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