Report (29) s 7 rnST 2o17- o0o7c_i
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� I FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
VERIFICATION
`_' FORM
A aSAFETM Flow Test Verification Form
Alliance Important Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
Company Name: A i 1.ow►c,- Pt 4.44 n em warranty.E-mail or fax completed form
,1 to the Uponor Fire Safety Design Department
Contact itAgit' DtSL 4t at technical.services@uporior.com or 952.997.1731.
SO 3- q 3y°)D For questions,contact Uponor Technical Services at
Phone: 888.594.7726 or technicalservioessu
Itona'.co(q.
Fax: SS
,/� Color of test orifice used:
Job Name: 9-Wei' Teer Ue. Static pressure(not flowing)reading at incoming
Project Number: 1 4 water supply into home or at main shutoff: ta.2
Job Address: 1357 S139�c4447- LL-7der
Residual pressure(flowing)reading at incgming water
City: Ti,wrai supply into home or at main shutoff: S4
State,ZIP: OIL) €0a4.5
What time of day was the flow test taken? (3:a„°
For designs not provided by Uponor,complete the
following information. J Flow test method used? ellucket 0 Flow Meter
Designer's Name: ?ft 4 T Flow test gpm: e70-1.
Company U; efMt~ How many gallons of water did the design predict
Phone: 954 -997- s)5°
��
as required? l`7
Did the test meet or exceed design flow? lYYes 0 No
Fax: Which sprinkler did you flow?Number: ii.
Is the warning sign permanently attached close to the Location of head: gee/ 2
At ths.44, main shutoff valve? 0 Yes C9 0
Date left in service with all valves open: /`")
Was this system required by code?lilies 0 No
ATest Witnessed and Verified by:
Name Signator Occupat on Date
yti1;1ic(420610.11Yv .gyp l4,44
r,
Q
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.cwn