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AQUASAFETM FLOW TEST
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FORM
AquaSAFErm Flow Test Verification Form
Alliance 1 )3 Important:Installing contractor must submit this
Member ID: /n� 1 completed form.Failure to do so nullifies the
Company Name: �NkPlumb system warranty.E-mail or fax completed form
to the Uponor Fire Safety Design Department
Contact: C O V INA I h31i S at technical.services@uponor.com or 952.997.1731.
Phone: 5�-y — t\Gid-' 341° For questions,contact Uponor Technical Services at
r� � +_888.594.7726 or technical.sery4s@upionor.com.
Fax: {} Color of test orifice used: G 0
Job Name: i`a.513 61 ( . Static pressure(not flowing)reading at incoming
Project Number: U\613- ' \ water supply into home or at main shutoff: 3
Job Address:
.p Residual pressure(flowing)reading at incorniner
City: 1 1 S 0'2 supply into home or at main shutoff:
State,ZIP: 0 V
What time of day was the flow test taken? if 1 3 0 A
For designs not provided by Uponor, complete the Flow test method used? rBucket 0 Flow Meter
following information.
Flow test gpm:
Designer's Name:
Company: How many gallons of water did thegesign predict
as required?
Phone: Did the test meet or exceed design flow? Yes 0 No
Fax: Which sprinkler did ou flow? Number: /14-it
Is the warning sign permanently attached close to the Location of head: 404 11 C-- 13 D rZ VA
main shutoff valve? 1 Yes U No
Date left in service with all valves open:
Was this system required by code?0 Yes 0 No
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Test Witnessed and Verified by:
Name 5i nature0 pation 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
Apple Valley,MN 55124 USA Web:www.uponor-usa.com
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