Report (60) ,; mST.20,7 — OD0 643
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uponor
FIRE SAFETY SYSTEMS
3 AQUASAFETM' FLOW TEST
VERIFICATION
FORM
AquaSAFETM Flow Test Verification Form
Alliance Important Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
A`)� � Pt tom,Li r, system warranty.E-mail or fax completed form
Company Name: , to the Uponor Fire Safety Design Department
Contact: Ie(eAt- DtslAwtao. at technicai.services@uporj►r.com or 952.997.1731.
SC S- q l- .,y°I G For questions,contact Uponor Technical Services at
Phone: 888.594.7726 or technical.serviceseu onor.com.
Fax: ,, Color of test orifice used: 6(145
Job Name: iwVe/' Terr'aGe. Static pressure(not flowing)reading at incoming
Project Number: Lit I water supply into home or at main shutoff: ro 6
Job Address: iY//e/S‘..J je 4 L. ,r,�---c*
Residua press re(flowing)reading at inakminq water
City: 7-1)0.1,01supply into home or at main shutoff: .5-1
State,ZIP: OIL i q 5
What time of day was the flow test taken? J:00
For designs not provided by Uponor,complete the
following information. Flow test method uus�ed�? el Bucket 0 Flow Meter
/3C i. v\ Flow test 9pm:
Designer's Name: � !4
Company: eNe1` How many gallons of water did the design predict
p� 5 33 o as required? /-7
Phone: 15 " )- Did the test meet or exceed design flow? C11<s 0 No
Fax: Which sprinkler did you flow?Number: H. 9
Is the warning sign permanently attached close to the Location of head: 2d 2_
A}1.r144 main shutoff valve? 0 Yes f9 No 7..�
Date left in service with all valves open:
Was this system required by code?1 'es 0 No
i
E
Test Witnessed and Verified by:
s Name Signatur Occup ion Date
t 01;V Cn n h ( er 7" 17
z
-
A
0
Additional Explanations and Notes
a
iii
Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www. a.cmn