Report (46) rrlsraol( - oo S"62.
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t ARE ` ,FETY SYSTEMS
m AQUAS •SFE'° FLOW TEST
VE! IFICATION
IRM
Aqua AFET` Flow Test Verification F i rill
Alliance important instaning . . amt submit the
Member ID: completed form.Failure to • so mantes the.
system warranty,E-mail or : completed form
Company Name:: fr ID u
�
Contact p-e 't �l�`i(ri�" that tace aUpon
t;�.ora Fice4 Saf
»,,et ,,s:iii Depa
Or9Srment
99a.1
?31.
Phone: fad (//)-129/6 For questions,contact Ulla , TechnicallSendces at
f3 .594 7126 or
Fax: .,
Color of test orifice used id Ass
Job Name: VC,/ ` erc c
Static pressure(not flowing)r:.ng at incoming
Project Number: Ls+ $-1 S-''/ water supply into home or at in shutoff:
Job Address: 112110 CU tie t, P(kw.eir.
-i � Residual pressure(flowing)re 'ng at incoming water
City: s� p,y � supply into home or at main s ; .ff: 17
State,ZIP: t/! -i t / d
What time of day was the flow,•• t taken? 0.`Gs
For designs not provided by Uponor,complete the
Tolle ng nfarmation. flow test method used? 'et la Flow Meter
i,
(1)112,4
t Flow test a
Designer's Name. t]fC (ani 9Pm: .
Company. !?dit f- How many gallons of water did a design predict
7- rte' 33d as required? Its
a
Phoney , ��(,'y���
- "^ Oid the test rneet or eked d �.n flow? t..i"less-0No
Fax: x. t
Which sprinkler did you flow? tuber 141
`. Is the warning sign permanently av ,.hed dose to the Location of head:. ri+
t t r"`" main shutoff valve? Cl Yes ° -No - ,
Was this Date left in service with all valy open:
system required by code?ales 0 No
Test Witnessed and Veri=fied by:
r Name
Signa ure £3 on r Date
Mrd
,Additional
Explarratl4TtLS and Notes
2.
Lipman,Inc. Tel:800 21.4?39
5925148th Street West Fax 952,997.1731 `'
Apple Valley,MN 55124 USA Web:www.0 r usa.com .
i