Plans (25) , 1
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FIRE ,AFETY SYSTEMS
LAQUAS ,FET'A FLOW TEST
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_4- C, 4 1 V:RIFICATION,
FORM
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AquaSAFETM Flow Test Verification I rm
Alliance Important:Installing oantra- ,r must submit this
Member ID: completed form.Failure to • so nullifies the
Company Name: A zh etga- iitttitetriA, system warranty.E-mail or r.t completed front
---, - to the Uponor Fire SafetyoIgor Department
Contact: hcal+ iksivi,,,. at technicatserviceseupo .'.cont or 9S2.997.1731.
Phone: ,ci3- ti, ' 3tilo For questions,contact Upo .r Technical Services at
8E8594.7726 or technicals •ceseuponoccom.
Fax: ey, Color of test orifice used:
Job Name: Ellitif'141Iettot.-
i i_ Static pressure(not flowing) ading at incoming .‘
Project Number: lir'''ot 14--(a water supply into home or at am shutoff: 40'04
Job Address: 170g 1 51.)IW.,' 0044-•t'''"(--
Residual pressure(flowing)r,"'cling at incomiswater
City: Tipow supply into home or at main , utoff: X,
State,ZIP: og-i in A'S
What time of day was the flo test taken? 21'412
For designs not provided by Uponor,complete the
following information. Flow test method used? .% :,.cket U Flow Meter
> '
Designer's Name: 64 Flow test gpm:lja41,4,
How many gallons of water d,the design predict
Company: „. Uli
as required? 17
Phone: %-qi)-5'330
Did the test meet or exceed i, ign flow? ees CI No
Fax:
Which sprinkler did ou flow. Number: M/
ji I Is the warning sign permanently attached dose to the Location of head:
it fe I I,147 main shutoff valve? C-.)Yes kNo
Date left in service with all v. es open: 7'0 5'17
Was this system required by code?Cii;es J No
51
Test Witnessed and Verified by:
Name Signatur Occupation Date
11414- trcyviAlk ,f r , ,-
4 ,
Additional Explanations and Notes
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Uponor,Inc. Tel;800321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-tekuote