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II: FIRE SAFETY SYSTEMS
X AQUASAFETM FLOW TEST
VERIFICATION
FORM
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AquaSAFEM I Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
Company Name: trc.t °I1int system warranty.E-mail or fax completed form
to the Uponor Fire Safety Design Department
Contact: O'''N \11.0i1Y145 at technical.services@uponoccom or 952.997.1731.
Phone: 5071-4ci3,-- For questions,contact Uponor Technical Services at
888.594.7726 or technical,segices(euponor.com.
Fax: Color of test orifice used:Job Name:Name: Static pressure(not flowing)reading at incomin
Project Number: q0-1 IA-0 1 water supply into home or at main shutoff:
Job Address: kt-A Z-L-kk St-x\
Residual pressure(flowing)reading at inc9,: g water
City: supply into home or at main shutoff:
State,ZIP: r)s?...,.) CAA
What time of day was the flow test taken? /0j3 en
For designs not provided by Uponor,complete the
following information. Flow test method used?ABucket Li Flow Meter
Flow test gpm: 41
Designer's Name:
How many gallons of water die design predict
Company:
as required?
Phone:
Did the test meet or exceed design flow.- 'Yes LI No
Fax:
Which sprinkler did you flow? Number: tt
Is the warning sign permanently attached close to the Location of head: 13CiAri4 ,1'N
main shutoff valve?,,, Yes J No
Date left in service with all valves open:
Was this system required by code?CI Yes LI No
C
Test Witnessed and Verified by:
-?..
j\l_ame, Si9 nu re Occupation Date
i kc, CZ<JtOrakir\ \ANN)br
Additional Explanations and Notes
Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponsar-usa.com