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FIRE SAFETY SYSTEMS
AQUASAFETMr FLOW TEST
. ,. tf. VERIFICATION
FORM
AquaSAFE' 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 Are Safety Design Department
Contact: Jon Hinkle at technicaLsservicesfupopor.com or 952.997.1731.
per : 503-490-0763 For questions,contact Uponor Technical Services at
888594.7726 or tedrricaLservices@uponar.com.
Fax: 971-250-3808 Black
Color of test orifice used:
Job Name: Summit Ridge Lityf 146 Static pressure(not flowing)reading at incoming
Project Number: 19070 F 00 water supply into home or at main shutoff: 78psi
Job Address: I1,t a L S.) Lt 6
e Residual pressure(flowing)reading at incoming water
city; Ti cjr supply into home or at main shutoff:
State,ZIP: D2.- C1.1ZZ-f4
What time of day was the flow test taken? i
For designs not provided by Uponor,complete the Flow test method used? O Bucket La Flow Meter
following information.
Designer's Name: Patrick Brown Flow test gpm: 115?04
Company' Uponor How many gallons of water did the design predict
as required?17gpm
Phone: 888-594-7726
Did the test meet or exceed design flow? ®Yes ❑No
Fax: 952-997-1731
Is the warning sign permanently attached close to the Location of head: Z=7—C(-11'
main shutoff valve? a Yes U No
Date left in service with all valves open:
p Was this system required by code?®Yes U No
Test Witnessed and Verified by:
Name10L. nature Occupation Date
?.,, .... ��w .,�, bu..4r 1-24-17
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Additional Explanations and Notes
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Uponor,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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