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Report (9) { • i. • r Ug)4:1011114:10( ,. . ci -0° `4z VIFIRE SAFETY SYSTEMS TM AQUASAFE • FLOW TEST VERIFICATION • 11111111111111111111111 AquaSAFETM Flow Test Verification Form . ...................................................... rl Alliance ................ ......................... Important:Installing contractor must submit this Member ID: Company Name: l i e q „�, com� form.Failure to do so nullifies the ., system warranty.E-mail or fax completed form a+k ea Contact: to the Uponor Fire safety Design Department kezEztisp6Ax2i— Phone-" at techeid :.. ___nsmom or --� �tR Z 5 Uponor T ech . For questions,contact 951997.1731. Servicesat Fax: __`_ .594.7726 or tfichakt Job Name: � T Color of test orifice used: u � ta nn� Project Number Static pressure(not flowing)reading at incomin water supply into home or at main shutoff: Job Address: Ct i.— _ City: -�- Residual pressure(flowing)reading at incoming water State,ZIP: supply into home or at main shutoff: For designs not provided by Uponor, complete the What time of day was the flow test taken?Jeri_ following information. Flow testmethod used, Bucket Flow Meter p ? Designer's Name: C Flow test gpm:_ man How Company: � y gallons of water did the design predict Phone: Q as required.`� Fax: Did the test meet or exceed design flow?)f Yes :3 No Is the warning Which sprinkler did you flow?Number: signpermanent) attached close to the main shutoff valve? )Yesoy\ . Location of head: 3 Was this systemNo R required by code?, Yes No Date left in service with all valves bpen: E Test Witnessed and Verified by: Na e a , Sig..tu AYE ,!I, .1.._ pation Dat fiiii Ali V c ! _ Aortal Explanations and Notes g Uponor,Inc. 5925 148th Street West Tel:800.321.4739 Fax:952 997,1731 Apple Valley MN 55124 USA Web:Www.upmwr-usa com