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FIRE SAFETY SYSTEMS
AQUASAFErm FLOW TEST
° ' VERIFICATION
FORM
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AquaSAFETM Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: At( completed form.Failure to do so nullifies the
Company Name: A ("A.,c. io7 system warranty.E-mail or fax completed form
to the Uponor Fire Safety Design Department
Contact: (2.t u'ci" DI Sinwnr,. _ at teclhnicaLservices@uponor.com or 952.997.1731.
Phone: 5®3-(N)--'3990 For questions,contact Uponor Technical Services at
888.594.7726 or technical.services@uponor.com.
Fax:
0 ,, Color of test orifice used: K/
Job Name: l�V°i 1 el`luC�
C Static pressure(not flowing)reading at incoming
Project Number: Let (2.9 water supply into home or at main shutoff: S�
Job Address: .V)-Sv 5LJ 4,66.7)ATer.
City: Be.-Ve
Residual pressure(flowing)reading at incoming water
supply into home or at main shutoff:
State,ZIP: ®QZ 17r�� 2
For designs not provided by Uponor,complete the What time of day was the flow test taken? da
following information. I Flow test method used? CiYgucket U Flow Meter
Designer's Name: f r4- ,V•E,4-,,- -- Flow test gpm: ?D
Company: ,^��t®/
How many gallons of water did the design predict
Phone: 95a-1c1-?- 5'95oas required? 17
Did the test meet or exceed design flow? elYes U No
Fax:
Which sprinkler did you flow?Number: /<
f iil.k. Is the warning sign permanently attached close to the Location of head: /..-eet-rm.-
main shutoff valve? U Yeso
�.,,// Date left in service with all valves open: C_ '/"<1
Was this system required by code?r.2 es U No
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Test Witnessed and Verified by:
Name Signature Occupation Date
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m Additional Explanations and Notes
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Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
j Apple Valley,MN 55124 USA Web:www.uponor-usa.com