Report (21) ni s T a o) 6 - 00 3 1 8
Uponor
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FIRE SAFETY SYSTEMS
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v AQUASAFETu FLOW TEST
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VERIFICATION
FORM
AquaSAFETM Flow Test Verification Form
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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: I/. 4 , 14,en,1 'Iv rwiA
to the Uponor Fire Safety Design Department
Contact: 12c4)44"1-"Vt*Otc441at technicalserviceseu noncom or 952.997j73 .
For questions,contact Uponor Technical Services at
Phone: St 5 ' 'V9'1-,34/9c, 888.594.7726 or technkal.servireseuponor.com.
Fax:
Color of test orifice used: 15->"-i••%,51;
Job Name. 11.i.,, e......
Static pressure(not flowing)reading at incoming
Project Number: it* /2) ‘Aok) 3 water supply into home or at main shutoff'
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Job Address. itt4A--*, ""--11,y4tr 4.....
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Residual pressure(flowing)reading at incoming water
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City: • '91 ' ' _-__ supply into home or at main shutoff: 9141
State.ZIP: 9722.2.3
What time of day was the flow test taken? 7::-30
For designs not provided by Uponor,complete the
following information,
Flow test method used?Al Bucket j Flow Meter
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Designer's Name, ititc,it"514 #(..4.)413i-et'Z _ Flow test
How many gallons of water did the design predict
Company: ‘44)4,1°41
as requited? 10
Phone' ..9....s.72.....1.:29.2L-...5-3.3b
Did the test meet or exceed design flow? 'Ores J Na
Fax:
Which sprinkler did you flow?Number )4.1
4i yr.! Is the warning sign permanently attached close to the t°cation of head: Apk,4.2,.. Loc44 is i,
.61 ....),..main shutoff valve? j YesAFNa
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Date left in service with all valves open' aid-01,l -I f
Was this system required by code?X'es :::I No
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Test Witnessed and Verified by:
Signature Dau.. '4n Date
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a:41- 17
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Additional Explanations and Notes
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Uponor,Inc. Tel'800 321.4739
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ti.',.'•. 5925 148th Street West Fax 952.997.1731
'S. Apple Valley,MN 55124 LISA Web:www.uponor-usa,com
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