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AQUASAFETM' FLOW TEST
VERIFICATION
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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 i l' plxvo, f(ttw►LJ n n" .Email or fax completed form
to the Uponor Fire Safety Design Department
Contact: 'Liget- Dtc6,4a,n at technicalsetvicaseupon r.comor952.997.1731.
Phone: cos.H ci.).- b4 q 0 For questions,contact Uponor Technical Services at
888.594.7726 or technicai.serviceseuponor.com.
Fax: 124
Color of test orifice used: `S,
Job Name: 124vet Tereate.. Static pressure(not flowing)reading at incoming
Project Number: 1.4- / water supply into home or at main shutoff: tv Z
Job Address: / 3 ,/c eitia
Residual pressure(flowing)reading at incoming water
City: Ti)µro( supply into home or at main shutoff: $4
State,ZIP: 4(t i 41‘),:).)-5
What time of day was the flow test taken? 8°OO
For designs not provided by Uponor,complete the
following information. L_ Flow test method used? Ve Sucket U Flow Meter
9 17 44/-k `� Flow test gpm: 20 T
Designer's Name: ti
Company eNel` How many gallons of water did the design predict
95�- � 5So as required?
Phone: - Did the test meet or exceed design flow? Cll s 0 No
Fax: Which sprinkler did you flow?Number: ii /
Is the warning sign permanently attached close to the Location of head: -Keel-7
It,4n4 main shutoff valve? 0 Yes J No 5--c
Date left in service with all valves open: Dr
Was this system required by code?Wes 0 No
'E
f Test Witnessed and Verified by:
Name Signaturj ' Occup��tion Date
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Additional Explanations and Notes
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Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor usa.com