Report (34) wow(•
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FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
VERIFICATION
AquaSAFE' Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: 1 _ completed form.Failure to do so nullifies the
Company Name: _ 116 1,P� U I system warranty.E-mail or fax completed form
n n.� to the Uponor Fire Safety Design Department
Contact: at technicalservices@uponor.com or 952.997.1731.
Phone cO) L/c 3996 For questions,contact Uponor Technical Services at
888.594.7726 or technical.services@uponor.com.
Fax: G�
_ - Color of test orifice used: &Itre
Job Name: PIY«- leIrgp-p
Static pressure(not flowing)reading at incoming
Project Number: I� water supply into home or at main shutoff: _ 9.
Job Address: i,;Lf3 5t) ( bid
C� Residual pressure(flowing)reading at incoming water
City:
supply into home or at main shutoff: LC)
State,ZIP: Cl? C3.A
What time of day was the flow test taken? 9:c/o
For designs not provided by Uponor, complete the
following information. Flow test method used? itff3ucket J Flow Meter
Designer's Name: _I t PAICkFlow test gpm: (8
_
Company9c- �J� How many gallons q{water did the design predict
�— as required? )
Phone. Did the test meet or exceed design flow?
Yes 3 No
Fax: 9 --
—— Which sprinkler did you flow?Number:
Is the warning sign permanently attached close to the
main shutoff valve? ]Yes No Location of head: 1.41.441+44
Was this system required by code?ji Yes 3 No Date left in service with all valves open:
10,
Test Witnessed and Verified by:
Name Sig atur- Occupation Dat
Fr
o -
Additional Explanations and Notes
LL
Uponor,Inc. Tel:800321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com