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FIRE SAFETY SYSTEMS
AQUASAFETM' FLOW TEST
VERIFICATION
AquaSAFE' Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
Company Name: _ I II cV T r i�i,. l system warranty.E-mail or fax completed form
Contact: _ i�r� M to the Uponor Fire Safety Design Department
wat technical services@uponor com or 952.997.1731
Phone-`_SG 3_tt9a.- W1d For questions,contact Uponor Technical Services at
888.544.7726 or technical.services@uponor.com.
Fax -
Color of test orifice used: g4,t.k.-f
Job Name: _ ki td" j_10 Static pressure(not flowing)reading at incoming
Project Number: _ _ _ water supply into home or at main shutoff: __ 1
Job Address: _43.1_0_ —
City: _ C Residual pressure(flowing)reading at incoming water
O_ _________
_ supply into home or at main shutoff: 60
State,ZIP:
For designs not provided by Uponor, complete the What time of day was the flow test taken? tY
following information. Flow test method used? ;>4 Bucket J Flow Meter
Designer's Name: _ SL'Yt, PO--`a Flow test gpm:—
Company: _ { _ How many gallons of w ter did the design predict
Phone: Qc�=g 1— 0' as required?_
Did the test meet or exceed design flow?Fax:
)(Yes J No
Which sprinkler did you flow?Number: if
Is the warning sign permanently attached close to the q
1
main shutoff valve? J Yes A No ' Location of head: -K
on �i n�s\-, '�c� —
Date left in service with all valves open: Li
Was this system required by code?0(Yes l No
Test Witnessed and Verified by:
Name Signat re
Occu ation Date
�► 1' � ., � bk� J
Additional Explanations and Notes
0
LLI
s Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
LL Apple Valley,MN 55124 USA Web:www.uponor-usa.com
ponor-usa.com