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FIRE SAFETY SYSTEMS
AQUASAFETm FLOW TEST
VERIFICATION
AquaSAFE2M Flow Test Verification Form
Alliance
Member ID: Important Installing contractor must submit this
— --_. completed form.Failure to do so nullifies the
Company Name: 1 I- - 1 system
��1 warranty.E-mail or fax completed form
Contact: _ 1 j to the Uponor Fire Safety Design Department
Ac,• ati_jisgmlasamenor corn or 952.997.1731.
Phone-'_ 4/9 _ Q For questions,contact U
_ __ Uponor Technical Services at
888.594.7726 or techrxiwl.serviceseuponorcom.
Fax:
u
Color of test orifice used: !21 P
Job Name: )>f(°j( Lc
tF Static pressure(not flowing)reading at incomin
Project Number: là _ water supply into home or at main shutoff: 1
Job Address: f c ' s. .
City: _6f'� Y c
Residual pressure(flowing)reading at incoming water
supply into home or at main shutoff: AO____
State,ZIP: dA COQ-) -.
For designs not provided by Uponor,complete the What time of day was the flow test taken?— ,`
following information. Flow test method!1used? (Bucket J Flow Meter
Designer's Name: CM/ �� — _ Flow test gpm:—.f8
Company: _ iL`4 - —_ How many gallons of water did the design predict
Phone: ' as required?____LI___________________
Did the test meet or exceed design flow? Ai Yes j No
Fax: Which sprinkler did you flow?Number G)?p
Is the warning sign permanently attached close to the
main shutoff valve? J Yes 4 No F''n�S 1. Location of head: - _t_____
Was this system required by code? 'Yes J No '\ Date left in service with all valves open: 0
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Test Witnessed and Verified by:
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s Additional Explanations and Notes
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z Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952-997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com
usa.com