Report U p 0 n 0 i
FIRE SAFETY SYSTEMS
' 4
AQUASAFETm FLOW TEST
. 1 .
VERIFICATION
-.. . ,
FORM
,
‘ ,s0;,,,*4',
V ,
. ' :tit.Ng-'''
AquaSAFE' Flow Test Verification Form
41 III
******•**'••••''''''•*•••
Alliance
important:installing contractor must submit this
Member ID: ______ ______:_____________________ completed form.Failure to do so nullifies the
Company Name. _AtiiAr,..ti j.....1...u.,$ system
warranty.E-m
ail or fax completed form
----,------- to the UpoFire ot• Safety Design Department
Contact: 4 tr
952.9973731.
Phone: C"c3-1454-34riO For quenorract ech°rnical Services at
Fax: ------------------ Color of test orifice used:
Job Name: )40 ar jj __-
, ,,, Static pressure(not flowing)reading at incoming
Project Number: "C elf water supply into home or at main shutoff:
Job Address: 7A..ftdee..".. ----------------------
city: , Residual pressure(flowing)reading at incoming water
supply into home or at main shutoff:
State,ZIP: ..___:._06.4._tual______________ ------•---------------_,
What time of day was the flow test taken?
For designs not provided by Uponor,complete the
following information.
Flow test method used? '411ucket r...1 Flow Meter
gpm:
Designer's Name: Flow test iiee.. (.11ci,..______
Company, ....„0 I,„.... How many gallons of water did the design predict
as required7 i I
Phone: :1A.....- ?- $3 It..)
----- Did the test meet or exceed design flow? ca‹s U No
Fax:
--- ----------------------- Which sprinkler did you flow?Number._
i 1 I 1 . Is the warning sign permanently attached close to the Location of tread: La
/f 4r-0,,,.-7 main shutoff valve? U Yes alio
Date left in service with all valves open;
Was this system required by code?Ur-es 21 No
......................................................................................,....................... ........ ......................
..)
Test Witnessed and Verified by:
.ts.
Narn ....I
olivo3Ltiv.%Joe(tv"...4... Signature
Occupation
'Vs„,_4 'L,S. Date
-__ ____________—_.
________
0
-a+
Additional Explanations and Notes
it:a
d
6
;
Liponor,int
Tel:800321.4739
1
5925 148th Street West Fax:952.9971731
1> Apple Valley,MN 55124 USA Web:wimituponor-usa.com