Report (8) 20I
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4w AV FIRE SAFETY SYSTEMS
- AQUASAFETM FLOW TEST
VERIFICATION
` FORM
AquaSAFETM Flow Test Verification Form
Alliance Important Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
( �� w`� '« system warranty.E-mail or fax completed form
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Company Name: V ^y
yt , to the Uponor Fire Safety Design Department
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Contact: tLIX I I-ta Fel at technical.services@uponor.com or 952.997.1731.
Phone: 1 1
11 it- 3 5 _0 04 For questions,contact Uponor Technical Services at
888.594.7726 or technical.services@uponor.com.
Fax: ,(� Color of test orifice used: '.'>)
Job Name: k Ci 5 ,Ic 0 a -y-livcr I f I(&CLtatic pressure(not flowing)reading at incoming ,
Project Number: '3`f(� water supply into home or at main shutoff: h L
Job Address��i it9q SW 11b/_q I /\\1Q
—}� Residual pressure(flowing)reading at incoming water
City: 1 l3C, �y ' supply into home or at main shutoff:
State,ZIP: l/i-(.1 Oont/ ?tLI t,� q 1�
What time of day was the flow test taken? Kg f!'
For designs not provided by Uponor,complete the
following information. Flow test method used? L Bucket ❑Flow Meter
Designer's Name: Flow test gpm:
Company: How many gallons of water did the design predict
as required? 1 3
Phone: Did the test meet or exceed design flow?.. IYes EINo
Fax: Which sprinkler did UN
flow?Number: '/
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Is the warning sign permanently attached close to the Location of head: 1,NS k('Is tx *k 7 04
main shutoff valve? ❑Yes ❑No
Date left in service with all valves open:
Was this system required by code?U Yes ❑No
-
Test Witnessed and Verified by:
Name; Signa . Occupation Date
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Additional Explanations and Notes
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E 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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