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�� ^. �` 1� FIRE SAFETY SYSTEMS
t '., (-O� 1 V� AQUASAFETM' FLOW TEST
;�',' VERIFICATION
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AaSAFETM Flow Test est Verification Form
Alliance Important:Installing contractor must submit this
Member ID: 11 completed form.Failure to do so nullifies the
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Company Name: A i heome e 1NI~.�i'u� m warranty.E-mail or fax completed form
to the Uponor Fire Safety Design Department
Contact: of 4 er'f" D 1 s nvtiwv\ at itechnical.services@yponor.com or 952.997.1731.
Phone: .5O 7, - (-11 — 34 cil 0 For questions,contact Uponor'Fetrnical Services at
888.594.7726 or technicalservices@uponor.cortl.
Fax: Color of test orifice used: rr:,SS
Job Name: let
Teft7Att Static pressure(not flowing)reading at incoming
Project Number: let' Cl 1 V. water supply into home or at main shutoff: 6o
Job Address: 1303 S 15‘,/ 169+1,-- cwe
Residual pressure(flowing)reading at into i water
City: I 1 card supply into home or at main shutoff: X14 f Ss
State,ZIP: dP-, 9 747 3
What time of day was the flow test taken? g''Oo.owl
For designs not provided by Uponor,complete the
following informatio j Flow test method used? L Bucket C3 Flow Meter
Designer's Name: %re V_ �G� Flow test gpm: 1'7 ,.
Company: Ufal' How many gallons of water did the design predict
X501-9�1- 53 c� as required? I7
Phone: Did the test meet or exceed design flow? q s CINo
Fax: Which sprinkler did you flow?Number:11-
,
xi.. r,kN1 11'31s the warning sign permanently a*ached close to the Location of head: 4 ee`'`i�
main shutoff valve? ❑Yes No 1�-�CL
Date left in service with all valves open: 7
Was this system required by code?t�Yes U No
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t Test Witnessed and Verified by:
Nam 5ignatur Occupation Date
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i1 Pktv-Scr- II-39-17
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Additional Explanations and Notes
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Uponor,Inc. Tel:800.321,4739
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5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www a a.com