Report (4) 4
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AQUASAIE"/ FLOW rflAT
VERIFICATION
FORM
Aqu.aSAl'ET" How nit, Vcri cationii ()F r. •,
All
Important:Installing contractor must submit this
b L completed form.Failure to do so nullifies the
1
( ,,y Pk-% 1,
system warranty. Email or fax completed form
rhpa l Name
to the Uponor Fire Safety Design Department
sntact at technical.servic eseworior,com or 952.99'7.1731.
Phone 2,54 For questions,contact Uponor Technical Services at
888,594.7/26 or techrtiral.service5,9upottnr,, orn.
N.4 f'ax
- - - Color of test orifice owl
int)Nam st,itic ,,,esstiro.(not flown, .1 at irr.ornin,1
Pr o,...4,Kt NUmbei3 - oy, water supply into borne or at main shutoff
Addr 141.3 36.) eia 9
Residual pre,,ohe(flowing)In lie owing water
City _ 4611N-(10 ... supply min home Or dt 011 l)1i0roff' ay.
State, _
Wile time of day was the flow test taker ?
not plovided by Uponor,complete tile
flow test method used,' CI Bucket lirrow Metcn
low test gpni:._13,
I low many gallons of wa' nd the design preuhd
1$-S-k" ‘.,)), -/ ,
(;)- // 7 1 3/
,•
Test Witnessed and Verified by:
e-41."1
j (1, '
1°4
' 8
Addit., Ii Ixplanatiom add I'
lel
Uponor,
ti92.5 I 48111'itic:0 Wi
Web:WW01,1,91)01101-1154,1:N1
Apple Valloy,MN I 24