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1 FIRE SAFETY SYSTEMS
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AQUASAFETM FLOW TEST
VERIFICATION
FORM
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AquaSAFETM Flow Test Verification Form
Alliance Important Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
Company Name: I fi l►ui:+�PP w ,1611ti systemwarranty.E-mail or fax completed form
))__ to the Uponor Fire Safety Design Department
Contact PDi)c r±I)(S%move\ at technkal senriceseuponor.com or 952.997.1731.
Phone: S.-63- /19a- Si q(3 For questions,contact Uponor Fecirnical Services at
888.594.7726 or technicalservices@uponor.corn.
Fes' Color of test orifice used: AI Lt-f'
Job Name: It e-,(T rraeP Static pressure(not flowing)reading at incoming°,
Project Number: L LjC0 water supply into home or at main shutoff: 1
Job Address: 134 41 Sw i -
Residual pressure(flowing)reading at incoming�/� water
City: . ci'81c-'r supply into home or at main shutoff: t i
State,ZIP: OP gni .)
What time of day was the flow test taken? 16'.1-1C)
For designs not provided by Uponor,complete the
following information, Flow test method used? , f Bucket C3Flow Meter
Designer's Name: /c r4 letA-I a Flow test gpm: 18 .
Company: (4 fd r\,O`t' How many gallons of water did the design predict
as required? I)
95.)-1q) -,53R0
Phone: ) 3R
Did the test meet or exceed design flow? 0 Yes ❑No
Fax:
Which sprinkler did you flow?Number: f1 f
Is the warning sign permanently attached close to the Location of head: I (d c 1 (9,-
main shutoff valve? U Yes 431.No Q(I rir\i
Date left in service with all valves open: il 4911
Was this system required by code? Yes D No
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2 Test Witnessed and Verified by:
N�e i I p 5.a41. Owpatiofl Willa"( Dat g
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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.uponopisa.com