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FIRE SAFETY SYSTEMS
•
AQUASAFETMI FLOW TEST
VERIFICATION
•
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AquaSAFEIM Flow Test Verification Form
•
Alliance
Member ID:
Important Installing contractor must submit this
----T--------T. _- .— completed form.Failure to do so nullifies the
Company Name: 1 system warranty.E-mail or fax completed to the Uponor FireDesign De stied form
Contact: _•_11121"-ati Ing Safety 9 Department
at technical.services@uponorcom or 952.997.1731.
Phone- S6 1 r __ For questions,contact Uponor Technical Services at
888.594.7726 or linirai.snrvir�.
Ftenor cem,
Fax:
�� ______ Color of test orifice used: _h.p
Job Name: _ s 2 iftret, CP
' Static pressure(not flowing)reading at incomin
Project Number: water supply into home or at main shutoff:
Job Address: S 6 _
—
City: _ Residual pressure(flowing)reading at incoming water
supply into home or at main shutoff: —J
State,ZIP: r,_
, For designs not provided by Uponor,complete the What time of day was the flow test taken?
following information. Flow test method used?)(Bucket 7 Flow Meter
Designer's Name: 1. e •- ea ci_, Flow test Bpm:— I ig
Company: __WC_n_ — How many gallons water did the design predict
Phone:
_Ica-2 as required?
Did the test meet or exceed design flow? kYes ]No
Fax:
----------- Which sprinkler did you flow?Number
Is the warning sign permanent) attached close to the
main shutoff valve? Yes No Location of head:___LQ,,,
Yes No Date left in service with all valves open:
Was this system required by code?
E
t
Test Witnessed and Verified by:
Name �' Sig ature
a 0 upation Date
4r/ —1
0
t Additional Explanations and Notes
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Uponor,Inc Tel:800.321.4739
5925 148th Street West Fax:952997.1731
1 Apple Valley,MN 55124 USA Web:www uponor-usa com