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FIRE SAFETY SYSTEMS
-•. e'a" — AQUASAFETM FLOW TEST
VERIFICATION
AquaSAFE ` Flow Test Verification Form
Alliance Important:installing contractor must submit this
Member ID: odd fora.Faure to do so nullities the
Company Name: /4114.Ase. Ptw»1.1 a5 system warranty.E-man or fax completed fonn.
to the Uponor Fire Safety Design Department
Contact: gokif Dtsl►Maa" atuchnkaimacestamwom or 952.997.1731.
Phone: SOS-H 611- 341 o For questions„contact Uponor TecNnial Sees at,
ea6.594 n6 or tighlikiddialMOISSOMMILUML
Fax: , Color of test orifice used: !no
Job Name: F+�1kr' Terrace Static pressure(not flowing)reading at incoming
Project Number Lit 1 water supply Into home or at main shutoff: C7
Job Address: 131kZ�� �Ak e�•�""`_-Tee
r ual�pressure(flowing)reading at incoming water
City: Ti3albl supply into home or at main shutoff: 5
State,ZIP: ®g1 q}41/5
What time of day was the flow test taken? dg'.°
For designs not provided by Uponor,complete the
Flow test method used? �udcet 0 Flow Meter
following information. I + �,
Designer's Name: /L
�'e ` Flaw test gpm: /7
Company: U: eller How many gallons of water did the design predict
S3e as required? /ti
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Phone: 95 "99)" __//
Did the test meet or exceed design flow? i�l'es 0 No
Fax: Which sprinkler did you flow?Number W. 11)
tj1l Is the warning sign permanently attached dose to the Location of head: ` Z
Af-rti Mt4 Main shutoff valve? 0 Yes l to
Date left in service with all valves open: et-Co-1'
IWas this system required by code?!i'c'es 0 No
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Test Witftessed and Verified by:
a Name Signatu Ckcu on Date
vtl:6.Gin �► I 9.-1.-i7
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Additional Explanations and Notes
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Uponor,Inc. Tei:800.321.4739
5925 148th Street West Far 952.997.1731
Apple Valley,MN 55124 USA Wdx