Report (19) /insTa016 - 0033a
-1 nor
1)
11 FIRE S.` ETY` SYSTEMS
AQ DASA :I'm FLOWTEST
its
VE ',., FICATION
:may s
FS„,,13'''..., FORM
,,,:',,,„',;,'•g
,
AquaSAFE' Flow Test Verification E s d
Alliance important;installing contra must submit this
Member ID: completed form.Failure to do ., nullifies the
Company Name: 3 t+r- system warranty.E-mail or f>t form
' to the tiporwr Fire Safety r ;. Department
Contact: a( 0A1A's, at tedinicaLsmiitesilibmorror.”. or 952997.1731,
Phone: Sal"911-'541t1 For questions,contact Upono- echulcai Services at
888:5,9477 ortec...n , ; E,. _. or.cg ,
Fax: color of test orifice used: f2
lob Name LIVe't 712 tL51 P.. Static pressure(not flowing)r.. 'ng at incoming/
Project Number: 1....i. '•I water supply into home or at in n shutoff:
Job Address: ) co9 lea*Louise.f,,
Residual pressure(flowing)ready g at incoming water
City: t).14(a supply into home or at main s •ff: '}'
State,ZIP: Ott- r ' 3 W_. m
What time of day was the flow 't taken? ? "
For designs not provided by Uponor,complete the
following information, Flow test method used? �uc',,,t :3 Flow Meter
Designer's Nance. QQ� Flow test m: ':
�1 ,� gP
Company: Ukflovior
How many gallons of water did 3 e design predict
as required? it
Phone: ,_ .') "117,. 533
(aid the test meet or exceed des„In flow? lees a No
Fax: Which sprinkler did you flow?N 1rnber: ii.3
3 is the warning sign permanently attached close to the location of head: f`t4x,5j1" ,, atm
A4-1p1. , main shutoff valve? 0 Yes io
tier
Date left in service with all vain. open: 44'17-17
Was this system required by code?tie es J No
Test iilribiessed and Verified by:
s Name Signatt e Ocalpation i` Date
g
Additional Explanations and Notes
Uponor,inc. Tel.800 321.4739
5925148th Street West Fax:952.997.1731
Apple Valley MN 55124 USA Web:ww;ncugarurr usaWearrs '.