Report (48) ,V?S -oi7- c oo73
uponol
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�o.� FIRE SAFETY SYSTEMS
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s • AQUASAFETM' FLOW TEST
VERIFICATION
FORM
CH.
AcuaS. FE' Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
A I� � Pl system warranty.E-mail or fax completed form
Company Name. Aj )A'� to the Uponor Fire Safety Design Department
Contact: ILe(gA Dtslnwta,n attechniraLsewiaes@uposor.com or 952.997.1'731.
Phone: cos-1113-- bu°i o For questions,contact Uponor Technical Services at
888.594.7726 or technicaLservices@uponor.com.
Fax: Color of test orifice used: Ensss
Job Name: iVef TeR'Glte.. Static pressure(not flowing)reading at incoming //
Project Number: 1-4 t water supply into home or at main shutoff: LO
Job Address: 134/✓"'"f? 5c... S.24.46,21,,,,,.1/4-3.c.Residual pressure(flowing)reading at inakming water
City: Tl)extbt supply into home or at main shutoff: 5
State,ZIP: OIL) q%)autl
What time of day was the flow test taken? 8°mo
For designs not provided by Uponor,complete the .�
following information. Flow test method used? is Bucket U Flow Meter
Designer's Name: e..1:•' ..1.41.- Flow test gpm: :'
Company: nflbl` How many gallons of water did the design predict
q S 33 o as required? /7 /
Phone: (5 D- Did the test meet or exceed design flow? Cir/les C I No
Fax: Which sprinkler did you flow?Number: /`?- 9
Is the warning sign permanently attached dose to the Location of head: "3GI7 _
A+1t,eA4 main shutoff valve? CI Yes L'9 No
Date left in service with all valves open: 7- 2.0--11_
Was this system required by code?fa es 0 No
i
E Test Witnessed and Verified by:
Name Signatur Occup ion Date
O1;1� 41 fir- 7-20-I
R
Additional Explanations and Notes
I.
il
Uponor,Inc. Tel:800321.4739
5925 148th Street West Fax 952.997.1731
Apple Valley MN 55124 USA Web:wwwa.com