Report (58) /n ST o2ot7- 000 6q
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uponor
FIRE SAFETY SYSTEMS
I d• 2. AQUASAFETM' FLOW TEST
VERIFICATION
FORM
A'i:?lM I
AquaSAFETM Flow Test Verification Form
Alliance Important Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
A I Iiowwce, Plt40.61 n warranty.Email or fax completed form
Company Name: `5 to the Uponor Rre Safety Design Department
Contact: Cleft- DtcL at technical.serviceseuporJOr.com or 952.997.1731.
Phone: SO 3-H q)-- b4°10 For questions,contact Uponor Technical Services at.
888.594.726 or technicalservicesluponor.cont.
Fax: Color of test orifice used: 55
Job Name: 941X/' Terrace. Static pressure(not flowing)reading at incoming
Project Number: I water supply into home or at main shutoff: 4.
Job Address: _ _
• id press owing)reading at incgming water
City: Tisupply into home or at main shutoff: 5(4
State,ZIP: Of-) 1`)a.).5
What time of day was the flow test taken? B'eb
For designs not provided by Uponor,complete the ,.�
following information. Flow test method used? tb Bucket 0 Flow Meter
Flow test gpm:
Designer's Name: 2c'r }
Company nUte!` How many gallons of water did the design predict
SS3o as required? �?
Phone: /5 "997 Did the test meet or exceed design flow? ('Yes 0 No
Fax: Which sprinkler did you flow?Number: /1 . 1
Is the warning sign permanently attached dose to the Location of head:
A4--r12444 main shutoff valve? Cl Yes a'No
Date left in service with all valves open: -1 47
Was this system required by code?Cletes 0 No
Test Witnessed and Verified by:
Name Signator Occup ion Date
04;Ise.(0.061.31 •nr `" . t 7
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Additional Explanations and Notes
Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997,1731
Apple Valley,MN 55124 USA Web:www.upoiwr-usa.com