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uponor
1 FIRE SAFETY SYSTEMS
AQUASAFETM' FLOW TEST
` VERIFICATION
FORM
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AiaSETM Flow Test Verification Form
Alliance Important Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
A �ow� Pt system warranty.E-mall or fax completed form
Company Name: 4i N`5 to the Uponor Fire Safety Design Department
Contact: 1(66E1 DtcLw'a,n at ISChiliCit69042120499426C2M or 952.9971731.
Phone: S03-lic11-- by°ID For questions,contact Uponor Technical Services at
888.594.7726 or technical.seQnriicesli@uponor.com
Fax: /� Color of test orifice used: *SS
gJob Name: Vec Terrace Static pressure(not flowing)reading at incoming
Project Number: 1...'1' i water supply into home or at main shutoff: SZ
Job Address: I3 22t., S� +414,....14...,-rtdr'
Residua p ure(flowing)reading at incoming water
City: TI)0.rai supply into home or at main shutoff: Slillir C
State,ZIP: 011-i q5
What time of day was the flow test taken? B°ee
For designs not provided by Uponor,complete the ��
following information, Flow test method used? Bucket C)Flow Meter
�p� Flow test gpm: ac)-1
Designer's Name: . ekei{' k 6�. ...,- f-L
How many gallons of water did the design predict
Company: u efAol`
a5.541. as required? /7
Phone: "!S -/17- cr D
Did the test meet or exceed design flow?`` s No
Fax: Which sprinkler did you flow?Number: H. cj
Is the warning sign permanently attached close to the Location of head: *Sod 9
hull w►4 main shutoff valve? 0 Yes trill
Date left in service with all valves open: 2-.9°-/`")
Was this system required by code?l 'es :]No
E
� Test Witnessed and Verified by:
s Name Signatu�rj Occup l ion Date
z
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Additional Explanations and Notes
d
Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.upawr-tsa.com