Report (42) ill$T,2016 - DO 4./6
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FIRE SAFETY SYSTEMS
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AQUASAFElm FLOW TEST
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; ;',i5 VERIFICATION
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FORM
AquaSAFETM Flow Test Verification Form
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Important:Installing contractor must submit this
Alliance
completed form.Failure to do so nullifies the
Member ID:
system warranty.E-mail or fax completed farm
Company Name: Atli Nilite- ftukkarto the Uponor Fire Safety Design Department
Contact: kti<4 t C otrAsr.. at technicalservicesrt'uporior.com or 952.9973731.
For questions,contact Uponor Technical Services at
Phone: Ca 3- .49-14410 888.594.7726 or technicalserviceseuponor.com
Fax. Color of test orifice used: tavc
Joh Name, NA*--/-71C.teil(R....- Static pressure(not flowing)reading at incomingco.
Project Number: -6i lot )Li ,k) water supply into home or at main shutoff:
Job Address: ) ... A-.2 'K.'- ''' it- ' Residual pressure(flowing)reading at incoming water
City: 1ee,crit. supply into home or at main shutoff: $9'
State,ZIP:
What time of day was the flow test taken?
For designs not provided by Uponor,complete the
Flow test method used? trCu'cket C:1 Flow Meter
following information.
gpm-Flow test Igf
Designer's Name: WA/50.- Pitittltaei- '
How many gallons of water did the design predict as required? 10
Company: lillArliar
Phone: 4.- -9 A 7
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— Did the test meet or exceed design flow? Ci‘s D No
Fax.
Which sprinkler did you flow?Number: I'I'`7
A i 1 ,.„..4 Is the warning sign permanently al/ached close to the Location of head:
11glee:6yr% v.)-
- tr . main shutoff valve? Li Yes .fl No
Date left in service with all valves open:
Was this system required by code?torces J No
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E Test Witnessed and Verified by:
...: Name Signature Occupation Date
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Additional Explanations and Notes
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Uponor,Inc.
Tel 800321:4739
5925 148th Street West
Apple Valley,MN 55124 USA Fax:952.997.1731
e' Web:www.uponor-usa,coin