Report (60) „,:z/
' /'a'I S r 2 o J 7- v o I I �
., ....,
uponol
. ,
.,
,. „„
.4
, /.., ..„.,
FIRE SAFETY SYSTEMS
�'' AQUASAFE”" FLOW TEST
t(-i J. Lf VERIFICATION
/
I*oRll,1
I
AquaSAFE' Flow Test Verification Form
Alliance Important Installing contractor must submit this
Member ID: / completed form.Failure to do so nullifies the
Company Name: Alliek t ('Cy, . systemwarranty.E-mail or fax completed form
to the Uponor Fire Safety Design Department
00
Contact: F4 •,/'T D li at tecimicalsetviceseuportor.com or 952.997.1731.
Phone: SDI- ("Me)" 3990 For questions,contact Uponor Technical Services at
888.594.7726 or technical services@uponor.cont.
Fax: p' Color of test orifice used:
Job Name: 'lkiC'erfacsl Static pressure(not flowing)reading at incomingC,
Project Number: k-7,11( water supply into home or at main shutoff: S�
Job Address: 1'W h$ SU ).,e Tec,
Residual pressure(flowing)reading at incoming water
City: MyArik supply into home or at main shutoff: So
State,ZIP: oe, 97D .?
What time of day was the flow test taken? a°a
For designs not provided by Uponor,complete the ��
following information, Flow test method used? rd Bucket Ci Flow Meter
Designer's Name: € leta P h Flow test gpm: I C+ .
Company: D�11
How many gallons of water did the design predict
as required? 11
Phone: q54"ff9 7- 5330
Did the test meet or exceed design flow? s 0 No
Fax: Which sprinkler did
ryou
-flow?Number: «,y
Is the warning sign permanently��ched close to the Location of head: Gmtly
7�+TM" -7 main shutoff valve? CI 3 No ,` A'12
y
,,.// Date left in service with all valves open: ! a�17
a
Was this system required by code? es D No
N
Test Witnessed and Verified by:
Name Signature Occupation Date,
Alf C o ✓I' CSP rLe - 9-do -l?
i
0
O
o
i Additional Explanations and Notes
g
a
1
Uponor,Inc Tet:900.321,4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:doom