Report (108) 1
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FIRE SAFETY SYSTEMS
AQUASAFET"' FLOW TEST
VERIFICATION
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AquaSAFETM Flow Test Verification Form
Alliance Important:installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
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Company Name: AO; Ate., C n 1U11Mt 1^q system warranty.E-mail or fax completed form
L J to the Uponor Fire Safety Design Department
Contact: P.OLje(T 1)rctAwIAU\ at technical.services@uponor.com or 952.997.1731.
Phone: 501- 41a-".. `i 10 For questions,contact Uponor Technical Services at
888.594.7726 or technical.seer�vices@uponor.com.
Fax: Color of test orifice used: 17CCtSc
Job Name: illU`e.r T'tR'o.(L Static pressure(not flowing)reading at incoming,^^
Project Number: Lgqau'� °i 9 .. i water supply into home or at main shutoff: UO
Job Address: 1)lOt sty mad—eti,u Tor.
Residual pressure(flowing)reading at incoming water
City: Tr 5gfa supply into home or at main shutoff: SY
State,ZIP:1I`,c 7aa3 66
What time of day was the flow test taken? O:00
For designs not provided by Uponor,complete the
following information. Flow test method used? Bucket U Flow Meter
Designer's Name: i}c k.4 Flow test gpm: DO
Company: dy�p,/ How many gallons of water did the design predict
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3 0 as required? tel
Phone: /5d
Did the test meet or exceed design flow? Comes U No
Fax: Which sprinkler did you flow?Number:ll4.I
Is the warning sign permanently attached close to the Location of head: , 00u
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A�Telin —7 ' -main shutoff valve? U Yes it'll()
Date left in service with all valves open:
Was this system required by code?C$rYes U No
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Test Witnessed and Verified by:
"_- Name Signature Occupation Date
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Additional Explanations and Notes
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g Uponor,Inc. Tel:800,321.4739
5925 148th Street West Fax:952.997.1731
ri Apple Valley,MN 55124 USA Web:www.uponor-usa.com