Report (36) •
Up011101
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FIRE SAFETY SYSTEMS
AQUASAFETm FLOW TEST
VERIFICATION
AquaSAFE1'M Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: _ completed form.Failure to do so nullifies the
Company Name: 1 system warranty.E-mail or fax completed form
— to the Uponor Fire Safety Design Department
Contact: Ke2,bect 0.9-‘V\A\ at technicalservices@uponor.com or 952.997.1731.
Phone" T(e1 For questions,contact Uponor Technical Services at
888394.7726 or technical.services@uponor.com.
Fax: rz'
Color of test orifice used: !
Job Name: et Il`Ct 1-4/ {,e,,C Static pressure(not flowing)reading at incoming
Project Number: [ water supply into home or at main shutoff: _5'(
Job Address: / 5tt) l 60
� � Residual pressure(flowing)reading at incoming water
City:
supply into home or at main shutoff: &C),
State,ZIP: OP 9)4
For designs not provided by Uponor, complete the What time of day was the flow test taken?
following information. Flow test method used? Ai Bucket Flow Meter
Designer's Name: I 6f" Qo tt(o Flow test gpm: 'i j
Company: _ i nc-( — How many gallons ofwater did the design predict
as required?
Phone: `lcrj 99)-53C3
Did the test meet or exceed design flow? Ar Yes `7 No
Fax:
Which sprinkler did you flow?Number:_ l i
Is the warning sign permanent) attached close to the
main shutoff valve? J Yes 4 No nLocation of head: ( .awn a
Yes No Date left in service with all valves open: _lb!
Was this system required by code?
Test Witnessed and Verified by:
Name Si.natur
Name
�r��� i / Occupation Dat
pa_
o — _
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Additional Explanations and Notes
O_
WI
Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
LLApple Valley,MN 55124 USA Web:www.uponor-usa.corn