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0 - 0o20 € b UOflO1 • E ° 4di7 • FIRE SAFETY SYSTEMS AQUASAFETM FLOW TEST iV�� VERIFICATION ' ' " FORM AquaSAFErm Flow Test Verification Form AllianceImportant:Installing contractor must submit this Member ID: �\ 3 0 completed form.Failure to do so nullifies the Company Name: ; 1,.t 1 Y,e%( system warranty.E-mail or fax completed form PP� ,, to the Uponor Fire Safety Design Department Contact: "W'v'V\ T ono MC"_.5 at technical,services@uponor.com or 952.997.1731. For questions,contact Uponor Technical Services at Phone: 3 �'1�� `/,�I� 888.594.7726 or technical,services@u onor.com. Fax: W Z/CJJ 3 . C Color of test orifice used: t C� Job Name: R.'.)Y Static pressure(not flowing)reading at incoming Project Number: kik1(10 'i .J water supply into home or at main shutoff: Job Address: Residual pressure(flowing) reading at incoming water City: T 1/.0e A supply into home or at main shutoff: 411 State,ZIP: '© i2 What time of day was the flow test taken? ')if For designs not provided by Uponor, complete the Flow test method usedBucket ❑Flow Meter following information. Designer's Name: Flow test gpm: Company: How many gallons of water did ire design predict as required? Phone: Did the test meet or exceed design flow)Yes ❑No Fax: Which sprinkler did you flow? Number: 1'r' Is the warning sign permanently attached close to the Location of head: 3 na C On 1V1 main shutoff valve? (es U No Date left in service with all valves open: Was this system required by code?❑Yes U No Test Witnessed and Verified by: Name ) { yj��p Occupation Date n /yah 1 Additional Explanations and Notes Uponor,Inc. Tel:800.321.4739 5925148th Street West Fax:952.997.1731 Apple Valley,MN 55124 USA Web:www.uponor-usa.com