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FIRE SAFETY SYSTEMS
AQUASAFET' 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: 44;61..„0,2,6! (\j system warranty.E-mail or fax completed form
n �.. — to the Uponor Fire Safety Design Department
Contact: Jl 1 ��s at technical.services@uponor.com or 952.997.1731.
Phonee`_S-(}Q.- 11CL),-g/_LCJ For questions,contact Uponor Technical Services at
888.594.7726 ortechnical.services@uponor.com.
Fax: n Color of test orifice used: S
Job Name: Y I-4P( Static pressure(not flowing)reading at incomin
Project Number: _ 1> _ water supply into home or at main shutoff: ri5
Job Address: D%) SIA) j(,e
Residual pressure(flowing)reading at incoming water
City: geaMkt9^� - supply into home or at main shutoff: La
State,ZIP: Qi? q)03)
What time of day was the flow test taken? On
For designs not provided by Uponor, complete the
following information. Flow test method used? Bucket 7 Flow Meter
Designer's Name: g(1r4it ert4b(C Flow test gpm:_ /8 _
Company: _
T�jVr \ How many gallons 9f water did the design predict
9) JQ3t� as required? )
Phone: t —
Did the test meet or exceed design flow? Yes No
Fax: (
Which sprinkler did you flow?Number: ff
Is the warning sign permanently attached close to the
main shutoff valve? L.l ' Location of head: R-e AMS,./LA No CR ►nls
3 No Date left in service with all valves open:
Was this system required by code?Ai Yes
Test Witnessed and Verified by:
F. aal!C Sigtu� 0patinN9 1779;7 F f Vn 1. i
Fp
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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.uponor-usa.com