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FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
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4 VERIFICATION
FORM
AquaSAFErM Flow Test Verification Form
Affiance Important:Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
Company Name: !I� OC Q� �z system warranty.E-mail or fax completed form
to the Uponor Fire Safety Design Department
Contact: G-1) \Y11r4\4'Ml.D5_, at technical.services@uponor.com or 952.997.1731.
Phone: 1 I—91D,_ 'u l® For questions,contact Uponor Technical Services at
888.594.7726 or technifal.services@uponor,com.
Fax: Color of test orifice used: R, ^
Job Name: r Static pressure(not flowing)reading at incomini 2
Project Number: vl C. t Q water supply into home or at main shutoff: 7
Job Address: \LIZ.3 S' 1.1d44
S' e.
Residual pressure(flowing) reading at inc2r ii water
City: /1 sa supply into home or at main shutoff:
State,ZIP: _�+ ,•_•_,_ f
What time of day was the flow test taken? m
For designs not provided by Uponor, complete the Flow test method used jBucket V Flow Meter
following information.
Designer's Name: Flow test gpm:
Company: How many gallons of water dice design predict
as required?
Phone: Did the test meet or exceed design flow? Yes ❑No
Fax: Which sprinkler did you flow? Number:
Is the warning sign permanently attached close to the Location of head: UD ,•2 51 \9 ,
main shutoff valve? J Yes ..a No
Date left in service with all valves open: _
Was this system required by code Yes U No
Test Witnessed and Verified by:
Name;) Si nature Occupation Date
a
0
Additional Explanations and Notes
u.i
Uponor,Inc. Tel:800.321.4739
5925148th Street West Fax:952.997.1731
LL
Apple Valley,MN 55124 USA Web:www.uponor-usa.com