Report (40) . , *
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FIRE SAFETY SYSTEMS
AQUASAFErm FLOW TEST
VERIFICATION
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
Alid-:_211kji system warranty.E-mail or fax completed form
Company Name: �
to the Uponor Fire Safety Design Department
Contact: ipge/T"•�„ .5tt,f11c,•.f\ at technical<services@uponor.com or 952.997.1731.
Phone: <c;,:,_ 'r 9� For questions,contact Uponor Technical Services at
888.594.7726 or technical<services@uponor,comm
Fax:
�y Color of test orifice used: 15`--.ti
Job Name: ,V W.I."Te r:.l
Static pressure(not flowing)reading at incoming/
Project Number: water supply into home or at main shutoff: C)
Job Address: 00,S'' s� pk,t ' S
• "r° A fiesidual pressure(flowing)reading at incoming water
City: I Ct..!' _ supplyinto home or at main shutoff:
Sy
State,ZIP:
What time of day was the flow test taken? 7
For designs not provided by Uponor,complete the
following information. Flow test method used? Bucket '`3 Flow Meter
Designer's Name: 1�r,' at A ' Z Flow test gpm: f9
Company: `4' r How many gallons of water did the design predict
as required? t'0
Phone ,_
— ~ -- bid the test meet or exceed design flow? Ass/es U No
Fax:
Which sprinkler did you flow?Number: I -,3
.i Is the warning sign permanently attached close to the _
main shutoff valve? U YesNo Location of head: '�►� 6rI
`'�
Date left in service with all valves open: c7-2.cr—f
Was this system required by code? Yes J No
Test Witnessed and Verified by:
Name,
j Signature Oc_ n Date
G
Additional Explanations and Notes
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Uponor,Inc,
Tel 800.371.4739
5925 148th Street West Fax:952.997 1731
Apple Valley,MN 55124 IDSA Web:www.uponor-usa.com