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FIRE SAFETY SYSTEMS
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AQUASAFErm FLOW TEST
VERIFICATION
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Q-Y►^1i FORM
AquaAFETM Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: AA completed form.Failure to do so nullifies the
Company Name: H(��C.sl LL system warranty.E-mail or fax completed form
'� to the Uponor Fire Safety Design Department
Contact: (2d r -`>`5 .ir+- at technicalsetvices@uponor.com or 952.997.1731.
Phone: �t — }Z-3�(� For questions,contact Uponor Technical Services at
888.594.7726 or technical.services@uponor.com.
Fax: n Color of test orifice used: Tires
Job Name: RI VAX" T,aecc,,.e.Le Static pressure(not flowing)reading at incomin
Project Number: :r water supply into home or at main shutoff: 0__
JobAddress: tt3IccsLv1A� iln.
/ 7-Ftesidual pressure(flowing)reading at incominowater
City: -r9cfd supply into home or at main shutoff: SZ
State,ZIP: Q(,... 57'722.
What time of day was the flow test taken?
For designs not provided by Uponor,complete the
following information.
Flow test method used?A Bucket U Flow Meter
Designer's Name: 3(e 4V-0-1,40,50,, Flow test gpm: `Iv `Jf"
Company: kAQG7A)caf How many gallons of water did the design predict
`` as required? I
Phone: 95-2—SA 7-5"33 C).
Did the test meet or exceed design flow?,I�Yes U No
Fax: Which sprinkler did you flow?Number: H. I b
Is the warning sign permanently attached close to the Location of head: -C7P- 1 2
);,15,1c.I1 14t """, main shutoff valve? LI Yes `AND
li w i 51._ Date left in service with all valves open: 9—la.-I7
Was this system required by code?V Yes U No
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Test Witnessed and Verified by:
i L € t/ Sig �t Oc Date
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2
a Additional Explanations and Notes
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Uponor,Inc. Tel:800321.4739
T 5925 148th Street West Fax:952.997.1731
a Apple Valley,MN 55124 USA Web:www.uponor-usa.com