Report (2) /11S'r17 - 00 737
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UPOnar
FY
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FIRE SAFETY SYSTEMS
AQUASAFErm FLOW TEST
VERIFICATION
AquaSAFE1M Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
Company Name ��l system warranty.E-mail or fax completed form
: _TU a i .�A __
to the Uponor Fire Safety Design Department
Contact: _. s/ J A ur A at technicalservices@uponor.com or 952.997.1731.
Phone-
®,_, d-` zi
t19^ For questions,contact Uponor Technical Services at
888.594.7726 or technical.seervices@uponor.com.
Fax: --- Color of test orifice used: RNA'
Job Name: ( I4 kifPC Static pressure(not flowing)reading at incoming
Project Number: /437.3... water supply into home or at main shutoff:
Job Address: a 3c-c _70,4,i 1t
Residual pressure(flowing)reading at incoming water
City. _. / > \ supply into home or at main shutoff: 6o
State,ZIP: 0 C ) -- r�
What time of day was the flow test taken? (f,C-0
For designs not provided by Uponor, complete the
following information. Flow test method used? 4Bucket Flow Meter
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Designer's Name: _ I"c 4' ' kf L,(' _ Flow test gpm:_ '43
Company: _ (;�;�j How many gallons water did the design predict
1t� as required? j
Phone: 1S `-9 q t) -C3?-0
Did the test meet or exceed design flow?*1 Yes .7 No
Fax:
— Which sprinkler did you flow?Number:AL _
Is the warning sign permanently attached close to the Location of head: T )4\"a _
main shutoff valve? -Yes No 61,\Pi n i ',,
Date left in service with all valves open:���Q
1i le
Was this-system required by code?'Yes 3 No
Test Witnessed and Verified by:
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Nam
rSI'�/�1P�}', Si; at 0 cupat n Dat
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• Additional Explanations and Notes
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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