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Report (117)
MIIIIIIIIMMINMIIIIIMIIMIIIIIMIIIIIMlk 1 I Z upono r i k' �� FIRE SAFETY SYSTEMS AQUASAFETM' FLOW TEST VERIFICATION FORM ?,Q,,r,y,Ns IASI- VD— 00 482 AquaSAF'ETM Flow Test Verification Form Alliance Important installing contractor must submit this Member ID: completed fonn.Failure to do so nullifies the A I I;� Pb6!� system warranty.E-mail or fax completed form Company Name. ) to the Uponor fire Safety Design Department Contact KA:get- 1:45104Ma,n at technical servicesseupot0r.c0m or 952.997.1731. Phone: So S-46a-- 34mo For questions,contact Uponor Technical Services at 888 594.7726 or techni<al.servicesluponor.cont. Fax: giver Color of test orifice used: "SS Job Name: Terrace,. Static pressure(not flowing)reading at incoming Project Number: 1,41- 1 water supply into home or at main shutoff: . Job Address: 43.2? ). i "'al pressure(flowing)reading at incgming wat:5: City: Ti)atot supply into home or at main shutoff: State,ZIP: ©g-i qy�5 �: What time of day was the flowlotest taken? For designs not provided by Uponor,complete the Flow test method used? a nutlet 0 Flow Meter following information. / I Flow test gpm: �'�Designer's Name: 2 i J>t ['r f s�,. How many gallons of water did the design predict Company: Upaibr as required? /7 Phone: 954, -117- 5)S o � Did the test meet or exceed design flow? 3'Ves 0 No Fax: Which sprinkler did you flow?Number: N. / Is the warning sign permanently attached dose to the Location of head: 7P L 2 At its"4 main shutoff valve? 0 Yes I3 No Date left in service with all valves open: i" F.-I) Was this system required by code?16es 0 No N .t! Test Witnessed and Verified by. 2 Name Signatur Occu ion Date Mib�mil '5'F' 9' s'17 O 0 Additional Explanations and Notes a 2 Uponor,Inc. Tel:800.321.4739 5925 148th Street West Fax:952.997.1731 Apple Valley,MN 55124 USA Web:www.uponer-usa.com