Report (50) K 3
$ ." .frk. .° Mg uponoi
Y
FIRE SAFETY SYSTEMS
"`, AQUASAFET FLOW TEST
VERIFICATION
E
-ti- erls-ro o 19 -- do tt5 FORM
AquaSAFETM Flow Test Verification Form
Alliance Important Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
Company 4 .CAS ��y� system warranty.E-mail or fax completed form
Com n Name: Lt a Safety DesignDepartment
'� to the nor Fire rtrraerrt
Contact: 1Dar4.1)j,S ..e,A at technical.servicesluponor.com or 952.997.1731.
-y ,2-3N q O For questions,contact Uponor Technical Services at
Phone: 888.594.7726 or technic l.senricessluponor.cont.
Fax: n Color of test orifice used: 13ca
Jab Name: 1\;W.t" 7,6rce-<-6 Static pressure(not flowing)reading at incoming
Project Number: 11110111F water supply into home or at main shutoff: (p O
Job Address: 131 t 2r SLA) >164.4e 'l,.e-p/
. * Residual pressure(flowing)reading at incgmingwater
.
City: 1 7 9,4 supply into home or at main shutoff: SZ
State,ZIP: C cf'72.2.1
What time of day was the flow test taken? 09
For designs not provided by Uponor,complete the
following information, Flow test method used?, Bucket 0 Flow Meter
Designer's Name: 13(44 V...04‘,4.0... test gpm:ue +
Company: I.A.Q�1est How many gallons of water did the design predict
`` as required? I
Phone: 982.-q q"7-.531 p Did the test meet or exceed design flow?14
,*Yes 0 No
Fax: Which sprinkler did you flow?Number: 1
Is the warning sign permanently attached close to the Location of head: 41s0U.t t' twusoary
1061c,,►i i+µ main shutoff valve? U Yes 7/No
Date left in service with all valves open: 9-l'2.-17
c 11 01 S1—• Was this system required by code?®Yes D No
r
L Test Witnessed and Verified by:
Name Sig63,...._ Occup i Date
1
0
0
s
Additional Explanations and Notes
d
a,
Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com