Report (60) f $ k
a
uponoiFIRE SAFETY SYSTEMS
' AQUASAFETM' FLOW TEST
s Acr �C?-owei VERIFICATION
. '' FORM
.
A aSAFE Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
Company Name: A I I i•owtce, P144,144s, system warranty.E-mail or fax completed form
to the Uponor Fire Safety Design Department
Contact Klett" D156.4a,n at tedudcal.serviceseuponor.cont or 952.997.1731.
Phone: SOS-H 4 34,1D For questions,contact Uponor Technical Services at
888.594.7726 or technicaLserviicessuponor.com.
Q
Fax: Color of test orifice used: 63
Job Name: fiver "retrace Static pressure(not flowing)reading at incoming
Project Number: L.4,f 1 water supply into home or at main shutoff: (0,'2--
Job
g,2Job Address: /3s& Z 23,-A, -tResidual pressure(flowing)reading at incoming water
City: T1)0rb1 supply into home or at main shutoff: Sy
State,ZIP: Oft) (1).),)-5
What time of day was the flow test taken? 8°°b
For designs not provided by Uponor,complete the Flow test method used? I aBucket 0 Flow Meter
following information, // 4� (
Designer's Name: �l'7 T' se, Flow test gpm: g.-CD -1- ''
Company: U; is IAD,- How many gallons of water did the design predict
954 "17 5 S9 a as required? 1 7
- -
Phone: Did the test meet or exceed design flow? arYes 0 No
Fax: Which sprinkler did youflow?Number: r/
Is the warning sign permanently attached close to the Location of head:13edrr- 2
k}Tr:wn4 main shutoff valve? 0 Yes alio
Date left in service with all valves open: /-25--/7
Was this system required by code?( es 0 No
I
Test Witnessed and Verified by:
Name Sr OccupOccupxion Date
R
e
Additional Explanations and Notes
a
is;
il
Uponor,Inc Tel:800.321.4739
5925148th Street West Fax 952.997.1731
Apple Valley,MN 55124 USA Web:www.0 ponw-usa.com