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FIRE S'FETY SYSTEMS
AQLJASA ;``ETM FLOW TEST
F-sVE ` FICATION
FORM
AcittaSAFErm Flow Test Verification F.2 i
Affiance Important Installing , Fmust submit this
Member ID: completed form.Failure to doh;, nullifies the
system warranty.E-mail or . completed form
CompanyMarne: Aitiall i to the uportor Fire Safety . n peparbnent
Contact:: t l l at technl trponor,',,E or 952.9973731.
Phone: SI' 947,}') For
questions.qcontact Upon, ethnical Services at
5594' or .49#k1h+%3 . r-ie g..fE2 ''a...a 4.1 ... -fi.
Fax: Color of test orifice used: r5
Job Name:. f - water pressure
(not home nr )re. flog at incoming
Project Number: � t '' supply :n shutoff: +
Job Address: I7aa!#f '"T . fit,
Residual pressure(flowing)rea.-,rg at incominnwater
City:: supply into home or at main sh off:
State,ZIP: _ 00- f 'i+
What time of day was the flow'. taken? 71
For designs riot provided by Uponor,complete then
following information. Flow test method used? Buc •t J Flow Meter
Designer's Name: tell** Flova test gpm:
Company �'1QrAt 1"_,. How many gallons of water did e design predict
as required? it)
Phone: _._.. s� ” S3310 — Did the test meet or exceed d- n flow? Yes D No
Fax: Which sprinkler did you flow?N,tuber: Wil
„ Is the warning sign permanently attached close to the Location of head: r °� - SAN.
1'`tr1V» main shutoff valve? U Yes 33110 g C p ►tl t?
,�,,�/ Date left in service with all valy Q en: '7
c Was this system required by code? Yes J No
g
iiz
Test Witnessed and Veen. :
Nameaf1a Si'i' Qccu•. ion
c
Date
o
Additional Explanations and Notes ..
__
{
Upaaor,loc. Tel:800.321.4739 ;
5925148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:+nww. aor-usa.com