flow test taken? 8'c c" following information. Flow test method used? 'ucket U Flow Meter Designer's Name: ii3(f-j- In Flow test gpm: P7 Company: l7 'nvo How many gallons of water did the design predict pppU as required? 17 Phone: Did the test meet or exceed design flow? LI Yes ©No Fax: ii Which sprinkler did you flow?Number: (4. L Is the warning sign permanently at.ached close to the Location of head: roxii.-t, N vAN/ main shutoff valve? CU Yes Zi No Date left in service with all valves open: ( (i 17 Y Was this system required by code? Yes D No t C Y Test Witnessed and Verified by: f, Name Signature Occupation Date ,r Ill - C,,,, ,9.4( -11 plLU 6.°/. /. 0 a 0 Z o, Additional Explanations and Notes cr wi gUponor,Inc. Tel:8(X7.321.4739 5925 148th Street West Fax:952.9971731 Apple Valley,MN 55124 USA Web:www.uponor-usa.com