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., uponor FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
VERIFICATION
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AquaSAFE' Flow Test Verification Form
AllianceImportant:Installing contractor must submit this
Member ID: I V completed form.Failure to do so nullifies the
��� system warranty.E-mail or fax completed form
Company Name: {��Cto the Uponor Fire Safety Design Department
Contact: 0 \A h)Y1'1C-S at technical.services@uponor.com or 952.997.1731,
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{ 7� c yo For questions,contact Uponor Technical Services at
Phone: /I��1 888.594.7726 or technicai.servicgsc uponor.com.
Fax: J LiC> SA) �d Color of test orifice used: yy
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Job Name: iRooho u, Static pressure(not flowing)reading at incomin ,
Project Number: ,A\ cic7q —) water supply into home or at main shutoff: --_`_ r�
Job Address:
I�,� Residual pressure(flowing)reading at incoming water
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City: 12 A supply into home or at main shutoff: i-15
State,ZIP: C)'? •
What time of day was the flow test taken?
For designs not provided by Uponor,complete the
following information. Flow test method used Bucket LI Flow Meter
Designers Name: Flow test gpm: (3
Company: How many gallons of waterdid the design predict
as required?
Phone: Did the test meet or exceed design flow?.idYes ❑No
Fax: Which sprinkler did you flow? Number: �`1 - I
Is the warning sign permanently attached close to the Location of head: )h1) � DQ�^^
main shutoff valve? jia Yes U No
Date left in service with all valves open:
Was this system required by code?J Yes C]No
Test Witnessed and Verified by:
Name L ''JI
- Signature Q{Qccupgation ate Gj
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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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