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FIRE SAFETY SYSTEMS
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AQUASAFEim FLOW TEST
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VERIFICATION
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FORM
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AquaSAFETM Flow Test Verification Form
Alliance Important Installing contractor must submit this
Member ID: completed form,Failure to do so nullifies the
Company Name: Allte414e: 6.4.301_,
system warranty.E-mail or fax completed form
to the Uponor Fire Safety Design Department
Contact gc‘0.24-1-..V.514..fm.t.y,".. at technical.services@uponor.com or 952.997.1731.
Phone. :4,1Cr; - 01:2, -34/91, For questions,contact Uponor Technical Services at
888594.7726 or technital.services@uponor.com.
Fax:
Color of test orifice used:
Job Name: (Z;korta.‘"110.=,..A. 0._ Static pressure(not flowing)reading at inroining ..„
Project Number: 1044. **1-e water supply into home or at main shutoff: • U
Job Address: 0 ii#51.0.4 ti. —
Residual pressure(flowing)reading at incoming water
City: • 11160M _ supply into home or at main shutoff: sy
State,ZIP: 97 —
What time of day was the flow test taken? 7
For designs not provided by Uponor,complete the
following information.
Flow test method used?AlBucket :-.1 Flow Meter
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Designer's Name, 44 eli'‘)/4 IZZATer/Z. Flow test gpm:_a0
Company:
How many gallons of water did the design predict
th. .(41
as required' 10
Phone: 9_572.—.7 .2.._-...5:34:36
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limd the test meet or exceed design flow? cifPfg-U No
Fax:
Which sprinkler did you flow?Number: tt,e
144 --T-r,, Is the warning sign permanently attached close to the Location of head: 41701/4.0e.., 1.0444er
main shutoff valve? U Yese4No
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rare left In service with all valves open. 3"7U 4?
Was this system required by code?taKes No
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Test Witnessed and Verified by:
•: N.4rny,.I . Signature Occu.. :n Date
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Additional Explanations and Notes
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Uponor,Inc. Tel'8(X1321.4739
' E' 5925 148th Street West Fax 952.997,1731
IApple Valley,MN 55124 USA Web:wwvir.uponor-usa.com