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• uponol FIRE SAFETY SYSTEMS AQUASAFErm FLOW TEST VERIFICATION /4451- 07_017'oo82 • AquaSAFE TM Flow Test Verification Form Alliance important:Installing contractor must submit this Member ID: p completed fonn.Failure to do so nullifies the Company Name: A 1 1.o me. I W ei w warranty.E-mail or fax completed form to the Uponor Fire Safety Design Department Contact: Klett' Dtc1#41.4s4n attchnicai.serviceslupogor.cotu or 952.9971731. Phone: CO 3- q - b4°I D For questions,contact Uponor Tedurical Services at 888.594.7726 or technical.serviceseuponor.conv Fax: /� Color of test orifice used: t'+*SS Job Name: gzver Terrace. Static pressure(not flowing)reading at incoming Project Number: 1-01. t water supply into home or at main shutoff: 6,2 Job Address: �3 5-2 City: Ti)µ/b1 Res duo pressure(flowing)reading at incgming water supply into home or at main shutoff: Y State,ZIP: ©ftp q0)1)-5 What time of day was the flow test taken? 8'"O For designs not provided by Uponor,complete the following information, test method used? Bucket ❑Flow Meter Designer's Name: Hied! 1664,-A. Flow test gpm: 7� Company: U, rs'Mr How many gallons of water did the design predict Phone: 954"997- 5S5o as required? /7 Did the test meet or exceed design flow? Wes O No Fax: / Which sprinkler did you flow?Number: Is the warning sign permanently attached dose to the Location of / �� 2 A}Tti 14/14 main shutoff valve? 0 Yes C9 No Date left in service with all valves open: 2-f/ Was this system required by code?aces D No Test Witnessed and Verified by. Name Si natur ©ccu ion Date tomCra taI ,.j ' p Additional Explanations and Notes a Uponor,Inc. Tel:80Q.321.4739 5925148th Street West Fax:952.997.1731 Apple Valley,MN 55124 USA Web:www.upa>or-usa com