Report (50) r201 — 0007'
uponol
A z FIRE SAFETY SYSTEMS
AQUASAFETM' FLOW TEST
VERIFICATION
AquaSAFETM Flow Test Verification Form
Alliance Important Installing contractor oust submit this
Member ID: completed form.Failure to do so nullifies the
Company Name: A I I�o„icG P(1 �i n system waw.E-mail or fax completed form
to the Uponor Fire Safety Design Department
Contact: itoi,eA" De Low" at tethnicai.servicesluporlor.com or 952.997.1731.
Phone: SO 3- q . 3y°)0 For questions,contact Uponor Technical Servkes at
888.594.7726 or technical.servicessuponor.com.
Fax: /� Color of test orifice used: Pr,'S
!
Job Name: )ec TetraCte. Static pressure(not flowing)reading at incoming
Project Number: L t 1 water supply into home or at main shutoff: i&b
Job Address: 13gg2_ S._,lara.ide �..=I esi 6
ua res Tfibwing)reading at incoming rater
City: TI)atitot supply into home or at main shutoff: £Y
State,ZIP: OIL) q�a.3
What time of day was the flow test taken? e$'mO
For designs not provided by Uponor,complete the
following information. Flow test method used? No Bucket 2 Flow Meter
33�e�,k Flow test gpm: `"
Designer's Name: ya
Company: nNb�' How many gallons of water did the design predict
95 -99 )- 55°} as required? 17
Phone:
Did the test meet or exceed design flow? ttYes 0 No
Fax: Which sprinkler did you flow?Number: ii.
Is the warning sign permanently attached dose to the Location of head: C-Rel.
.
A4-11 6,44 main shutoff valve? 0 Yes Co
Date left in service with all valves open: )
Was this system required by code?IYes 2 No
Test Witnessed and Verified by:
Name Signaturj / Occu ion Date
(N1;1�Gra r�a11 r�" 1 e- -`2.0 a'7
a
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Additional Explanations and Notes
Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com