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uponoi FIRE SAFETY SYSTEMS i AQUASAFETM FLOW TEST VERIFICATION r, A; FORM, .' k . 'Yc, AquaSAFETM Flow Test Verification Form Alliance Important Installing contractor oust submit this Member ID: completed form.Failure to do so nullifies the Company Name: A 11;044e, f p tkw4(aL had system te warranty.E-mall or completed form UponorSafety DesignDepartment Contact .,(g )•' DI 51.0.4art at technical.services@uporzor.com or 952.997.1731. Phone: co 3-Li Gi - Yy ato For questions,contact Uponor Technical Services at 888.594.7726 or technical.serrviicesluponor.com. Fax: ,/� Color of test orifice used: E'SS 124 Job Name: Ve1 Terrace Static pressure(not flowing)reading at incoming Project Number: `•'f 1 water supply into home or at main shutoff: Job Address: i 3230 Sc.› AAti.Lrrw hNt- . Residual pressure(flowing)reading at incgmin water City: -1-1)0.(1,1 supply into home or at main shutoff: It 442- State,ZIP: ©!Z) q k) r? What time of day was the flow test taken? 0'ee For designs not provided by Uponor,complete the , � following information. Flow test method used? tBucket 0 Flow Meter Designer's Name: ✓rr4,1.e% Flow test gpm: -p '' - Company: PnNoI` How many gallons of water did the design predict 954-99)- S S3 c as required? /`7 Phone: Did the test meet or exceed design flow? C ' s 0 No Fax: Which sprinkler did you flow?Number: /I. / A}Tr! Is the warning sign permanently attached close to the Location of head: �.i2_ '* main shutoff valve? 0 Yes io & F--!,7 Date left in service with all valves open: Was this system required by code?alles ;J No 2 Test Witnessed and Verified by: Name S' natur ©ccu ion Date 13z V�,1� t1 �r�l �'P r Er-g-,7 c R U N Additional Explanations and Notes a Uponor,Inc. Tel:800.321.4739 5925 148th Street West Fax:952.997.1731 Apple Valley,MN 55124 USA Web:www.uponorvsa,wm