Report (68) 0
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44.51)-o0-05-9
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Uponor
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FIRE SAFETY SYSTEMS
, . L0+ el ) 1:::-) AQUASAFErm FLOW TEST
i VERIFICATION
FORM
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AquaSAFETM Flow Test Verification Form
Affiance
Important:Installing contractor must submit this
Member ID:
completed form.Failure to do so nullifies the
Company Name: A)1!Aate_ etAkvA‘ILin system warranty.E-mail or fax completed form
to the Uponor Fire Safety Design Department
Contact: SZI. - LID)4'.- 1J1-1115 at technical,services@uponor.com or 952.997.1731.
Phone: gO6r+ pi,5t104ttn. For questions,contact Uponor Technical Services at
888,594.7726 or technical.serviceseuponor.com.
Fax:
Color of test orifice used: RITA42.-
Job Name: RIVI-r
Static pressure(not flowing)reading at incoming ,
Project Number: Lit °I, I i E--/ water supply into home or at main shutoff: 600
Job Address: )3 1.-7o eaki,-fliA,,,,Tcr.
Residual pressure(flowing)reading at incoming
City 1 i 5 cArd(
supply into home or at main shutoff: ••• 4/
State,ZIP: OP—i enf)t)
What time of day was the flow test taken? g
For designs not provided by Uponor,complete the
following information.
Flow test method used? bucket J Flow Meter
Designer's Name: C2/4 1/-04146.- Flow test gpm: if)
Company: (A ,0 How many gallons of water did the design predict
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as required? I.?
Phone: 9Ce — 11)- S 33c.
Did the test meet or exceed design flow? Va<s t:f No
Fax:
Which sprinkler did you flow?Number: hi'?
A
1, ,Is the warning sign permanently attached close to the Location of head:
At I tIWOmain shutoff valve? Li Yes No
Date left in service with all valves open: T2—i?- 17
Was this system required by code?feies J No
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P Test Witnessed and Verified by:
Name Signa r Occupation Date
14/11 IQ-(folk(I
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Additional Explanations and Notes
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Uponor,Inc. Tel:800.3214739
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5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com