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FIRE SAFETY SYSTEMS
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9 AQUASAFETm FLOW TEST
VERIFICATION
FORM
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AquaSAFErM Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
Company Name: I 1 1 t '6C c 1)Thi' \ ih system warranty.E-mail or fax completed form
to the Uponor Fire Safety Design Department
Contact: G1-eDv'+h h011)4 °� at technical.services@uponor.com or 952.997.1731.
3_Phone: (,-1 3 L'c For questions,contact Uponor Technical Services at
J 888.594.7726 or technical.service oner.com.
Fax: Color of test orifice used:
Job Name: t ' Static pressure(not flowing)reading at incoming
Project Number: V� ' � ®'� - 0, water supply into home or at main shutoff: t1
Job Address: IN u`l 5 11-129044
Residual pressure(flowing) reading at inconii g io{ater
City: 1/���' supply into home or at main shutoff: �Gi
State, ZIP: C JV.— , a1 r
What time of day was the flow test taken? / 1Y).
For designs not provided by Uponor, complete the Flow test method used? y ucket U Flow Meter
following information. /
Designer's Name: Flow test gpm: /5
Company: How many gallons of water didx113 design predict
as required?
Phone: Did the test meet or exceed design flown Yes LI No
Fax: Which sprinkler did you flow? Number:, IJ
Is the warning sign permanently attached close to the Location of head: t a h e. ire-6Qoxv
main shutoff valve? Yes J No
Date left in service with all valves open:
Was this system required by code fAYes U No
Test Witnessed and Verified by:
�Vam Si na ure 0 cupation Date
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Additional Explanations and Notes
LL
Uponor,Inc. Tel:800,321.4739
5925148th Street West Fax:952.997.173i
LL
Apple Valley,MN 55124 USA Web:www.uponor-usa.com