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Report (33) Pls , O) 7- boe> I, fit uponot ' FIRE SAFETY SYSTEMS ' AQUASAFETM' FLOW TEST VERIFICATION FoRto AquaSAFET Flow Test Verification Form Alliance important:installing contractor must submit this Member ID: completed form.Failure to do so nullifies the Company Name: A 114,4 , P(wVAIDl N system warranty.E-mail or fax completed form to the Uponor Fire Safety Design Department Contact: iteLett Di;l..w 0^ at 1gchnicaisetvIceslupolor.com or 952.997.1731. Phone: co 3- es - 3Lf°)O For questions,contact Uponor Technical Services at 888.594.7726 lurical serviceslrrponor coal. Fax: *SS , Color of test orifice used: Job Name: 1lF1ve/" Te -*te. Static pressure(not flowing)reading at incoming Project Number: W. 1 water supply into home or at main shutoff: L Z Job Address:/6q7JP l"et-v t TCS/ Residual pressure(flowing)reading at inakming water City: Ti)fitrod supply into home or at main shutoff: ,5 State,ZIP: ©IL gya13 8 What time of day was the flow test taken? :°° For designs not provided by Uponor,complete the Flow test method used? e3ucket 0 Flow Meter following information. Flow test gpm: Designer's Name: f23/441 4"b Company a UbI' Phone: How many gallons f water did the design predict /Sd-��- SSSe as required? �Did the test meet or exceed design flow? les 0 No Fax: Which sprinkler did you flow?Number: H• I Is the warning sign permanently attached dose to the Location of head: til. 2 A4-Tt,444 main shutoff valve? 0 Yes 1J No Date left in service with all valves open: Was this system required by code?Vetes 0 No ATest Witnessed and Verified by. Name Signator Occupation Date yytt , Additional Explanations and Notes Uponor,Inc Tel:800.321.4739 5925 148 h Street West Fax 952.997,1731 Apple Valley,MN 55124 USA Web:www.upottor-usa.com