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FIRE SAFETY SYSTEMS
AQUASAFETm FLOW TEST
VERIFICATION
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AquaSAFE' Flow Test Verification Form
Alliance ( t Important:installing contractor must submit this
Member ID: "1 �''"t completed form.Failure to do so nullifies the
j system warranty.E-mail or fax completed form
Company Name: l 'yc'-`,'i(4 a i sy+��t + � to the Uponor Fire Safety Design Department
Contact: .1 d++ -t+t-t at technicaLservices@uRgngr—.com or 952.997.1731.
For questions,contact Uponor Technical Services at
Phone: '� ``�q '�� 888.594.7726 or technical.servicesOunonor com.
Fax: Color of test orifice used: 9
Job Name: i;.ivy hiet tCXa Q Static pressure(not flowing)reading at incoming
Project Number: Ct ti Q water supply into home or at main shutoff:
Job Address: /S13&c1A1
residual pressure(flowing)reading at incoming water
City: supply into home or at main shutoff:
State,ZIP:
What time of day was the flow test taken?
For designs not provided by Uponor,complete the
following information. Flow test method used? ❑Bucket Flow Meter
Designer's Name: Flow test gpm:I
Now many gallons of water did the design predict
Company: as required?
Phone: Did the test meet or excee design flow? l (Yes ❑No
Fax: Which sprinkler did you flow?Number: 2-
Is the warning sign permanently attached close to the Location of head: €ra w+
main shutoff valve? ❑Yes ❑No
Date left in service with all valves open:
Was this system required by code?0 Yes ❑No
Test Witnessed and Verified by:
Name ature Occupation Date
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A Additional Explanations and Notes
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Uponor,Inc Tet 800.321.4739
i 5925148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com
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