Report (69) FIRE SAFETY SYSTEMS
AQUASAFETM' FLOW TEST
VERIFICATION
AquaSAFEIM Flow Test Verificati
on Form
Alliance Important:Installing contractor must submit this
Member ID: — _ completed form.Failure to do so nullifies the
Company Name: LS L1LCs�hr / i11 system warranty.E-mail or fax completed form
to the Uponor Fire safety Design Department
Contact: _�� at technical services
noir
or os
or 952.997.1737,
Phone" ` - �/�� t For, questions,contact Uponor Technical services at
888.594.7726 or technical.services@uponor.corn
Fax:
(� Color of test orifice used: R�u C
Job Name: _ R I_ V'P�`_��t-�q�.�_
Static pressure(not flowing)reading at incoming
Project Number: _i'- �y� water su I into home or at main shutoff:
Job Address: ► 1 w
City: � � „ Residual pressure(flowing)reading at incoming water
--- supply into home or at main shutoff: 6 0
State,ZIP: �
For designs not provided by Uponor,complete the What time of day was the flow test taken? :G
following information. Flow test method used? Bucket J Flow Meter
Designer's Name. _ S ,1� K Flow test gpm:—.
Company: _ _ How many gallons of water did the design predict
Phone: as required? �,
Fax:
— Did the test meet or exceed design flow? 4'Yes 7 No
Is the warning sign permanently attached close to the Which sprinkler did you flow?Number: fl
main shutoff valve? ..]Yes 4 No O , Location of head:
Was this system required by code? Yes J No Date left in service with all valves open: _—
Test Witnessed and Verified by:
Name r Signature
1 r. ;kt Occupatio Date
g Additional Explanations and Notes
mm_O
tti
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
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