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FIRE SAFETY SYSTEMS
, n `” AQUASAFETM FLOW TEST
' VERIFICATION
FORM
AquaSAFETM Flow Test Verification Form
Alliance � i important installing contractor must submit this
Member ID: 4 completed form.Failure to do so nullifies the
Company Name: (3v .OL� Pl�i.miot system warranty.E-mail or fax completed form
to the Uponor Fire Safety Design Department
Contact: 7Dr t.tn.( j at tecbeical servlceauponor con or 952.997.1731.
Phone: SO-1- 44C O^ ai b S For questions„contact Uponor Technical Services at
1 ( -Z S 0 '� 888594.7726 or technical.services9:uponor corn.
Fax:
t, Color of test orifice used: g LL le..Name: Jl Ia t I y ics(n 1 to t t&Z
Static pressure(not flowing)reading at incoming
Project Number: (g 070 F 00 I water supply into home or at main shutoff: 7OPSe
Job Address: 1 (2e) _54;qApciLlAttkuj
Residual pressure(flowing)reading at incoming water
City: 'Tic)aid t 6a. supply into home or at main shutoff:
State,ZIP: 9'7 2Z,1
For designs not provided by Uponor,complete the What time of day was the flow test taken?
following information. Flow test method used? U Bucket Flow Meter
Designer's Name: Flow test gpm: 17,P ivk
Company: How many gallons of water did the design predict
as required? (-1
Phone:
Did the test meet or exceed design flow? Yes U No
Fax:
Which sprinkler did you flow?Number: in
Is the warning sign permanently attached close to the Location of head: 1v.irorki% 3
main shutoff valve? D Yes D No
3 Was this system required by code?D Yes D No Date left in service with all valves open: 6-2 3 I to
3
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Test Witnessed and Verified by:
Name
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Additional Explanations and Notes
9
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k Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax 952.997.1731
Apple Valley,MN 55124 USA Web:www u
it