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Report (27) S ©1 C 1 c_:J 0 Oct UP00101. FIRE SAFETY SYSTEMS AQUASAFETM FLOW TEST VERIFICATION AquaSAFE1M Flow Test Verification Form Alliance _ Member ID Important:Installing contractor must submit this --_.___ completed form.Failure to do so nullifies the Company Name: _ I Cir,ce PRA, bj system warranty.E-mail or fax completed form —� — _—, to the Uponor Fire Safety Design Department Contact: (" p 51�M at technicalservic..� ---_ unor.corn or 952.997.7731, Phone- For questions,contact Uponor Technical Services at _ 888.594.7726 or technical.services@uoonor com. Fax 0r99 , Color of test orifice used: Job Name: K ��`ttC TPt'Tz^ ( �_ ----__ Static pressure(not flowing)reading at incoming Project Number: water supply into home or at main shutoff: Job Address: l-a L s . 6 - City: _ ��+ d 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 ]Flow Meter Designer's Name: _ /5 f'P'Ltr) 14-ht Flow test gpm:_, Company: _ How many gallons of water did the design predict Phone: r' - as required?_D Did the test meet or exceed design flow? Yes No Fax: Is the warning sign perm attached close to the Which sprinkler did you flow?Number:____ main shutoff valve? 1.1 Yes 24 No Ori f h115\1{ Location of head: �+�,q y 0,3 Was this system required by code?Q�(Yes No Date left in service with all valves open: Alia Test Witnessed and Verified by: Na e Sig ture Occupation Dateh 2 _ Additional Explanations and Notes 0 LLI Uponor,Inc. Tel:800.321.4739 5925 148th Street West LL-- USA Apple Valley,MN 55124 Fax: 7.1731 ' Web::www.uponor-usa.com