Report (18) 1
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i- ARE S ;FETY SYSTEMS
':. 10.1 E—S AQUASA Em FLOW TEST
VE ' FICATION
,
,
FORM
•
AcpiaSAFE Flow Test Verification Fl:',1
Alliance ........ ... <... ..... ........ .. Important: ._.....
Member ID: jet, l completed form.Failure to do' nullifies the
Company Name:_ t�+► - ti system warranty.E-mail or ,completed form
to the i ipwnot Fire Safety o n Department
Contact. jC'tt Vt SLr. at t pkalservices@upanar. ,m or 952.997.1731.
' *f 6 For questions.contact Upono ethnical Services at
Phone: ' 594.7726 or technlcal.se r up er cam,
Fax; Color of test orifice used:
Job Name: M ` Static pressure(not flowing)r irrg at incoming
Project Number, 10.1 water supply into home or at m• shutoff:
Job Address
l'70 a-Sw 9.!'� t tel.
Residual pressure(flowing)rea+;'g at inc+ in water
City: 04, supply into home or at main sit +ff: V
State,ZIP: + ,
What time of day was the flow 1 taken?
For designs not provided by Uponor,complete the
following information, Flow test method u ? 58u =-t 1 Flow Meter
Flow test m:. i
Designer's19
Name: gp
company, pi+'lr How many gallons of water did ,e design predict
as required? t i'
Phone: _ ,*1477- ,31:14Did the test meet or exceed des'''.in flow? es o No
Fax: Which sprinkler did you flow?N!tuber; //.3
j_ Is the warn' sign permanently_attached dose to the "
"'qf' '444�' ig p y location of head: �f � '"�,,,
main shutoff valve? U Yes 1o '
�, Date left in service with all valve.open:
t Was this system required by code? +!Yes J No f
r,
g Test Yititnessed and Verified by �.
Nam Si nature Occupation Date
E. All"-V040141 . >j '•f7 ?
r.
Additional
Explanations and Nates
ii Uponor,inc. Tel
5925 148th Street West Fax;952,997.1731 ,_
Apple Valley,MN 55124 USA Web:www.uponor-usa.com
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