Report 5, •V y .
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FIRE 'AFETY SYSTEMS
'i ' tirf c.3, A.-Co AQUAS .. FETu FLOW TEST
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.
V !° IFICATION
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FORM
AquaSAFETM
Flow Test Verification F,s rm
Alliance Important installing contra: .r must submit this
Member ID: completed form.Failure to — so nullifies the
system warranty.E-mail or :# completed form
Company Name: iiiii4t0#2.-r lat-ilter_. to the Uponor Fire Safety 1' Ign Department
Contact: (Atril. Pksiktpakirs, at technicatsen.rices@upon# .com or 952.997.1731.
For questions,contact Upo #r Technical Services at
Phone: 50 - tld) '5416 888.594.7726 or technical • cesq:uponor.com.
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Fax: Color of test orifice used: ••d "
(414 feTe itotf_
Job Name:
Static pressure(not flawing) ,ading at incoming/1
Project Number: lii- c,s, k- 4 water supply into home or at .am°shutoff: C7°‘
Job Address [7070 50 4,1,/ft.-4te.cAve_
Residual pressure(flowing)r• ling at incoming water
City: 150,1( supply into home or at main :utaff: %
State,ZIP; Of. 1)) 3
What time of day was the fib test taken?
For designs not provided by Uponor,complete the
following information, Flaw test method used? ri :; ket J Flow Meter
An
Designer's Name; gf4 1144,440- Flow test gpm:
How many gallons of water d.#the design predict
Company: Urn 0 r
as required?
Phone: 45)q--- ° 1 5130
Did the test meet or exceed a ign flow? ifes 1;:-.1 No
Fax:
Which sprinkler did you flow? umber:
, Is the warning sign permanently attached close to the Location of head: ltdokoiao. ',`
Ai, Tui * main shutoff valve? 0 Yes No ,
Date left in service with all va es open: 7-03'1'7
Was this system required by code? Yes r.3 No
D Test Witnessed and Verified by:
,t
,
Name Signature Oce ion , Date
1 Plitt (tP44101.- __.e1K - 131 f .-1 '' '7-0'5-11
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Additional Explanations and Notes
..•
Uponor,Inc. Tel:800321.4739
5925 148th Street West Fax:952.9971731
Apple Valley,MN 55124 USA Web:vvwwuponor-usa.com
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