Report urilonof
FIRE SAFETY SYSTEMS
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,- AQUASAFETM FLOW TEST
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VERIFICATION
FORM
AquaSAFEFlow Test Verification Form
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Alliancelmportant
or must submit this
form.Member ID: 1964 plated foiaga.MFaagilure to
er do so nullifies thcompleted foerm
system warranty.E-mail Design Department
CompanyName: Gravity Plumbing
to the Uponor Are Safetyor 952.9973731.
contact; Jon Hinkle
.7726 or tediskaLserWcesetWoanr tom.
phone; 503-490-0763 °atr qu (*Mad Uponor Technical Services at
Fax: 971-250-3808 L4 t 4,4 sCtoaltoicr opfretensturoen(fincoet flowing)reading at incomi used: Black .n
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Job Name: Summit Ridge
L4
Project Number: 19070 F 00% - water supply into home or at main shutoff: 78os1
Job Address: 13020 Sw o4
i_ LA
City: -I- -cic`*'1"tk Residual pressure(flowing)reading at incoming water
esupply into home or at main shutoff:
State,ZIP: 6 .
What time of day was the flow test taken?
For designs not provided by Uponor,complete the
following information. Flow test method used? U Bucket W Flow Meter
gner s
Desi ' Name: Patrick Brown Flow test gpm: 11 J?w
Company: Uponor How many gallons of water did the design predict
as required?17gPM
Phone: 888-594-7726
Did the test meet or exceed design flow? a Yes CI No
Fax: 952-997-1731
Which sprinkler did you flow?Number:... 10
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Is the warning sign permanently attached close to the Location ofhead: ctroovvt 5
-1
main shutoff valve? 591Yes CI No
Date left in service with all valves open: I -2. :1
Was this system required by code?ID Yes LI No
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Test Witnessed and Verified by:
Name . natur
ocUpon Date
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Ini,crtieloYN -1--ku,Att4 C ).0 4L-"t1L-LP C°1'.6%-C.L.- 1-2.-11
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Additional Explanations and Notes
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Uponor,Inc. Tel 800.321.4739
x 5925 148th Street West Fa952.997.1731
VaNey MN 55124 USA
Ape , Web:vwsw.uponor-usa.com
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