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(*NWFIRE 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: I I leis., AtiviviLk system warranty.E-mail or fax completed form
—— to the Uponor Fire Safety Design Department
Contact: Cr O tSlr yy‘ at technicalservices@uponor.com or 952.997.1731.
Phone-' Stn-C f -VRRO For questions,contact Uponor Technical Services at
888.594.7726 or technical.services@uponor.com.
Fax: p
- Color of test orifice used: flu..?
Job Name: li?-1 ,W �l ffo�,{,
Static pressure(not flowing)reading at incoming
Project Number: _ tz) , water supply into home or at main shutoff:q$'
Job Address: /33i3. 51.t) /Ei: % _ —'_
��� _�,, Residual pressure(flowing)reading at incoming water
City: _ —.
supply into home or at main shutoff: tt'�
State,ZIP: (.5n 9)03)
For designs not provided by Uponor,complete the What time of day was the flow test taken? 7 0(j
following information,/SFlow test method used? Ai Bucket Flow Meter
Designer's Name: _ Pe* Kp�[t1-� Flow test gpm:_ /8
Company: _ t .r +! _ — How many gallons of water did the design predict
ca!9 17 as required? I',
Phone:
Did the test meet or exceed design flow? Yes .3 No
Fax: �,/
Which sprinkler did you flow?Number: �[
Is the warning sign permanently attached close to the Location of head: gdroa
main shutoff valve? ]Yes No
Was this system required by code?) Yes Cl No Date left in service with all valves open:
, 77
Test Witnessed and Verified by:
N`me t,,cr Si;ature
d!� K _/ Occupation Date
ei ti-t23-
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o _
Additional Explanations and Notes
LLi
Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com