Report (28) •f: / ' .,"n41, , .,
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uponol
FIRE SAFETY SYSTEMS
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AQUASAFETM FLOW TEST
} VERIFICATION
1
0 ��, r ,• ,� FORM
AquaSAFETM Flow est Verification Form
•
Alliance t} ( Important Installing contractor must submit this
Member ID: t �Q`1 completed form.Failure to do so nullifies the
Company Name: l9"�ca c1 E^ Lt-:"..u") system warranty.E-mail or fax De ern
form
11
' to the Uponor Fire Safety Design Department
Contact: ....16-'61,744),
(ti at technicaiserviceseu
ponor.com or 952.997.1731.
Phone: SL). '`{g 0 - . k j For questions,contact Uponor Technical Services at
p 888 594.7726 or technicalservices@uponor Com.
Fax: -11(.Z5C.. j 'r�
i; Color of test orifice used: g tom^i(
Job Name: .5irann nA ti et� I S 1"/
Static pressure(not flowing)reading at incomin
Project Number 14 010 F • CO, water supply into home or at main shutoff:
Job Address: 13DL1c1 SA" f 4y
al CI
Residual pressure(flowing)reading at incoming water
City: 'ic e.14
supply into home or at main shutoff:
State,ZIP: 0 et 'Iia q
For designs not provided by What time of day was the flow test taken?
Uponor,complet•the
following information. Flow test method used? U Bucket lX Flow Meter
Designer's Name: Flow test gpm: rl 5pvvx
Company: How many gallons of water did the design predict
Phone:
as required? i•"lei �,yvw.
Did the test meet or excee'design flow? 'Yes U No
Fax:
Which sprinkler did you flow?Number: 2.,
Is the warning sign permanently attached clos•to the
main shutoff valve? C]Yes 0 No Location of head: ���Gtr "Z
Date left in service with all valves open: -7-2.1-t-7-2.1-tWas this system required by code?C]Yes 0 o (42
•
Test Witnessed and Verified by:
Name i, ti :tore ��
7tsra e'n. t'R 4e- —e' �` 4.1.,... k.4.- 1-4-,- k Occupation Date
kov-' 1 -tel-t(0
Additional Explanations and Notes
Uponor, . Tel:800321.4739
5925 148th Street West Fax 952.997.1731
Apple Valley,MN 55124 USA Web:wv. -usacom