Report (42) y '1 2
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FIRE SAFETY SYSTEMS
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„b„,--rx AQUASAFETm FLOW TEST
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Aq .aS E Flow Test Verification Form
Alliance a _; # irr rortant:Installing contractor must submit this
Member if): tai``� systeur pieced fora.Faure to do so nullifies the
Company Name: i'('c j 1�4t E-rrc�il a fax Department
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1 ) to the t pener Fire safety Design
Contact: Ctrs,. r d.t. k-C at techrdcaLseivicesetuponaccom or 95 .997.1731.
For questions,contact!loaner Tedsniad
Phone: ci.. -'AR 0 -0'1 1388394.7725 or tedaolra erwono at
Fax: CI 1 -25C' B Color of test orifice used: gt.,-
Job Name: 5i;:. + tt,t t ice Staticressure(not flowi g
p ng)reading at in . f >
Project Number , q D 7 fI:.-(-fi r—� water supply into home or at main shutoff: a.
Job Address: b( S ty tL(A)i( A
dual pressure(flawing)reading at incoming water
City: 1 i supply into home or at main shutoff:
State,ZIP: Ott q `Z? J
What time of day was the flow test taken?
For designs not provided by Uponor,complete the
following information. Flow test method used? ®Bucket a Flow Meter
Designer's Name: Flow test gpm:
How many gallons of water did the design predict
Co as required? k-43
Phone: Did the test meet or exceeTdesign flow? 1Yes CI No
Fes' Which sprinkler did you flow?Number:
Is the warning sign permanently attached close to the Location►of head:
main shutoff valve? ®Yes ®No
Date left in service with aft valves open:
1 Was this system required by code?U Yes Q Na
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Test Witnessed and Verified by:
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Additional Explanations and Notes
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Tel800321.4739
5925 148th Street West Fax:952997.1731
Apple Valley,MN 55124 USA Web: nrtgoonor-usa.com
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