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Report (42) (-1ST aai 6— 00 35-q o ' ' :4:,,,s1:::,ss ' , FIRE S. ETY SYSTEMS _ .t.it it). AQUASA 'E1M FLOW TEST ,, VE ' FICAT I©N d n FOR PL1 1 `d+ � �f '�' tri � v �*� .gaSAF TM Flow Test Verification F6 m Alliance impoita installing contract must submit this Member ID: completed form.Failure to do` w nubs the Company Name: ; �) 1sstem yE-ma#or competed form ( to the Uponor Fire Safety ,--;!n Department Contact: DtSk at . ii .r.,..t,ii,.. '=;r l..e.., ,ii or 952.9973731. Phone: SO) "liel 'Yitio For questions,contact U ethnical Services at .599.7726 or technlcaLse Fax Color of test orifice used: j.° {S Job Name: Static pressure root flowing)r .Wing at incomin toProject Number: LOT (0 4'`1_ water supply into home or at m.l n shutoff: Job Address: I1111)-SUPtow*Lti r„t, _.. Residual pressure(flowing)rea i'E g at incoiriinag water City: je^11,04.1ik supply into home or at main sh soff: 'l State,ZIP: I -f q74 What time of day was the flow :`tst taken? " .) For designs not provided by Uponor,complete the following information. Flow test method used? Cl�u Flow Meter �f ��� Flow test gpm: '' Designer's Name: u w, .. Company: 4i1l 9� How many gallons of water did e design predict e as required? iv Phone: �,17-5730 ? �,✓ Yes L No Did the test meet of exceed des a n flow Fax: tt Which sprinkler did you flow?N ober: +r t.+ Is the warning sign permanently atychetl dose to the Location of heats: ,, 2/"" )rt+ 'main shutoff valve? C]Yes o tt Was this systemDate left in service with_all vale .",open: 7�,"ii? ys required by code? No Test 1Nitrtessed and Verified by: s Name Signatu ;" 0¢ 4 ation ' Date 1 10114-LtovskAti 9-i)1,o Additional Explanations and Notes d E Uponor,Inc. Tel:&X1321.4739 s 5925 148th Street West Fax:952.997.1731 Apple Valley MN 55124 USA Web:www.uponot-usa.com