Report (33) , ryi sr 016 - 003s-q
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-eim -Z I FIRE SAFETY SYSTEMS
AQUASAFErm FLOW TEST
... .
VERIFICATION
FORM
AquaSAFETM Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
Company Name: Ail ictrii,e, 6 71 %al inilk system warranty.E-mail or fax completed forrn
to the Uponor Fire Safety Design Department
Contact: fZc;w.er-Vs5‘tsvtdk" at technical.servicesatoanor,com or 952.997.1731.
Phone: 'ecC,A -072-34/9z, For questions,contact Uponor Technical Services at
888.594.7726 or technical.services@uportor.com.
Fax: Color of test orifice used:
Job Name: ( ,4,4L '...rel._Cr .t• e,_
Static pressure(not flowing)reading at incoming ,...,
Project Number: Lot 7.1 water supply into home or at main shutoff: OCI
Job Address: 0951 54•4 0e$40...1.40iviCe.,1 , ______ _
Residual pressure(flowing)reading at incoming water
City; . I 191kr _ supply into home or at main shutoff: SY .
State,ZIP:
. . What time of day was the flow test taken?
For designs not provided by Uponor,complete the
following information, Flow test method used?Atif Bucket "...I Flow Meter
A. "7... , .
Designer's Name: ktei,$44 glIcki „de. Flow test gpm,
Company: :31*-444‘------- 10
How many gallons of wftel did the design predict
as required?
Phone' -9-57-2.------ -2-7-55315.-- Did the test meet or exceed design flow? it< J No
Fax:
Which sprinkler did you flow?Number:
At Is the warning sign permanently attached dose to the Location of head: 14,. r 11)41'0,1,11%
main shutoff valve? U YesAINo
Dote left In scwitc with all vekieit0--7
Was this system required by code?ilKes J No
-.L
..-i; Test Witnessed and Verified by:
NaiTKSignature Occu ' n Date
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t. Additional Explanations and Notes
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Uponor,Inc, Tel 130a321,4739
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5925 148th Street West Fax'952,997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa,corn
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