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Report (35) 4 ISl , 017 - oC xF' UpOn10111 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: �y, system warranty.E-mail or fax completed form�I"_ r� l �--- to the Uponor Fire Safety Design Department Contact: L:Th' (Ji j J, at technical.ser vices@uponor.com or 952.997.1731. Phone �Q� i.f ate- L,ot For questions,contact Uponor Technical Services at -- — 888.594.7726 or technical.services@uponor.com. Fax �) --- Color of test orifice used: /4,rtr f Job Name: Pi le( T& ,.2_C Static pressure(not flowing)reading at incoming Project Number: water supply into home or at main shutoff: Job Address: / I 5 U) J&q — Residual pressure(flowing)reading at incoming water City: $ supply into home or at main shutoff: 60 State,ZIP: 012 91) For designs not provided by Uponor,complete the What time of day was the flow test taken? following information. Flow test method used? Bucket 7 Flow Meter Designer's Name: _ gl'elle1 to-Ofe Flow test gpm:_.10 Company: I' ��-(' _ How many gallons of water did the design predict Phone: I 1C1as required? ( Did the test meet or exceed design flow? *Yes J No Fax: Which sprinkler did you flow?Number t1 Is the warning sign permanent) attached close to the y main shutoff valve? r1 Yes No Location of head: �S tG!{O Pte,rye 1 Date left in service with all valves open: Was this system required by code?AYes No Test Witnessed and Verified by: Name Si.natur- "_ Occupation Dat , s • Additional Explanations and Notes mO_ LL z Uponor,Inc. Tel:800.321.4739 5925 148th Street West Fax:952.997.1731 3 LL Apple Valley,MN 55124 USA Web:www.uponor_usa.com