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/• AQUAS "'E' FLOW TEST
- VE ;;',IFICATION
FORM
Aqua A E Flow Test Verification. Fu.. rm
d.
Alliance important hrstalring:contra. must submit this
Member ID: completed form.Failure to . so nullifies the
f 1 t system warranty.Email or completedform
Company Name; : i . (�' .o r to the Uponor Fire Safety D ;, n Department
Contact: I Pi) " at., i i,- ..,ss=x ,,,, '.0,1 or 952.9973731.
S 1 - Li/).- 3',./o , For questions,contact • Technical Services at
Phone: 888594.7726 or tedmical u,:cesithrponor.cam.
Fax. Cour of test orifice used:
Job Name,. * Ie ct Static pressure(not flowing)r-'.ting at incoming
Project Number: tek •- k-s-1 water supply into home or at :in shutoff. WV
Job Address: !335b 5,4 : e„ . 1
Residual pressure(flowing)re..ing at incoming water
City' -ft supply into home or at main off: Y
State,ZIP af71'0)`t,).3j
What time of day was the . Fest taken? r5'OC)
For designs not provided by Uponor,complete the
Flow test method used? B' • LI Flow Meter
following information.
Fiow test gpm: OOP
Designer's Marne: �:
Company ---111M1411-r" How many gallons of water dr the design predict
as required? ID
Phone. .:_ 5'73Did the test meet or exceed d ign flow? L s Q No
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Which sprinkler did you flow? umber: 1
S-- Is the warning sign permanent) attached close to the Location of head: • e - jj__ j''�
At 1�` main shutoff valve? ( Yes t o�,r Date left in service with all vat,r•s open: 6-P,-r P
Was this system required by code'?t Ye 0 No
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y Test Witnessed and verified by:
Name,i x ik t” krtkr" l Signature - -. Occupation, yQa 1 ;i
k.I
Additional emanations and Notes
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5925Uponor,
r48th Street West Tel:8 .321.+1739
Fax.952.997.1731
Apple Valley,MN 55124 USA Web:www.up�,
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