Report (13) •
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FIRE SAFETY
SYSTEMS
MS
AQUASAFETM' FLOW TEST
VERIFICATION
IIIIIIIIIIIIIMIII
AqUa.SAYETM Flow Test Verification Form
'
..................
Alliance
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Member ID: Important Installing contractor must submit this
Company Name: Blj . .� �. completed form.f=ailure to do so nullifies the
titita
system warranty.E-mail or fax completed form
Contactnt
_ Qa�,.;�- (�� 1 to the Uponor Firen Departme
Phone" s� G)�°1 ..21J at serr `sr— °°n°r�gu or 952.997.1731.
f ctquestions,contact Uponor Technical Services at
Fax: 887726 or ftiUdgthu ewvionc
Job Name: _j �{ "_' _ Color of test orifice used: -�L�e.
�� ---- Static pressure(not flowing)reading at incomin
Project Number: — water supplyinto home or at main shutoff:
Job Address: 01.^
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?_ _
following information. Flow test method used? Bucket Flow Meter
ABDesigner's Name: Flow test gpm:_
Company: How many gallons of water did the design predict
Phone: -• 1`I as required?
Fax: ? — Did the test meet or exceed design flow? )4 Yes a No
Which sprinkler did you flow?Number:`
Is the warning sign permanently attached close to the
main shutoff valve? ....1Yes 2I No �- ft Location of head:
Was this system �r1 t��
required by code? Yes No Date left in service with all valves open: r�+rr
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Test Witnessed and Verified
by
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Occupation
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Additional Explanations and Notes
Uponor,Inc. Tel:800.321.4739
5925 148th Street West
Apple Valley MN 55124 USA Fax:952.997.1731
Web:www.uponor-usa.com