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FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
� ,, a# Q�j VERIFICATION
r �.i ' g
,� FORM
AquaSAFETM Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
pay i;�L ri,-,- �e system warranty.E-mail or fax completed form
ComnName: '� to the Uponor Fire Safety Design Department
Contact: GIVih 1—Ae)k/1 at technical.ser contact Uponor coTechnical Services at
Phone: -. 888.594.7726 or technical.serviyes@uponor.com.
Fax: Color of test orifice used:
Job Name: R Name. 4
`+t l' r Static pressure(not flowing)reading at incoming
Project Number: 1-S S _1 L water supply into home or at main shutoff:
Job Address: I�i‘ 314) 6e IJ&r> �'�
Residual pressure(flowing)reading at incoming wrater
City: supply into home or at main shutoff: ��$�
State, ZIP:
What time of day was the flow test taken? /OPFuf
For designs not provided by Uponor, complete the
following information. Flow test method used? Cucket U Flow Meter
Designers Name: Flow test gpm: 13
Company: How many gallons of water did the design predict
as required? 13
Phone: Did the test meet or exceed design flow?10 Yes 0 No
Fax: Which sprinkler did you flow?, Number: H.. 2
Is the warning sign permanently attached close to the Location of head:Top [«sF tiz — 5 c,
main shutoff valve? jYes 0 No
Date left in service with all valves open:
c Was this system required by code?!Yes 0 No
Test Witnessed and Verified by:
Name Signature Occupation Date
e
I
0
a
N
Z
S
F Additional Explanations and Notes
0
k
wi
Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com