Report (19) (4)1000(
FIRE SAFETY SYSTEMS
•
AQUASAFETM FLOW TEST
VERIFICATION
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AquaSAFE1M Flow Test Verification Form
Alliance
Member ID: Important Installing contractor must submit this
-- --- completed form.Failure to do so nullifies the
Company Name: __Al 1►CAAA:f t' __mb;h system warranty.E-mail or fax completed form
{� —� to the Uponor Fire Safety Design Department
Contact: _ aikka ]�yy
at technicalserviceseuponor corn or 952.997.1731.
Phone"_ c' 119 For questions,contact Uponor Technical Services at
888.594.7726 or technical nrices@u com.
Fax
i
Color of test orifice used:
Job Name: K 1 l{f
Static pressure(not flowing)reading at incoming
Project Number: _ water supply home or at main shutoff
- PP Y�into :
Job Address:
City: t Residual pressure(flowing)reading at incoming water
— supply into home or at main shutoff:
State,ZIP: __ _
For designs not provided by Uponor, complete the What time of day was the flow test taken?
following information. Flow test method used? Bucket i Flow Meter
Designer's Name: _f ;Vu tti Flow test gpm:__
Company: _ C How many gallons of water did the design predict
Phone: (3_1/2_13.5- — as required? 1)
Did the test meet or exceed design flow? 3'Yes ]No
Fax
Is the warning sign permanently attached close to the Which sprinkler did you flow?Number u
main shutoff valve? J Yes No Oh ��h�slN Location of head:
Was this system required by code?i Yes No Date left in service with all valves open: Jt
Test Witnessed and Verified by:
Name
iffiii
Occu ationSi.
�� a.� � �(. p Date
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OW
Additional Explanations and Notes
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2
2 Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
LL Apple Valley,MN 55124 USA Web:www u
ponor-usa.com