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FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
VERIFICATION
AquaSAFE 1 M Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID completed form.Failure to do so nullifies the
Company Name: Ai I;0.hCC P�ur���.h _ system warranty. E-mail or fax completed form
to the Uponor Fire Safety Design Department
Contact. Rpt jc%. Maw at technical.services@uponor.com or 952.997.1731.
Phone SC33 ((CO– 4416 For questions,contact Uponor Technical Services at
888.594.7726 or technical.services@uponor.com.
Fax 3l
— ---– Color of test orifice used: '
_ 11�
Job Name: _
Static pressure(not flowing)reading at incoming
Project Number: Lk water supply into home or at main shutoff: ��__
Job Address: 136 ci Sw Wb_ —_—_
Residual pressure(flowing)reading at incoming water
City: --I '�ee_ `,
�� supply into home or at main shutoff: L
State, ZIP: CA 9)0a) — —
What time of day was the flow test taken? /G r3-0
For designs not provided by Uponor, complete the
following information(5pp�� Flow test method used? Bucket J Flow Meter
Designer's Name. t`Ghd- K df.40, Flow test gpm: ( S
Company: L+L QeMn( How many gallons of water did the design predict
Phone:
C(s 901)- Sn as required?
--- Did the test meet or exceed design flow? )'Yes J No
Fax:
Which sprinkler did you flow? Number.
Is the warning sign permanently attached close to the
Location of head:
main shutoff valve? J Yes No p + LGt1�h�A'
0� lr-ihis� (�r
Was this system required by code?'Yes J No Date left in service with all valves open: . L'
Test Witnessed and Verified by:
- Nam Si. ature
-� iA[ 4.0 Occupation Dat
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Additional Explanations and Notes
LLl
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