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Report (67) • „ • /„cST,,/7—dc C2i,( • upon01 FIRE SAFETY SYSTEMS Le+ Gi. k27 AQUASAFE' 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 Company Name: *COLA130 n,a system warranty.E-mail or fax completed form `"`t to the Uponor Fire Safety Design Department Contact: R, `'r"�j i54...1,%c,,,R at technical.services@yponor.com or 952.997.1731. Phone: -C3`j V92-.34/9ra For questions,contact Uponor Technical Services at 888.594.7726 or technicaiservices@uponor,com. Fax: Color of test orifice used: ';, 5 5 Job Name: R ky,41"��+�`�,(.„ Static pressure(not flowing)reading at incoming Project Number: q G7,2j V-7 water supply into home or at main shutoff: Job Address: I3V I y 514 0 .19 w pr, �!CYo Residual pressure(flowing)reading at incomin water City: supplyinto home or at main shutoff: Sy state,ZIP: For designs not provided by lJ�onor,complete the $What time of day was the flow test taken? 7;=.„,3 following information. gyp - Flow test method used? Bucket ❑Flow Meter Designer's Name: Flow test gpm: Company: y How many gallons of water did the design predict Phone: _ b..S.72_7_23,22:-$.:33t),__ as required? 17 . Did the test meet or exceed design flow? fs ©No Fax: f14Y Which sprinkler did you flow?Number: / r Is the warning sign permanently attached close to the Location of head: 1•214,400..- a, In main shutoff valve? U Yes No Date left in service with all valves open: 7-1)—17 Was this system required by code?X'es No Test Witnessed and Verified by: Signature ©ccu Date /14•1 144 CCC•ftelCti tACt* iJ a 0 Additional Explanations and Notes J Uponor,Inc. Tel:800.321.4739 5925 148th Street West Fax:952.997.1731 Apple Valley,MN 55124 USA Web:www.uponor-usa.com