Report (46) 4
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FIRE SAFETY SYSTEMS
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AQUASAFEIM FLOW TEST
°I VERIFICATION
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i — L FORM
AquaSAFE' 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: i4itii tolig '?1,1,41"L'irs.4 - '
A to the Uponor Fire Safety Design Department
Contact: _10424-T'...M51,4114,cnet. at technical.services@uponotcom or 952.997.1731.
For questions,contact Uponor Technical Services at
Phone: <TC.:,,A - (i72-...34/9e, 888.594.7726 or technlcal.services@uponor.corn.
Fax:
Color of test orifice used: 15(..-Z:4-. !..)
Job Name. 'ji WA" 19..C .0 e.,_ Static pressure(not flowing)reading at incoming ,
Project Number: 13/41:1-1 LOT 15- water supply into home or at main shutoff: &CI
Job Address: /3, -5t.x..1 5aesit4 Ccr-rerre.a.e.
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Residual pressure(flowing)reading at incoming water
City: p 4
supply into home or at main shutoff:
State,ZIP: 972.2.:1
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What time of day was the flow test taken? 7-.....--)c
For designs not provided by Uponor,complete the
following information. Flow test method used?4 Bucket d Flow Meter
Flow test gpm. /
Designer's Name: ad,-„,4 121,8,42.
How many gallons of water did the design predict
Company: tAfeAcr
as required? /0
Phone: ,.9.5.7.2..... ..5:33rA •
--- Did the test meet or exceed design flow? ' es U No
Fax: e
Which sprinkler did you flow?Number:
/14 1-1.1,..._ . Is the warning sign permanently attached close to the Location of head:
In -Op main shutoff valve? U Yes, No
Date left in service with all valves open. - 7
Was this system required by code?eitlYes :1 No
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Test Witnessed and Verified by:
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Additional Explanations and Notes
51
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' tb. Uponor,Inc. Tel 800.321,4739
5925 148th Street West Fax.952.997.1731
-S. Apple Valley,MN 55124 USA Web:www.uponor-usa,com
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