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FIRE SAFETY SYSTEMS
AQUASAFETM' FLOW TEST
VERIFICATION
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AquaSAFETM Flow Test Verification Form
Alliance Climportant Installing contractor must submit this
Member ID: � -{ 11 completed form.Failure to do so nullifies the
Company Name: r?ra_v chi t/ Pt/t,W4 61 system warranty.E-mail or fax completed form
ff 1 to the Uponor Fire Safety Design Department
Contact: 31)h (4 I v lc at tedmicalservicessuoonor.com or 952.997.1731.
Phone: 503 'U 4 o-o'-11, 3 For questions,contact Uponor Technical Services at
888.594.7726 or tedrrial.servicestguoonor.com.
Fax: 171-Z5c)"3$O
,,// n Of Color of test orifice used: SI��.
Job Name: Su-Montt lc•-1 R. Li-(59Static pressure(not flowing)reading at incoming Q
Project Number: 1 q 0"10 F 001 l,/ l water supply into home or at main shutoff: 1(IS t
Job Address: (3054 S‘...) W o-kv�.u7(`�1
( Residual pressure(flowing)reading at incoming water
City: \ aIrsupply into home or at main shutoff:
State,ZIP: (7V- q 1 2-2-14
What time of day was the flow test taken? 10 6 WN
For designs not provided by Uponor,complete the
following information. Flow test method used? IBucket I Flow Meter
Designer's Name: Flow test gpm: 11 y '
Company: How many gallons of water did the design predict
as required? t-1 5r AA
Phone: Did the test meet or exceed design flow? 411.Yes U No
Fax:
Which sprinkler did you flow?pNumber: 10
Is the warning sign permanently attached close to the Location of head: l i;.aC YY. —44--3
main shutoff valve? U Yes No y`ZS
Date left in service with all valves open: (v
>4 Was this system required by code?18 Yes ❑No
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Test Witnessed and Verified by:
Name I+ '� Ii.a..1L.,,WA Ckcuf�ation Date
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Additional Explanations and Notes 14.5J o r5 t�1n Ltn . 'v1 t w u l 04-1,U
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Aa S t CyA IL 1- 4 Ln►511
Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax 952.997.1731
1 Apple Valley,MN 55124 USA Web:www.uponor-usa.corn
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