Report (26) r (4)000(
FIRE SAFETY SYSTEMS
AQLJASAFETM 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
A ii A
Company Name: _ I c�.,_ _____83131.111.hisystem warranty.E-mail or fax completed form
to the Uponor Fire Safety Design Department
Contact: - b'Pd 01531"In at technical.services@uponor.com or 952.997.1731.
Phone"_so%- L(eia gLito For questions,contact Uponor Technical Services at
888.594.7726 or technical.services@uponor.com.
Fax: D 1
--- Color of test orifice used: 171 tke
Job Name: P t'NPC(Te I`CA.P- Static pressure(not flowing)reading at incoming
Project Number: _ L-Cd 1 3 t water supply into home or at main shutoff:_ CjJ_
Job Address: 13(T 3 S W I G g
Residual pressure(flowing)reading at incoming water
City: _ 12QCk,/C etc f\ supply into home or at main shutoff: 1,6
State,ZIP: 00 9) .�
ForWhat time of day was the flow test taken? 9 Li 6
designs not provided by Uponor,complete the
following information. Flow test method used? 14 Bucket :Flow Meter
Designer's Name: _ ej"- ' ' ttl a, Flow test gpm: 'I C')
Company: _ kfOr How many gallons of water did the design predict
n f 1', 5'320as required? 1")Phone: '7 l
Did the test meet or exceed design flow? A Yes J No
Fax:
Which sprinkler did you flow?Number: Pt I
Is the warning sign permanently attached close to the 'e-`1
Location of head: 1 Je($(-OG YY1 g.,
main shutoff valve? :]Yes ;2Q No oft fIni51.,
Date left in service with all valves open: —�
Was this system required by code?4Yes J Nov.
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Test Witnessed and Verified by:
Namme , Signa retc 1\OWN fltAtibeAr
Oc ation Date
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Additional Explanations and Notes
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Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com