Report (3) Al
n1ST 1o16 - 00337
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FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
VERIFICATION
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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: d�� system warranty.E-mail or fax completed form
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�c�"1 to the Uponor Fire Safety Design Department
Contact: R'>bZe'r h'.`J�R.fkt',l at technical.services@uponor.com or 952.997.1731.
Phone: ;j j�9��� 9i,
For questions,contact Uponor Technical Services at
888.594.7726 or technical.services@uponor.com.
Fax:
(� Color of test orifice used: 151::-;:"L . `)
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Job Name: kAy,6'`TP�Cr_,.L Static pressure(not flowing)reading at incoming
Project Number: water supply into home or at main shutoff: !J G/
Job Address: /74,47 Sca ;1C,4n. 1or're —_..
...* '' 1_/' Rens al pressure(flowing)reading at incoming water
City: . i C.. i e _ supply into home or at main shutoff: s'ef
State,ZIP: 9,72 Z
For designs not provided by Uponor,complete the What time of day was the flow test taken? .7 3c
following information,
/7 Flow test method used? 44 Bucket )Flow Meter
Designer's Name: ad,`jd4 1Ct.;�+c`z Flow test gpm: 26
Company: Y How many gallons o1{Der did the design predict
Phone: ._
- as required?
—" -a:36_ Did the test meet or exceed design flow? AgYes J No
Fax:
Which sprinkler did you flow?Number: 1* 7
4r "r �) Is the warning sign permanently attached close to the
r main shutoff valve? LI Yese4No Location of head: (f C011y‘
Date left in service with all valves open: 2 if.-/S
Was this system required by code? Yes J No
Test Witnessed and Verified by:
Signature Occu ' n Date
a
T Additional Explanations and Notes
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S Uponor,Inc. Tel'800.321.4739
a 5925 148th Street West Fax:952.997.1731
_ Apple Valley,MN 55124 USA Web:www.uponorvusa.com
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