Report (40) 11157" aor6 ov a w.--
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FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
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aa VERIFICATION
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�. : FORM
Aqua A.F'ETM Flow Test Verification erxflcation Form:
Alliance
........ .........
Member ib; important.Installing contractor must submit this
/) completed form.Failure to do so nullifies the
Company Name: t ittiq e , ,_Li ?_ ._ mem warranty.E-mail or fax completed e1 to if<e Uparior Fire Safety Design form
Contact: ��..� �Y depaitmeM
at tchnlcxl od -,
Phone: !!!or 952.997.7731
j,2 ?,i f For questions,contact Uponor Technical Services at
Fax: 8B8 594.7726 or technic m:n,{ ,. --_
---__ --- --- Color of test orifice used: .Z
Job Name: K)ms's E nr f.,_',
to{ Static pressure(not flowing)reading at incoming
Project Number: - tT , . water supply into home or at main shutoff:
Job Address; .L jtJ c .i'."`. Te .. - _ _--•—
City: Residual pressure(flowing)reading at incoming water
`®---- supply into home or at main shutoff; ,
State,ZIP: ___ °J?l1 j
For designs not provided by Uponor,complete the What time of day was the flow test taken?
following information.
Flow test method used?
b
�,t bucket CI Flow Meter
Designer's Name: e1Ofi�ar..r Flow test
Spm: 1&f
Company: ,; �^ How many �" �`
gallons of water did the design predict
Phone: 95,>—_,t12::.j 41 as required?__________A___________
Did the test meet or exceed design flow?FaGs No
x
Which sprinkler did you flow?Numbers
Is the warning sign permanently attached close to the '
f;410- main shutoff valve? CI Yes l No location of head,______ ____________________
es No Date left in service with all valves open: _ J- _
P.
Was this system required by code?
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f.
Test Witnessed and Verified by
Name Signature
. Occupation Date
Additional Explanations and Notes u
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Uponor,Inc. Tel;800.321,4739
5925 148th Street West Fax:952.997,1731
Apple Valley,MN 55124 USA
Web:www uponor usa.wrn