Report (49) 11157-2016 oo.S6 3
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FIRE ,AFETY SYSTEMS
y f AQUAS :FE"" FLOW TEST
V 7.. IFICATION
F ORM
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AquaSAFETM Flow Test Verification 'Irr,r1
po�. . .
Alliance .a . , - must whit*tisis'
Member)0 completed form.Failure to•• so minifies the
Company Name: f�. CG ( system warmer.E-nrall or completed form
to the Uponor Fire Safety ! :;. Den
Contact: f r+ t.L,wwr" at;=tt,,,,K, ..,&L,--1: a..,e, es„or 952.9973731.
Phone: -Y/,)--)(1/6 For questions,minted U•. `Technical Services at
888394.7726 or ,.br..a -xis , ,:L.+,:.,o.0
Fax:
Color Of rest orifice used: a
Joh Name: J 12.1ver`T etdmL1 - Static pressure(not flowing) ,:ding at incornin
Project Number: L4 S.)., 14•7 water supply into home or at:'.in shutoff:
Job Address. 1‘ .1)14 tt S w teed Silt+* et.
-,.1 Residual pressure(flowing)re .ing at incoming water
City: t supply into home or at main s E 5F
State,ZIP:
What tune of day was the fl. est taken? tS:.G'd
For designs not provided by Uponor,complete the
following information. Flow test method used? FlowMeter
Designers Narrpe: 11404,v‘ Flaw test gpm:
Company: a Al " How many gallons of rater d1,:.he design predict
^� as required? P
Phone. w a' t- 5 1 L+ _
Did the test meet or :'. flow?
exceed
d " n Yes J Na
Far
Which sprinkler did you flow? = mber: 14.1
v 1". is the warning sign permanently attached close to the Location of head: ,
N�' 1(i t/0main shutof€valve? C1 Yes to�,��"� ��rr
Was this system required bycode?($'1'es ;l NO Date left in service with all vat open: t `ff'l�f
.... ........ ....... . . .........
g Test Witnessed and Verified try:
Name l 4-t Signature Dcci .; ion
Date
I.
IAdditional mations and Notes
`�: Uponor,inc. Tel 8(X1.31:4739
I S925148th Street Wes Fax:952.997.1731
Apple Valley,MN 55124 USA Web: u
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