Report (8) •
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° II UP01/01.
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#57-,
FIRE SAFETY SYSTEMS
:`,, AQUASAFETM' FLOW TEST
VERIFICATION
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AquaSAFE' Flow Test Verification rlfication Form
Alliance
Member ID: important i
__ 1m9 COntract°r must submit this
Company Name: fO� Failure to do so nullifies the
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i :,, system warranty.E-mail or fax completed form
Contact c "
u., Uponor, Safety Design Department
Phone_ �(S 23:� For or X2.997.1731.
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questions,contact Uponorechnicai Services at
Fax: —�— x•7726 ortedhni� ns
•-- - eor aom,
Job Name: j ?��- y Color of test orifice used: �.Q
' Project Number: �{ '` ( � Static pressure(not flowing)reading at incomin
water supply into home or at main shutoff:
Job Address: _
City: _gra �`� Residual pressure(flowing)reading at incoming water
State,ZIP: — x'1'1 supply into home or at main shutoff:
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r For designs not provided by Uponor,complete the What time of day was the flow test taken?___,141.4_
following information. Flow test method used? ) Bucket 7 Flow Meter
Designer's Name: — it..
Flow test gpm:_
Company: How many gallons of water did the design predict
Phone: . _131.0-
as required?_
Fax: Did the test meet or exceed design flow? ❑Yes :7 No
Is the warning sign permanent) attached close to the oc ti sprinkler did you flow?Number:_
main shutoff valve? .]Yes 04 No Location of head:
Was this systemFl^11�
required by code? Yes No Date left in service with all valves open:
E
Witnessed and Verified
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2 TestName t)
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8iy', Occupation Dat
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Additional Explanations and Notes
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Uponor,Inc. Tel:800.321.4739
5925 148th Street West
Apple Valley,MN 55124 USA Fax:952997.1731
Web:www upon com