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. 1 r isr2Oi7 - oaitq j yo UOflO( FIRE SAFETY SYSTEMS AQUASAFETh FLOW TEST VERIFICATION „ p , FORM x x , AquaSAFE ` Flow Test Verification Form Alliance Important Installing contractor must submit this Member ID: completed form.Failure to do so nullifies the Company Name: A 1 I'O ACI, PLIALtttplit5 system"ate• ilorfax co d form Uponorto die Safety Design Department nt Contact flete A" Dtdep.a,n at gchnicaLserviceseuporyir.com or 9.52.997.1731. Phone: SOS-i'I91.- b4lo For questions,contact Uponor Tedmical Services at 888.594.7726 or technical.senrices@uponor.comt. Fax: ,/�, Color of test orifice used: erect$ Job Name: g4ver Ter-0.Ce, Static pressure(not flowing)reading at incoming Project Number: 14 1 water supply into home or at main shutoff: ..Sy Job Address: 31 3 Z es'd ai pressure(flowing)reading at incgmin water City: TI)a� supply into home or at main shutoff: L State,ZIP: ©(.i (/}a4-5 What time of day was the flow test taken? 8°e° For designs not provided by Uponor,complete the , following information. 11' tt Flow test method used? Bucket 0 Flow Meter Designer's Name: dri/ Ie�t...dFlow test gpm: /7 Company: titetAp - How many gallonspf water did the design predict gs�-��- SSSo as required? // Phone: Did the test meet or exceed design flow? CilK s 0 No Fax: Which sprinkler did you ow?Number: il. y Is the warning sign permanently attached dose to the Location of head: L,, 4$Lug/ Af,rr= 4 main shutoff valve? 0 Yes al No Date left in service with all valves open: g—1-1, Was this system required by code?I�Yes 0 No v .m .# Test Witnessed and Verified by: Name Signa,tu__rss � Occup ion Date �; 11 rtinGG �3Pr 4"f+i'l7 4 0 R 0 Additional Explanations and Notes a 2 li Uponor,Inc. Tel:800.321.4739 5925 148th Street West Fax:952.997.1731 Apple Valley,MN 55124 USA Web:www.uparor.usa.com