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' FIRE SAFETY SYSTEMS
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t AQUASAFETm FLOW TEST
VERIFICATION
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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 ou.(4 pll tM,ta/ r system warranty.E-mail or fax completed form
/n� (/ to the Uponor Fire Safety Design Department
Contact: t�E9(aC' 47c1Awvn. attechnicaLserviceseuponor.comor952.997.1731.
Phone: S03 ` � ��'_ 1�?� For questions,contact Uponor Technical Services at
888.594./26 or technicalselyiceseuparor.coni.
Fax: Color of test orifice used: Ua,SS
Job Name: ' 'k-1- \l ?'-'k.'__ Static pressure(not flowing)reading at incoming
water supply Number: /177-I IC).I into home or at main shutoff:
Job Address: 13134 Si) AiAl2Prl t e? ler,
Residual pressure(flowing)reading at incominn water
City: 71),\A supply into home or at main shutoff: a
State,ZIP: / 7) -
What time of day was the flow test taken? 8
For designs not provided by Uponor,complete the ��-
following information. Flow test method used? L4Bucket 0 Flow Meter
Designer's Name: l D 1./kat + Flow test gpm:
Company: fire/14- 14-8`I1+t-ek - How many gallons of water did the design predict
as required? 1/0
Phone: 410 `117- S3 30
Did the test meet or exceed design flow? i s ❑No
Fax: Which sprinkler did you flow?Number: I, •
r„ Is the warning sign permanently,a close to the Location of head: Wr9O -
�.� 1/1{�n-7 main shutoff valve? ❑Yes Nnf a
Date left in service with all valves open: / ` /
Was this system required by code?16es 0 No
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Test Witnessed and Verified by:
Name"" Signat re Occupation Date.
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Additional Explanations and Notes
i Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com