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i; uponor At r on ; FIRE SAFETY SYSTEMS J e, Asr�i� - AQUASAFETM FLOW TEST r • 0„ita r,4 1 3 Q7 14t �rdr si VERIFICATION ar . FORM AquaSAFETTI Flow Test Verification Form Alliance 04 Important:Installing contractor must submit this Member ID: n completed form.Failure to do so nullifies the Company Name: l ut�`t P(0-w,_v t-uz system warranty.E-mail or fax completed form ' I r JJ to the Uponor Fire Safety Design Department Contact: T]} 41. �-e at technics services@uponor.com or 952.997.1731. Phone: ^- For questions,contact Uponor Technical Services at '- f` 888.594.7726ortechnical.services@uponor.com. Fax: q 7I-WC- 3 Sp 0 ? Color of test orifice used: g{G.0 IC Job Name: _Si LAA4 W11* f tCY. LA I- t' ( L'!) Static pressure(not flowing)reading at incoming Project Number: 19 C-7 0 F r}©2 ¢water supply into home or at main shutoff: 76 r5 1 Job Address: 1 3(Y7 It. LL} R a(ii.j Residual pressure(flowing)reading at incoming water City: I my cc supply into home or at main shutoff: State,ZIP: O`celrYX. t 72.2-Y What time of day was the flow test taken? For designs not provided by Uponor,complete the following information. Flow test method used? ❑Bucket Flow Meter Designer's Name: Flow test gpm: Company: How many gallons of water d the design predict as required? - Phone: Did the test meet or exceed design flow?g Yes U No Fax: Which sprinkler did you`fl`ow?Number: 1 1 Is the warning sign permanently attached close to the Location of head: i care - `I main shutoff valve? 0 Yes ❑No / Date left in service with all valves open: k/-I L a Was this system required by code?0 Yes Li No 5 l; G Test Witnessed and Verified by: Name s ' atur Occupation Date i a ry .g sAdditional Explanations and Notes 5 E l i Uponor, Inc. Tel:800.321.4739 5925 148th Street West Fax 952.997.1731 1 Apple Valley,MN 55124 USA Web:vyww.uponor-usa com 2