Report (73) • n/S`>2®i7 - OCA 16
uponoi
FIRE SAFETY SYSTEMS
AQUASAFETha FLOW TEST
' VERIFICATION
ra
Aqu.aSAFET Flow Test Verification Form
Alliance Important Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
Company Name: A i I i khu'_ 't'b ,kS osystem E-mail or fax completed form
{� f to the Uponor Fire Safety Design Department
Contact: Le T D SLaye attechnical.services@uponor.contor952.997.1731.
Phone: 503- 911 '3990 For questions,contact Uponor?'ethnical Services at
888.594.7726 or technical se—_�v�ponorwrsd,
Fax: Color of test orifice used: O(rkc5
Job Name: r142 etc Ce Static pressure(not flowing)reading at incoming /�
Project Number: (p+ 3`I E water supply into home or at main shutoff: ®9
Job Address: 130 t 7 'itJ +61 ft.61/41r2
—�-r Residual pressure(flowing)reading at incomi water
City: I nCtrcy supply into home or at main shutoff: 5S id's i
State,ZIP: dQ- I 1'0
What time of day was the flow test taken? p=064,4„
For designs not provided by Uponor,complete the
following information. Flow test method used? ucket C:1Flow Meter
Designer's Name: 5('Q/L iso , Flow test gpm:
Company: UNFOvV)(` How many gallons of water did the design predict
as required? 1
Phone: /57- 5330Did the test meet or exceed design flow? ilk Yes ❑No
Fax: Which sprinkler didAouflow?Number:14.1
Is the warning sign permanentlyapshed close to the Location of head: 1 1 totipA
A+ I r1 v\'3 main shutoff valve? O Yes r9'No )1-
I- nd_17
Date left in service with all valves open:
Was this system required by code?des ❑No
Test Witnessed andrVerified by:
3 Name�gCro SignatureeV^
Occupation Date
•Additional Explanations and Notes
Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:yww,uponor-usa,com