Report (4) ri ;:'-----;
tt uponor
,.„
I 1 r:
AQUASAFE" FLOW TEST
VERIFICATION
FORM
;\I ,
.'\(iliaSAI'l . Flow TCSt Verification Form
... . ... ....... , . _ , . . ... „ , ,
Important:Installing contractor must submit this
t",tember 314
completed form.Failure to do so nullifies the
Company Name 001,!‘„itti e I,.-b i...t„s system warranty.E-mail or fax completed form
to the Uponor Fire Safety Design Department
130 Cocoa t C / 2r).A"' at technical.servicesr.iPuponor,corn or 952.997.1731,
.\ ' Phone ,.,i-C1 3 66'7 i?id For questions,contact Uponor Technical Services at
------------ 888.594.1726 or technicilm,ry„„ices/uppsIgf,,s,grn.
Color of test orifice llSed: _
lob Name _ P091AL4..< - ----- Static pressure(not flowing)reading at incoming
' rtai t ec Number 3,2,5775-C
' — water supply into home or at main shutoff:
Job Address iY.J., 5-,L5k1.-k_fie.ii______
city _. .10. Residual pressure(flowing)reading at incoming water
supply into home or at main shutoff:
,\..........,v) State, ZIP 46
_
What time of day was the flow test taken')
l'I4 For designs not provided by Uponor,complete the
Flow test method used' j Bucket Wriow Meter
foliowing information
Flow test gpm..,.L.3._
Designer's Name jiyes,--/, II_ _ ..,.... __—
How many gallons of water did the design predict
riivliParlY ---------0-11-4--1-.-*:"*- ----7--- aS required? L .
Phone .erir ''' 5' 7 2 '7 ' — Did the test meet or a i ' i- !
,) g--/ i)
-."' L.' / ' 21.1/ -i— Which sprinkler did you rl i-,
F..tile warning sign permarienCy attached close ro the t IA it ot head.
rn,im shixtoff valve? J Yes j Nu Nate left in service with all vat , , ii) /5.- )'-
'„Nai,,,the,system required lay.t ride?tfrrrLi L.1 No
„_„ . ...... ..,_ .... ..
Test Witnessed and Verified by:
o ... .II .,
'1'.' ..., 1 ) 4
Additional Explanations and Notes „, .._ , , _,,,,,,_,, ,.„,.
.......
I.4 iitri of ii'i i
Uportor.Inc.
1.1, iii,iiri i id ti
5925 148 TI.
311cAer We,,r
Web:wywviuponor-Usar,‘OM
Apple Valliei,MN'at I q;I'ao
,1,_-1,,„i'a.;1,4'..,iek.iaovaririiiiiiiiia4,041WA-NITO4l"4taac'-'-1,4'0iWjail4