Report (56) k,\--VR,a Gad C -\- T .
,
uponol
; ' FIRE SAFETY SYSTEMS
�
V AQUASAFETM FLOW TEST
.,,
,, ` VERIFICATION
#'r
FORM
d4
T '
k n
AquaSAFE` ` Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
Company Name: *ti., ptL+-/w system warranty.E-mail or fax completed form
to the Uponor Fire Safety Design Department
Contact: C9' .T v '� at technical.serviceseuponor,com or 952.997.1731.
��L_ Q For questions,contact Uponor Technical Services at
Phone: 888.594.7726 or technical.serrviiceseuponor.com.
Fax: pp __,,__ Color of test orifice used: !
244
Job Name:ncws�t r.* •it`r" OiP',c4:e Static pressure(not flowing)reading at incoming ,
Project Number: 3 2s7S-4-- oe, ( water supply into home or at main shutoff: $-1-- .Se
Job Address: i/u1E52.. 50 &old‘04.1k r
Residual pressure(flowing) reading at incoming water
City: supply into home or at main shutoff: 4-6)7 5-e
State, ZIP:
What time of day was the flow test taken? 16 0-4,
For designs not provided by Uponor, complete the
following information. Flow test method used? 0 Bucket LIFlow Meter
Designer's Name: Flow test gpm: 3
Company: How many gallons of water did the design predict
as required? (3
Phone: Did the test meet or exceed design flow? I ,Yes :I No
Fax: Which sprinkler did you flow?
jj Number. N"- i 1
1
Is the warning sign permanently attached close to the Location of head: . sr-60•C 0•C J+ aLPOk t
main shutoff valve? 'Yes L]No
Date left in service with all valves open:
Was this system required by code?*Yes ❑No
5
N
Test Witnessed and Verified by:
s
Name Signatur- Occu ation Date
a
g0
X
0
ry0
O
0
Additional Explanations and Notes
V
d
8
nl
LL
Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com
N
LL