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FIRE SAFETY SYSTEMS
AQUASAFETA° FLOW TEST
VERIFICATION
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FORM
AquaSAFETM Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: completed form. Failure to do so nullifies the
/ 1 ' system warranty. E-mail or fax completed form
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Company Name: 00 'LA"'4, to the Uponor Fire Safety Design Department
Contact: c-k-4a git-J"•M.r�- at technicalservices@uponor.com or 952.997.1731.
`., For questions,contact Uponor Technical Services at
Phone: 888.594.7726 or technical.services@uponor.com.
Fax: Color of test orifice used: g(ack
Job Name: rec7ShArk- Static pressure(not flowing)reading at incoming
m Project Number: 3r')s OD 2 water supply into home or at main shutoff: yy
Job Address: J�9'
Residual pressure(flowing)reading at incoming water
City: T.G/✓'O supply into home or at main shutoff: 34
State,ZIP: r
What time of day was the flow test taken? / f2M
N For designs not provided by Uponor,complete the
1., following information./ Flow test method used? 0 Bucket low Meter
Designer's Name: I2i'4-a-dr/ t tmei)erS,r-✓ Flow test gpm: 3
Company: (.?PO NC.R.__ How many gallons of water did the design predict
as required? 1 3
Phone: 'f,S�— ? 1'7 3 Did the test meet or exceed design flow? s 0 No
Fax: Which sprinkler did you flow?Number: /+ 3
Is the warning sign permanently attached close to the Location of head: 3 rifla4r' S/A1
main shutoff valve? ❑Yes 0 No
�� Date left in service with ail valves open: Y �
Was this system required by code?l�Yes ❑No
Test Witnessed and Verified by:
s. Si Occupation Date
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Additional Explanations and Notes
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Uponor,Inc. Tel:800,321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-isa.com