Report (31) •
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MS'r x,01''1- DO4O6 FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
VERIFICATION
•
AquaSAFETM Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID:
_ __ completed form.Failure to do so nullifies the
Company Name:— system warranty.E-mail or fax completed form
Contact: �_ to the Uponor Fire Safety Design Department
- = ate°=vA at technical.servicesauponor corn or 952.997.1731.
Phone: 4122. ^1j - For questions,contact Uponor Technical Services at
888.594.7726 or technical emunor cnm,
Fax:
n ---- Color of test orifice used: I t�,-e 4
Job Name: . Ki Y�TesmrX/�-�- ���/' Static pressure(not flowing)reading at incoming
Project Number: - -E�-�-- water supply into home or at main shutoff:
-- PPY
•
Job Address: - � l ---t1 _____,
Residual pressure(flowing)reading at inc ming water
City: -._
supply into home or at main shutoff: �
State,ZIP: _Q�
For designs not provided by Uponor, complete the What time of day was the flow test taken?_ -
following information. Flow test method used? 4Bucket J Flow Meter
Designer's Name: _ �k Flow test gpm:— /gj
Company: __ 1
—
How many gallons of water did the design predict
--_
Phone: � as required?I
— � � ����-- —__ Did the test meet or exceed design flow? J Yes J No
Fax: _
Which sprinkler did you flow?Number: _
Is the warning sign permanent) attached close to the
main shutoff valve? J Yes No Location of head:
Yes J No Date left in service with all valves open: Y-/': _
Was this system required by code?J
v.9
Test Witnessed and Verified by:
Nam
Sig t r Occupation Date
N0
Additional Explanations and Notes
V
t7
LLi
,i Uponor,Inc. Tel:800.321.4739
3 5925 148th Street West Fax:952.997.1731
LL Apple Valley,MN 55124 USA Web:www.uponor-usa.com