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FIRE SAFETY SYSTEMS
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AQUASAFETM FLOW TEST
F ,tVERIFICATION
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: urtr� �!r-W system warranty.E-mail or fax completed form
���" to the Uponor Fire Safety Design Department
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Contact: ( 44,4-t Ie ' at technical.services@uponor,com or 952.997.1731.
Phone: ' 4�f 9Z' 3 L/ For questions,contact Uponor Technical Services at
888.594.7726 or technical,services@uponor,com.
Fax: Color of test orifice used:
Job Name: ?O517.+6.k rt"4T� Static pressure(not flowing)reading at incoming
Project Number: ?2-5 7, I water supply into home or at main shutoff:<2-g/
Job Address: i`l ll Li 5i,.! Lc•id (dr
Residual pressure(flowing) reading at incoming water
City: supply into home or at main shutoff: y''" .
State,ZIP:
What time of day was the flow test taken? IC?` ,
For designs not provided by Uponor, complete the
following information. Flow test method used? 71.8ucket C]Flow Meter
Designer's Name: Flow test gpm:
Company: How many gallons of water did the design predict
as required? f 3
Phone:
Did the test meet or exceed design flow? ' LYes C7 No
Fax: Which sprinkler did you flow? Number:
Is the warning sign permanently attached close to the Location of head: (OP PAX'
main shutoff valve? .Yes LI No
Date left in service with all valves open:
c Was this system required by code?9tYes U No
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Test Witnessed and Verified by:
Name Signature �--- Occupation Date
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$ Additional Explanations and Notes
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Uponor,Inc.
Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
i Apple Valley,MN 55124 USA Web:www.uponor-usa.com
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