Report (30) 0201
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, .., y : FIRE .AFETY SYSTEMS
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1v-1 c.=9 ( -( AQUAS , FE'"'" FLOW TEST
VE;' IEICATION
FORM
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A.q .a AFE M Flow Test Verification Fs' rm
Alliance Important:instaHing contra ,.r must submit this
Member ID: ii completed form.Failure to ,. so nullifies the
Company Name: ..ft t&.,, ki'.�,rr„ system warranty.E-mail or , completed form
i tl to the Uponor Fire Safety r%ign Department
Contact: lrq` Q1S� at feehnicaaLsenrices@upo ,` cont or 952.997.1731.
r`�►3-yi b"39�p For questions,contact Upo 'r Technical Services at
Phone: 888.594.7728 or ___,E r..•:1 tt,1:.' •,'., .„i.
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Fax: Color of test orifice used: ► •SS
Job Name: P-1�11F.✓'TeOritt . Static pressure(not flowing) jading at incoming /”
Project Number: to+5:1" / if"/� water supply into home or at%,ain shutoff: bCJt
Job Address: 1/0‘,41 7W 1efl4/i1 k Lave
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City:
/ flr • at incominater
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City: t r supplyResidual into homepressure(or at main
owing) ,utolugff:
State,ZIP: t-i ?74 .3
What time of day was the fib test taken? NE.'cti
For designs not provided by Uponor,complete the
following informationFlow test method used? :)cket C°Flow Meter
g U,a Flow test gpm; �sit7 I`
llesigrrer's Name;
How many gallons of water d the design predict
Company t1,8110 r
as required? 1
Phone: 7)?— -S 2 73t7
Did the test meet or exceed .'.sign flow? Yes C]No
Fax: Which sprinkler did you flow ,umber: #i
'f1 Is the warning sign permanently ached dose to the Location of head:
main shutoff valve? Ci Yes r5No
���� Date left in service with all va '
es open: 1 °.`/2
Was this system required by code?Ucl Yes CI No
X ... .... . ...... ............, .. ..... . ....... .........
g Test Witnessed and Verified by:
c Name ,` ' (' Signature Occup on? Date
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Additional Explanations and Notes
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Uponor,Inc. Tek 81X1.321.4739
1 5925 148th Street West Fax:952.997.1731
li Apple Valley,MN 55124 USA Web:www.ummor-usa.com