Report (33) /'n5r- -0/–7 —00loa
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`'RE SAFETY SYSTEMS
AQ r >SAFE"' FLOW TEST
:. z VERIFICATION
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. .r aSS, F'E " Flow Test Venficatio _ Form
must sittbinit this
Member 10: form. rp.:to do{sa.IttaiDDes the
Company Name: 41ic444l--pfio. l L' fax caul/gated fer1/1
to dm Fire - Design Depattrismit
Poe at
Phone: ;" ?�. 4: - ' Z'
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Fax. Caku of test office k.a ft
kda Marne: L16;
1. -4C" r ,G 'static pressure(rapt • _ rearfing at incom
Project l‘lirmber: water sonnly into • of at main shutoff:
Job Address: I s _ :. .-,�; ` , ,
•fir: , ., e(fl reading at in ming water
: � C. into home or at} ._n shutoff: D
ZlP; .- 9.'72'2-'5 '
Vv1 at tittle of day ass=, flow test taken? a
For designs not provkled by tip t,complete the
fe+gow iriforrnatfori Flowt ITIettiod used . Oticitet to Flow Meter
Designer's Name: 4 'k�`- C"'t ems' +
How marry gallons of - did the,design predict
Company' *' as required? j1
Phone: 9 2 99 7 `5";
Dirt the test meet or . .design flaw? Cl*
Fax
Which strritikter dirt "ow?Number• ~ 4'
Ai
t Is the ware g sign p endy attached dose to the f of tresct 14 La
''''' maw shutoff ? 0 yes
Date left in service ,• valves open:- r1' .
vias this system required by code?Wes O No
i Test igattnessed and Verified by: .
a N _r re 4to..#r Date
ititcc
14
' iAdintiessi ExrpianaD ans and Notes
Inc. Tel:8 4.321+4739
5925148th Street West Fax 952.997.1731 &; `
Apple Veley,MN 55124 USA Welt 1400VW.ispaatatutisacatli