Report (29) tin 3 T'?,01 6 - 00 3c6
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Uponor
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FIRE SAFETY SYSTEMS
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AQUASAFETM FLOW TEST
VERIFICATION
FORM
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AquaSAFE Flow Test Verification Form
.•..•..............•.•................"..............„-..,„.4.,„.„.....................................„...
Alliance
Important:Installing contractor must submit this
Member ID:
completed form.Failure to do so nullifies the
Company Name: ,4
'‘ 'ARV system warranty.E-mail or fax completed form
(.41. to the Uponor Fire Safety Design Department
Contact: f0.142,.... at techgkeLsenkesegagnottcom or 952.997.173'1,
For questions,contact Uponor Technical Services at
Phone. :- -
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MS.594.7726 or i i, ••I.4 *u.
Fax:
* -
Color of test orifice used:
Job Name. • 0"", -
Static pressure(not flowing)reading at incoming
Project Number: i - water supply into home or at main shutoff.
Job Address: 1704)/ 51.n .....4
*--' ,
oty: . Residual pressure(flowing)reading at incoming water
supply into home or at main shutoff:
State,ZIP:
__.__._._._._.._._........________
What time of day was the flow test taken?
For designs not provided by Urxmor,complete the
following information. Flow test method used?kBucket -,,../Flow Meter
•
______:__
Designer's Name: el Flow test
,,
Company: iAvcacte:c._______'' - How man),gallons of water did the design predict
as required?.
Phone: 25:-2„ '..L'' '..2 - •...- •.,3.3t) '
Oki the test meet or exceed design flaw? lirres LI No
Far
Which sprinkler did you flow?Numb - its
4./i 7 . t
isi Is the warning sign permanently attached close tohe . er'"----------
- _ (VI ......0 mitai,..t.....7 144,450003 .. .,'..., . ,, ,____„.___...... ____.r
Date left in service with all valves open:_: ___- 1)
Was this system required by code?giKes J No
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Test Witnessed and Verified by:
.:.,
NTT,. 7 Signature Occu ' n Date
Y.
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3.
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Additional Biplanations and Notes _________________
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Uponor,inc.
Tel 800.321.4739
5925 148th Street West Fax 952,9971731
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C.- Apple Valley,MN 55124 USA Web:www.uporme-usa.cren
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