Report (29) /1/157--a701&
a a
, , ...., u s ono(
. ., ,
. ,
.., g-
L FIRESAFETY SYSTEMS
1 t -,G i--- C, /
1 I '
AQUAS FE-Thi FLOW TEST
V:1• IFICATION
FORM
. , ,;, .. , ' • if l'''''''
. ..,.
. .
AquaSAFETM Flow Test Verification *I rril
Alliance Important:Installing contra",, . must submit this
Member ID: completed form.Failure to • so nullifies the
Company Narne: AlkiaLlt-t 6(44. .,.. tosyst.eem warranty.E-mail or 'x completed form
th Uponor Fire Safety 0-ign Department
Contact: 19 e.f4' 01<144'll.v‘ at technicaiserviceseupon. .con or 952.9971731.
Phone: C>c9- 9/ - '391D For questions,contact Upo ,r Technical Services at
888.594.7726 or technicals ceseuponor.com.
Fax: >to
Color of test orifice used:
Job Name:Name: giVet Terre4e-
Static pressure(not flowMg) ading at incoming
'
Project Number- 104- 5 I i 5-6, water supply into home or at shutoff-
ain
Job Address: 11996 St,/Ilookii 4.,...1 rt.tokoke. --
er i Residual pressure(flowing)riding at IrtconLgin water
City r 156,..rd ........ supply into home or at main . utoff:
State,ZIP: .I.:;41-/. iii!).0t/1/
What time of day was the fl. :test taken? 414'490
For designs not provided by Uponor,complete the
following information U
Flow test method used? ,!: t.'Icket Flow Meter
Designer's Name: (4;r7.1,067, Dte4t- 141.0fiaek Flow test qpm: b '
How many gallons of water d'.the design predict
Company: kit fOtAer
as required' 17
Phone: 5e,157-7 " 530
Did the test meet or exceed r ign flow? '"eYes CI No
Fax:
Which sprinkler did you flow. Number: il.41
Is the warning sign permanently }att ched close to the Location of head. Wr
A+Trivvil main shutoff valve? U Yes a'No
Date left in service with all v. es open. -7-e'S-(-7
Was this system required by code?ZrYes J No
3 ._...'' . . . ..._...__......._....'..'_..
Test Witnessed and Verified by:
t
Name Signature Occu§ation Date
l'45 -17
R —
0
z
Additional Explanations and Notes
- . —
) '
Uponor,inc. Tel:800.321.4739
5925 148th Street West
Fax:952.997,1731
Apple Valley,MN 55124 USA
Web:wwwv.ttponor-usa.com 1