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Report (53) MSS x. 017 — 00070 I ,..,&.:,/,' t,. i , ,, „, upono ', ....„, ,, , ,,.,., FIRE SAFETY SYSTEMS E : AQUASAFETM FLOW TEST b .3 VERIFICATION r-0fal AquaSAFETM Flow Test Verification Form Affiance important:installing contractor must submit this Member ID: completed form.Failure to do so nullifies the Company Name: A I I;o Mt f p(i.43/44.1„ system warranty.E-mail or fax completed form to the Uponor Fire Safety Design Department Contact: itet,ett Dt5L 4o n at technical.services@uporior.com or 952.997.1731. Phone: So 3-1')13-- ', °i o For questions,contact Uponor lechnial Services at 888.594.7726 or technicalservic+es@uponor.com. Fax: ,,//�� Color of test orifice used: SS iw Job Name: VVc Terrace Static pressure(not flowing)reading at incoming Project Number: Lit 1 d ^ water supply into home or at main shutoff: Cs Job Address: /3113o SC.J wo.� 1Pc., . Hey 4.v -(fl neowing)reading at ince ming water City: -,64.4 supply into home or at main shutoff: 5S/ State,ZIP: ©r-, epai3 What time of day was the flow test taken? 13° For designs not provided by Uponor,complete the . following information. Flow test method used? Bucket 0 Flow Meter Flow test gpm: "+� Designer's Name: I,-..,4 kb ,o. „�; Company: U, elle!' How many gallons of did the design predict a 5 SS o as required? Phone: /5 -197" __�� Did the test meet or exceed design flow? Crf s 0 No Fax: Which sprinkler did you flow?Number: W. Is the warning sign permanently attached dose to the Location of head: "-gel_ 2...._ A4-1r1 4.4.3 main shutoff valve? 0 Yes tJ No Date left in service with all valves open: �' Z.e.—I Was this system required by code?1Yes 0 No I v Test Witnessed and Verified by: "__ Name Signatur Occup ion Date 1 IM;1�C 1► nc. r. 0 R I Additional Explanations and Notes A 1 Uponor,Inc Tel:800.321.4739 , 5925 148th Street West Fax:952.997.1731 Apple Valley,MN 55124 USA Web:www.uponor-usa.con