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FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
\ ` VERIFICATION
FORM
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AquaSAFETM Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
Company Name: �I��i � �� r+^�i system warranty.E-mail or fax completed form
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/ to the Uponor Fire Safety Design Department
Contact: i . 4 i1 r he 4111. at to.hnical.services@uponor.com or 952.997.1731.
LsU �/�I--3`!�9d For questions,contact Uponor Technical Services at
Phone: 888.594.7726 or technical.services@uponor.com.
Fax: , t Color of test orifice used: lr'Sf
Job Name: w�C wrG� G�J�es� Static pressure(not flowing)reading at incoming
Project Number: 31-s-7SJ oo. water supply into home or at main shutoff: S2/95,'
Job Address: 10 NG/ 5u) Ocie ( tlkr,
Residual pressure(flowing) reading at incoming pater
City: supply into home or at main shutoff: L/r fc
State,ZIP:
What time of day was the flow test taken? /l 41-4-1
For designs not provided by Uponor,complete the
following information. Flow test method used? tit Bucket L]Flow Meter
Flow test gpm: 13
Designer's Name:
How many gallons of water did the design predict
Company: as required? l 3
Phone: Did the test meet or exceed design flow?'l Yes LI No
Fax: Which sprinkler did you flow? Number: 1. 1--
Is the warning sign permanently attached close to the Location of head: -reie r4'i .5 "f1i
main shutoff valve? VI Yes Ll No
Date left in service with all valves open:
Was this system required by code? 1 Yes ❑No
a Test Witnessed and Verified by:
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Name„ Signa r Occupation Date
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Additional Explanations and Notes
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Uponor,Inc.
5925148th Tel:800.321.4739
5925Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com