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FIRE SAFETY SYSTEMS
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AQUASAFErm FLOW TEST
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VERIFICATION
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FORM
AquaSAFETM Flow Test Verification Form
. .„.....,.........
Alliacce _...,......„_...............„.„.„,
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Important:Installing contractor must submit this
Member ID:
completed form.Failure to do so nullifies the
Company Name. 4 • ' system warranty.E-mail or fax completed form
. _
• to the Upenor Fire Safety Design Department
Contact: 9.010, '' _n__. at eLchatcacesekr...----• '
Lam_
or 952.9971731.
Phone. — ... a? ?, For questions,contact.tiptinor Technical Services at
594.7726 or...=.....„waraticamitIllanzatm
Fax:
--------.---. ----------- Color of test orifice used:
__.._.._...
Job Name:
Project Number: cf ' '
Static pressure(not flowing)reading at incomi
Lng
water supply into home or at main shutoff-,__,..k_', 41„,,, •
Job Address: j, 65 kJ fiCvi Pr.R.talfe,AIL, '------------------------
- , .4-------- Residual pressure(flowing)reading at incornir g water
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City . 1 0 A supply into home or at main shutoff:
State,ZIP: ZZ.2,..a... _ ---------------------------------------
What time of day was the flow test taken?.__________
,
For designs not provided by Uponor,complete the
Flow test method used?4 Bucket Li Flow tvleter 1
following information.
Flow test
Designer's Name: eill:‘ ' •
How many gallons of water did the design predict
Company: -
as required?
— .„_,
Phone: .9....572,... 2_7_,..?......z...10..._
Did the test meet or exceed design flow? Les ....1 No
fax —_________________
Which sprinkler did you flow?Nurnher:__Mi_.
4/ Ti.I Is the warning sign Permanently attached close to the Location of head:
trA ....,),. main shutoff valve? U Yes...617N°
Date left in service with all valves open:
Was this ystern required by code? Cs -...1 No
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Test Witnessed and Verified by:
Signature Occu a. 'a n Date
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Additional Explanations and Notes
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Uponor,trIC.
Tel 8CO.321.4739
F. 952.997.1731
5925 148th Street West
Apple Valley,MN 55124 USA Web:www.uponoNusa,com