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IRgxwwA FIRE SAFETY SYSTEMS
AQUASAFETM' FLOW TEST
MST a,C.,Irt- °C) 4.0r/ VERIFICATION
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AquaSAFEIM Flow Test Verification Form
Alliance
Important Installing contractor must submit this
Member ID. completed form.Failure to do so nullifies the
Company Name: Itile4. llp� ,mini ti system warranty.E-mail or fax completed form
Contact: _�A{1r t i'J1Ch � to the Uponor Fire Safety Design Department
at technical.services@uponorcorn or 952.997.1731.
Phone' �0�� For questions,contact Uponor Technical Services at
--- 888594.7726 or technical.serviceseuponor com.
Fax:
— T P Color of test orifice used: __8_6,4_t____.____
Job Name: r1N
Static pressure(not flowing)reading at incomin
Project Number: ____4_0±s35____________ water supply into home or at main shutoff:
_ PPy
Job Address: 131, ( CII .
Residual pressure(flowing)reading at incoming water
City: . ,q� ----- supply into home or at main shutoff: __
State,ZIP: _ae 22 '2
For designs not provided by Uponor, complete the What time of day was the flow test taken? 7 G
following information. Flow test method used? Aii Bucket J Flow Meter
Designer's Name: _ ' ed - Flow test gpm:_
How many gallons of water did the design predict
Company: _ Sc a 4'1 -
Phone: _ - * ' as required?_
Did the test meet or exceed design flow? #Yes , 1 No
Fax: _
--- Which sprinkler did you flow?Number if
Is the warning sign permanently attached close to the Location of head: ��c.[C
6,../
main shutoff valve? ]Yes �`!No �1 .e°riI S] i'
Was this system required by code? Yes No " Date left in service with all valves open: ! : --'-�1.__
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Test Witnessed and Verified by:
Nam
r Si atur Oc ation
a Date
c< a' PI
Q
a Additional Explanations and Notes
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:I Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
LL Apple Valley,MN 55124 USA Web:www.uponor-usa.com