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FIRE SAFETY SYSTEMS
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AQUASAFETM FLOW TEST
'',- VERIFIcAT1ON
QiFORM
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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
system warranty. E-mail or fax completed form
Company Name: i1il�nal/ 1iGGro�l�
/ ''P'1-6/4-1
to the Uponor Fire Safety Design Department
Contact: � i� `j7�fly, at technical.services@uponor.com or 952.997.1731.
For questions,contact Uponor Technical Services at
Phone: �3 fl Z— a 888.594.7726 or technical.services@uponor.com.
Fax: Color of test orifice used:
Job Name. R1i,�Gt!"I-err Static pressure(not flowing)reading at incoming
Pro'ect Number: ~+ water su I into home or at main shutoff: 2
J 1)1107,12_—c/1 PPY S
Job Address:/4-1)-451) SZ i /611
_ f Residual pressure(flowing)reading at incoming water
City: Thi re q supply into home or at main shutoff: t/L -'
State,ZIP: c% 4.
What time of day was the flow test taken?
For designs not provided by Uponor,complete the
Flow test method used? y Bucket ❑Flow Meter
following information.
Designer's Name:
Flow test gpm: I 3
Company: How many gallons of water did the design predict
as required? i 3
Phone. Did the test meet or exceed design flow? Yes ❑No
Fax
Which sprinkler did you flow? Number: 3
F i
Is the warning sign permanently attached close to the Location of head: r t�pY
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:
NameSi nat r• ,i 1.- Occupation Date
Additional Explanations and Notes 4 r
0
g
Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com