Report (20) .1444,•i 0ii
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. ., FIRE SAFETY SYSTEMS
{ AQUASAFETMr FLOW TEST
VERIFICATION
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FORM
AquaSAFETh Flow Test Verification Form
Alliance Important installing contractor must submit this
Member ID: 1964 completed form.Failure to do so nullifies the
Company Name: Gravity Plumbing system warranty.E-mail or fax completed form
to the Uponor Fire Safety Design Department
Contact: Jon Hinkle attechnicaLserviceslyponor.conlor952.997.1731.
503-490-0763 For questions,contact Uponor Technical Servkes at
Phone: 889.594,7726 or tedinicaLservicessu
ponarconi.
Fax: 971-250-3808 Color of test orifice used: Black
Job Name: Summit Ridge Lot 14B
Static pressure(not flowing)reading at incoming
Project Number: 13 19070 F 00 + water supply into home or at main shutoff: 78psi
Job Address: 12-S (6,-.LA L %
Residual pressure(flowing)reading at incoming water
City: Tt Lt...vel. supply into home or at main shutoff:
State,ZIP: (jam C1.1 2.-2-L-1
What time of day was the flow test taken?
For designs not provided by Uponor,complete the +
following information. Flow test method used? O Bucket L Flow Meter
Designer's Name: Patrick Brown Flow test gpm: 11 lwx
Company Uponor How many gallons of water did the design predict
as required?179pm
Phone: 888-594-7726 Did the test meet or exceed design flow? 0 Yes ❑No
Fax: 952-997-1731
Numhpr
Is the warning sign permanently attached close to the Location of head: 2-2.-4 11'
main shutoff valve? la Yes U No
Date left in service with all valves open:
Was this system required by code?0 Yes ❑No
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i Test Witnessed and Verified by:
Name nature f Occupation Date
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t Additional Explanations and Notes
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iUponor,Inc Tel:800321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa,com
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