Report (26) c
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,,„. ,Itit, i r uponol
r 5r FIRE SAFETY SYSTEMS
°V AQUASAFETm FLOW TEST
.40i VERIFICATION
, .44 FORM
AquaSAFETM Flow Test Verification Form.
•
•
Alliance if: j � , ( important:Installing contractor must submit this
Member ID: I I lU'1 completed form.Failure to do so nullifies the
Company Name: l Y ‘c3t"�� 9 t t�i+a ts.tL warrarrtyr...E-mail or fax canpleted form
' + � � to the Uponor FiSafety Design Department
Contact: ....1,3-r, tt r 6..Le at technical.servicesauponor.com or 952.997.1731.
Phone: C.j3 'AR t'3 — —j �: Far questions,contact Uponor Technical Services at
886.594.7726 or technical.services€uoonor corn.
Fax: 9 1 t-25c• 'j Bc 9, Color of test orifice used: g taC Y.
Job Name: 5i:..k1n Kit a Z.c1/43.,(0-i Static pressure(not flowing)reading at incomta
Project Number: 01 F Q�� water supply into home or at main shutoff: t
Job Address: 13061 Sw BLo.ete WeLtrukfcr
Residual pressure(flowing)reading at incoming water
City: `� .,
supply into home or at main shutoff:
State,ZIP: 0' q 1224
notprovided byWhat time of day was the flow test taken?
For designs
Uponor,comptel e the
following information. Flow test method used? GI Bucket Flow Meter
Designer's Name: Flow test gpm: f 1 5P`v'
Company: How many gallons of water did the design predict
as required? 1.1�e‘v
Phone:
Did the test meet or exceeXdesign flow? ; Yes ❑No
Fax:
-'1Z
Which sprinkler did you flow?Number:
Is the warning sign permanently attached close to the Location of head: g.eickr00 wt 3
main shutoff valve? ❑Yes ❑No
Was this system required by code?U Yes 0 No Date left in service with all valves open: g-S-((p
Test Witnessed and Verified by:
Name
7rejt......:4„.1,1/421, p u mon Date
ji` L
Additional Explanations and Notes
Uponor,,Inc. Tel:800321.4739
5925 148th Street West Fax 952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com