Report (33) - , PiSToid -
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FIRE SAFETY SYSTEMS
AQUASAFETm 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
Company Name: LA,„
system warranty.E-mail or fax completed form
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to the Uponor Fire Safety Design Department
Contact: Px r,,-- ‘)I('Liekr, at technical.services@uponoccom or 952.997.1731.
Phone:
For questions,contact Uponor Technical Services at
5017- 494-391°
888.594.7726 or technicalservices@uponor.corn.
Fax:
Color of test orifice used: Orcv-.1.
Job Name: V—Ikkreirrftkte— Static pressure(not flowing)reading at incoming
Project Number: \--ok-- Co.t, .F.--7 water supply into home or at main shutoff: -)
Job Address: \11)-Vi CL) Aliii>Yr )0e—Ter.
Residual pressure(flowing)reading at incomineater
City: PetAic,--6v-,
supply into home or at main shutoff:
State,ZIP: OR. / '17.)
What time of day was the flow test taken?
For designs not provided by Uponor,complete the
following information,
Flow test method used? 1ucket U Flow Meter
Designer's Name: VIre4/4 1,44hAS, Flow test gpm:
Company: as required? h
How many gallons of water did the design predict
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Phone: 9... .,). 011-7- 5110
Did the test meet or exceed design flow? ial Yes U No
Fax:
Which sprinkler did you flow?Number: it 7
, Is the warning sign permanently attached close to the Location of head: gee3Tior.,
main shutoff valve? U Yes :el\lo
Date left in service with all valves open: 6- /
Was this system required by code?Lerces U No
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Test Witnessed and Verified by:
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_as Name , , Signature Occupation Date
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Additional Explanations and Notes
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Uponor,Inc. Tel:800.321.4739
5925 1118th Street West Fax:952.997.1731
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Apple Valley,MN 55124 USA Web:www.uponor-usa.com
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