Report (51) 1 33 5-te 16C/A-M /gum
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„,,,,,,,.,,, i 1.6+ vi 14-7 FIRE ' .•FETY SYSTEMS
AQUAS FE 0A FLOW TEST
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" V:•* IFICATION
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FORM
AcitiaSAFETm Flow Test Verification 0 rm
Alliance Important:Instating - — must submit this
Member ID: completed form.Failure to , so nullifies the
system warranty.E-mail or $ completed form
Company Name: AltiNate., (ILA),,„ to the Uponor Fire Safety i ... , Department
Contact: } -r+t4Str.o."41,v• at ..,...i 11.... .. ...,14,..4.,:!t.,.•4.; ,,a1 Or 952.997.1731.
Phone: ti -.41)-- 3W74 For questions,contact U., :,r Technical Services at
888.594.7726 or technical, cestlluponer.com.
Fa : A --Color-of test orifice used',
Job Name: t-lut.riemote- Static pressure(not flowing) '.ding at incoming/4_
project Number: LA- H , 14-7 water supply into home or at am n shutoff: 104.9
Job Address: 113570 W
Residual pressure(flowing)r.... sing at incoming water
City: --ti yewitt supply into home or at main :jutoff. , .5y
State,ZIP: 09-:
What time a day was the flo'test taken? oir°0
For designs not provided by Upanor,complete the
Flow test method used? ` P,cket 0 Flow Meter
following information.a .
Designer's Name: 4204' 4Met_ Flow test gpm:
How many gallons of water d:the design predict
Company: titX4/4/e. as required? 16 ';
Phone.,1 -/ : - 533(pi _______
Did the test meet or exceed . ign flow? ITYes 0 No
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Fax: Which sprinkler did you flow,i umber; i Iij'l
ff,..-irtui is tihneswhialronpvaslivgen7j
permanently yaneenstly4iioattached close to the Location of head: ...,
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Date left in service with all v., -s open:
Was this system required by code?1&l Yes C)No
Test Witnessed and Verified by:
e. Name Signature Occupation [tate
1 OA ilAtket0A 14-**4----- -1 f .',
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IAdditional Explanations and Notes
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Opener,Mc,
Tel:803,321.4739
S925 148th Street West
Fax;952 9971731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com
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