Report (18) ryisT ,c;,/6 - oc) aL/3
I ,
' A'
U
pono f
FIRE SAFETY SYSTEMS
. ow.
AQUASAFET" FLOW TEST
t, ,_;:, k4 (DT11
VERIFICATION
.•; i /:::1';'°:;'
fOlIM, ., ''',,-;, --: -- ., ' .,,',.i. ,•'-,
• At
AqUasAFETM Flow Test Verification Form
...„......................„..................„.„..................................................,.........._._......„............„...
Alliance
Important:Installing contractor must submit this
Member ID: __________________________ completed form.Failure to do so nullifies the
system warranty.E-mail or fax completed form
Company Name; Alhadi ji ..$*
, to the Uponor Fire Safety Design D
Contact: ###4 ; ‘ .... oPartment
at...inerawauseacemostarQuam or 9519971 ni•
Phone: 5i) - Ii. -3 610 , For questions,cci„,...._,__. .rttact Uponor Technical Services at
888.5947726 or Askuummszkiattamont,cm,
Fax;
------------------- Color of test orifice used:
Job Name: --t. 41--(&ege.....______- Static pressure(not flowing)reading at incoming
Project Number: "t;ii eft i ;. i 3
. water supply into home or at main shutoff: 6e-)
......_______
Job Address: 0 *„. cl it.* '4 tl, " ----------------"u-------------------
Residual pressure(flowing)reading at incomin water
City: —. .e....r I
.......____ supply into home or at main shutoff:
State,ZIP: : .)a
............__ __
What time of clay was the flow test taken?....._________
For designs not provided by Uponor,complete the
followininformationHow test method used? 'Bucket J Flow Meter
g .
Designer's Name: ...,00J(: tk-tAtt Flow test gprn:_ g± __________
How many gallons of water did the design predict
Company: #* k.
,4
Phone: 1 _04 ..7...._.:9_, as required?
— -- Did the test meet or exceed design flow? Cill'c'es Li No
Fax:
Which sprinkler did you flow?Nurnber: ,
Is the warning sign permanently ached close to the ,,,.
Location of head: i.....:,- . .#
.... A
A4 411,X, main shutoff valve? U Yes '...no
Date left in service with all valves open:
Was this system required by code?LeYes J No
e ............................................................................................................. ....... ...„,....,.......... ..
Test Witnessed and Verified by:
'i.'..
Nam Signature , Occupation , Date
...:4 4 ..,,i, 61)
41et" ..__________ '.
,e, i
Z
11,
Additional Explanations and Notes
01
Uponor,Inc. Tel:8C0.321.4739
.i.,
' 4 5925 148th Street ltliest Fax 952.997.1731
'' Apple Valley,MN 55124 USA Web:www.uportor-usa.com