Report (17) Tr? crC7i7_ 0095�
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FIRE SAFETY SYSTEMS
AQUASAFETm FLOW TEST
VERIFICATION
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AquaSAFE' Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
ai� M�^ system warranty.E-mail or fax completed form
Company Name: ._411 1 q t
n 1" to the Uponor Fire Safety Design Department
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Contact: C3hcd" DISI at technicalserviceseuponor.com or 952.997.1731.
Phone-_y_ 3-LIC . p y ct a For questions,contact Uponor Technical Services at
888.594.7726 or technical.serviceseuponor.com.
Fax:
/� Color of test orifice used: (3(c -e
Job Name: !C 1 4-C r TC(SY'A--c
— Static pressure(not flowing)reading at incoming_
Project Number: water supply into home or at main shutoff:: r'
Job Address: I U'1 S UI q
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City: _gPa1K 0-(\ 1 Residual pressure(flowing)reading at incoming water
supply into home or at main shutoff: 60
State,ZIP: _o_R____g_,Oaf
For designs not provided by Uponor, complete the What time of day was the flow test taken?�' �
following information. Flow test method used? XBucket J Flow Meter
LaDesigner's Name: _ `' AN � 4 Flow test gem:
Company: __4_0__ ______ How many gallons of water did the design predict
qca.,qq.) - -g�0 as required? f'1
Phone:
Did the test meet or exceed design flow? , Yes J No
Fax:
Which sprinkler did you flow?Number: ft
Is the warning sign permanent) attached close to the —
main shutoff valve? -1 Yes 9 No 0� s•�15� Location of head: �(}rf� cg—
Was this system required by code? Yes J No Date left in service with all valves open: la f
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Test Witnessed and Verified by:
v Name �' Sig ture f�P � {,
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Additional Explanations and Notes
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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