Report (116) uponol
l4_wV FIRE SAFETY SYSTEMS
......4-,.:, AQUASAFET"" FLOW TEST
VERIFICATION
AquaSAFETm Flow Test Verification Form
Alliance important:installing contractor mist submit this
Member 1D: completed form.Failure to do so nullifies the
Company Name:
A 11441,Q. Pluto,N, system
warranty.E-mall orcompleted form
UponorSafety Design Department
Contact: tote tt DtsL 4av at ischniod.serviceseupow.com or 952.997.1731.
Phone: co$-i'I q .- 3y°I O For questions,contact Uponor Technical Services at
888.594.7726 or technical.sendces@uponor.coin.
Fax: Color of test orifice used: SS
Job Name: 124t}et Teerate. Static pressure(not flowing)reading at incoming
Project Number: 1.4t 1 ,/ water supply into home or at main shutoff:_ Z
Job Address: /3 24/2 so i4c jvta feet,Hes! ua sure(flowing)reading at incgming water�/
City: Tsti�i'1supply into home or at main shutoff: 74
State,ZIP: OIL) eiya.).t7
What time of day was the flow test taken?
For designs not provided by Uponor,complete the
following information. Flow test method used? b Bucket O Flow Meter
Designer's Name: rer)/ / y` Flow test gpm: "r te *
Company: a lMr How many gallons of water did the design predict
5 S3 o as required? 1 7
99)Phone: 95 - �- Did the test meet or exceed design flow? ��s O No
/
Fax: Which sprinkler did you flow?Number: it,Is the warning sign permanently attached dose to the Location of head: V 2..
firth a44 main shutoff valve? O Yes llrhro S
Date left in service with all valves open:
Was this system required by code? Yes O No
N
E
.ss
A Witnessed tnessed and Verified by:
"_ Name Signatur Occuplion Date
1
O
R
0
Additional Explanations and Notes
a
vii
Uponor,Inc Tel;800.321.4739
5925148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www .con