Report (37) ‘V.,,•--
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FIRE SAFETY SYSTEMS-
Lo\-1-. (D,I LI.-'7
f--:.:7 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
system warranty.E-mail or fax completed form
Company Name: 4uo-c,
to the Uponor Fire Safety Design Department
Contact: goLft D 1 ,Siesrxi, at technir.al.sentices@uponorcom or 952.997.1731.
Phone: 5i9' - For questions,contact Uponor Technical Services at
888.594.7726 or technicalserviceseuponorcom.
Fax:
Color of test orifice used: 415153'
Job Name: g 1Ar.'re ftaCe_ Static pressure(not flowing)reading at incoming
Project Number: Lot-4•1 "E-9 water supply into home or at main shutoff:
Job Address: 11 e)-cL1 e,tV X03.-erfj:v•-7.:W's.
Residual pressure(flowing)reading at incoming water
City: geetreetilre< 1-1-,c4/4 supply into home or at main shutoff: 4/6
State,ZIP: 0R—
What time of day was the flow test taken? £ 0,,
For designs not provided by Uponor,complete the
following information, Flow test method used? /Kucket J Flow Meter
Designer's Name: iret„.4- k0hs2A Flow test gpm: Da
Company:
How many gallons of water did the design predict
(Ayetp./
as required? 17
Phone: $570
Did the test meet or exceed design flow? itries Ci No
Fax:
Which sprinkler did you flow?Number: 57
Is the warning sign permanently 5tached close to the
Location of head: 1 - ,.., )-
I l';‘-•"1 main shutoff valve? Cl Yes 5Na
Date left in service with all valves open: 6- /-i
Was this system required by code?i 'c'es Ci No
.41
Test Witnessed and Verified by:
-.f.-
-Z- Name Signature Occupation Date
6.
0
3
Additional Explanations and Notes
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El
1. Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952,997.1731
1,1 Apple Valley,MN 55124 USA Web:www.uponor-usa.com
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