Report raa.R.
uponor
t�— FIRE SAFETY SYSTEMS
O °�� V` AQUASAFETM FLOW TEST
VERIFICATION
FORM
AquaSAFETM Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
Company Name: . A//(V/L ?(A 1` system warranty.E-mail or fax completed form
to the Uponor Fire Safety Design Department
Contact: go\J,?e V.5 t,fyt,c.,tt at technical.services@uponor.cor or 952.997.1731.
Phone: a`1 V�j,�'-'31194C3For questions,contact Uponor Technical Services at
888.594.7726 or technical.services@uponor.com.
Fax:
Color of test orifice used:
Job Name. R. ,
Static pressure(not flowing)reading at incoming
Project Number: Lek" c;), k—'7water supply into home or at wain shutoff:
Job Address: 13380 $w
Residual pressure(flowing)reading at incoming water
City: . I f-Z ° — supplyinto home or at main shutoff: 55/
State,ZIP: 9727..
What time of day was the flow test taken?
For wing in not provided by Uponor, o i plete the
following information. (ZY�MKo9�"Ahe– Flow test method used? jBucket ;j Flow Meter
Designer's Name: Flow test gpm: �Q
Company: Lr How many gallons of water did the design predict
as required? 11
Phone:
Did the test meet or exceed design flow? ✓des LI No
Fax: �`
Which sprinkler did you flow?Number: l ►f!
447-i! Is the warning sign permanently attached close to theP main shutoff valve? U Yese4No Location of head: I?s�,.,
Date left in service with all valves open: 7-1?-11
Was this system required by code? 'es J No
V1
Test Witnessed and Verified by:
NAcat X1 Cr N j Signature Occu _ Date
0
'43U
Additional Explanations and Notes
8
Uponor,Inc.
Tel 800.321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com