Report (28) . .
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E- 5 FIRE SAFETY SYSTEMS
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AQUASAFETM FLOW TEST
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VERIFICATION
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FORM
AquaSAYETM Flow Test Verification Form
Alliance
Important:Installing contractor must submit tins
Member ID-
completed forrn.Failure to do so nullifies the
I 'AMP system warranty.E-mail or fax completed form
Company Name.
----y to the Uponor Fire Safety Design Department
Contact ,g,0_10 ..rt at fechnioLietylutehonoratm or 952.997.1731.
Phone, -.. • ..y9i. For questions,contactTechnical Services at
594.7726 or mcjimkausoassamansatsgm.
Fax: Color of test orifice used: 15......_
Job Name: ZiAhdr_aekt
Static pressure(not flawing)reading at incoming,/ At,
Project Number- A.'1- al ii'i a water supply into home or at main shutoff:
11.11 a ci..; j-„. 4...L. ,71,,.,, ...__________________.........____ _......
Job Address: !...) ' 1 .., actm_IL6Z5_•
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Residual pressure(flowing)reading at incomin we
City-
cl....._. ... supply into home or at main shutoff.
State,ZIP: _zz_z.z ___________ --------------------------,—
What time of day was the flow test taken?_ ,/_ „,,)A__
For designs not provided by Uponor,complete the
Flow test method used?4 Bucket :-..1 Flow Meter
following information.
Designer's Name: .4 dr' ,. 4 .-...Z... _ Flow test gprn: 12____.
How many gallons of water did the design predict
Company' Vidzocr___________
as required?
Pilane: -9-517227: 71-2---1'5:34--'N:k- did the test meet or exceed design flow? SC J No
Fax:
--------------------- Which sprinkler did you flow?Number:__ELI___
14.1. yr i Is the warning sign permanently attached close to the Location of head:_ S'kr t,.... 4..„
6) main shutoff valve) U Yesei0No
Date left in service with all valves open. _A:kg_
Was this system required by code2N(es j No
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Test Witnessed and Verified by:
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irnSignature OCCII ' n Dee
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Additional Explanations and Notes
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Uporior,Inc.
Tel 800.321.4739
5925 148th Street West Fax-952997.1731
Apple Valley,MN 55124 USA Web:vuww.uponor-usa.com