Report (53) ,. ,.. . .
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FIRE SAFETY SYSTEMS
AQUASAFETm FLOW TEST
:,.. VERIFICATION
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AquaSAFETM Flow Test Verification Form
Alliance Important Installing contractor must submit this
Member ID: completed form.Fedore to do so nullifies the
A 1 % 0,, system warranty.E-mail or fax completed form
Company Name: 1 'A,,,_ am "s . - tothe Ulmer fire Safety Design Department
Contact?ilbfil" DIblet/i at ifidlifilithlththffilithifilithfirzfath or 9U-950.1731-
Phone.SOS-Lig 2.-3-1(46 For questions,contact Uponor Technical Services at
899.594.7726 or tedmical.sapleesauponor.cow.
Fax: Color of test orifice used: lora.55
Job Name: 2iktir Yeiratot Static pressure(not flowing)reading at incoming
Project Number: water supply into home or at main shutoff: ••• 0
Job Add ress:131164 SUJ Beteii piu.,*Teo . .
Residual pressure(flowing)reading at incominggr.
City: 71 Vr3 supply into borne or at main shutoff: i
State,ZIP. 0 q-7 Z23
What time of day was the flow test taken? qa Yet
For designs not provided by Uponor,complete the
Flow test method used? .Bucket i:l Flow Meter
following information,
Designer's Name: AA LUSAri.
%xi .1.1t-z.. Flow testdid the
,
gpm: go S .1)01/i
How many gallons.ptrater dirlihi design predict
Company: ()Or
(1-2)
Phone: 1 2-c1417--S 350 as required? i..) 6-Pilr1
Did the test meet or exceed design flow?)(Yes Ca.No
Fax: Which sprinkler did you flow?Number: U. )3'
Is the warning sign permanently attached close to the Location of head: gehRefro Z 3if Clow-
main shutoff valve? pikes ti No
a 6
Date left in service with all valves open:Atatii./ZOi
O_ ... _ ,.
Was this system required by code?plYes a No
Test Witnessed and Verified by:
, A /
i a ,i, 4 4 31°Wrtccu a*"‘4"-•'n (164.H. -) DIC1/13-i/WI OP'
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0
s
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Additional Explanations and Notes
S
11
Uponor,Inc
5925 148th Street West
Tel:soa321 A739
Fax:9S2.997.1731
Apple Valey,MN 55124 USA Web:wvnv.uponor-sna.com