Report (28) ,.,..
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FIRE SAFETY SYSTEMS
`' AQUASAFETM' FLOW TEST
VERIFICATION
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.AquaSAFE' Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
Company Name: li 1 1)a4,4e.r ova4:n warranty.E-mail or fax completed form
S to the Uponor Fire Safety Design Department
Contact: fr' P;411\00,-\ at technicaLservicesluponor.com or 952.997.1731.
Phone: . C.).;-4-1 -314 ctm For questions,contact Uponor Technical l Services at
898.594.7726 or technlcal.services#uponor.comt.
Fax: of test orifice used: f4 u1.-c
Job Name: 1 vci TCfif c%P' Static pressure(not flowing)reading at incoming
Project Number: L-di- 2,1 water supply into home or at main shutoff: 1
Job Address: 130 N") Sbtl 16
p_ � Residual pressure(flowing)reading at incoming water
City: ISP supply into home or at main shutoff: 6 U
State,ZIP: 6R Qi-) ,
What time of day was the flow test taken? la t'/d
For designs not provided by Uponor,complete the
following information, Flow test method used? Clif Bucket 0 Flow Meter
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Designer's Name: �LM; O O� Flow test gpm: �p �
Company: Li C3 v�p f How many gallons of water did the design predict
as required? I)
Phone: _ci —�q):
Did the test meet or exceed design flow? 4Yes ❑No
Fax:
Which sprinkler did you flow?Number: H '1
Is the warning sign permanently attached close to the Location of head: I-' k rtgl(•y
main shutoff valve? ❑Yes.$No Oh F-.,niS\
Date left in service with all valves open: 117k-)(18
Was this system required by code?CI Yes D No
3
2 Test Witnessed and Verified by:
Name3 p'i tcAe 5 e 0 Oc�
KJ kill
1 ill 70(13
Ift Additional Explanations and Notes
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Uponor,Inc Tel:800.321.4739
1 5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com