Report (67) )4 I 3 ,
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FIRE SAFETY SYSTEMS
AQUASAFETh FLOW TEST
7n I`7 . f j VERIFICATION
Sf
FORM
4
AaSETM Flow Test Verification Form
Alliance Important installing contractor must submit this
Member ID: completed fonn.Failure to do so nullifies the
A11;4,10.. Pl Wµ�►1 system warranty.E-mail or fax completed fona
Company Name: r►` to the Uponor Fire Safety Design Department
Contact: Itelleff' Dtsl*wta" attechnicaLservicess uporpr.coraor952.997.1731.
Phone: S03 I'Iq�- �y°l0 For questions,contact Uponor Technical Services at
888.594.7726 or technlcalserviceseuponor.com.
Fax: /� Color of test orifice used: &CS
,
Job Name: +Vet T>Drr'ate. Static pressure(not flowing)reading at incoming `
Project Number: 1.44 i water supply into home or at main shutoff: b 7
Job Address: /3s—gz..
Residual pressure(flowing)reading at incoming water
City: Troll o4 supply into home or at main shutoff; -If
State,ZIP: OIL) q}�-3
What time of day was the flow test taken? 8°eO
For designs not provided by Uponor,complete the Flow test method used? a Bucket 0 Flow Meter
following information.
Designer's Name: 73(.61/ Flow test gpm: 26 f ''r
Company: nlAoJ` How many gallons of water did the design predict
954-99�- S)S o as required? !—7
Phone: Did the test meet or exceed design flow? t.Y1'es 0 No
Fax: Which sprinkler did you flow?Number: 11.
Is the warning sign permanently attached dose to the Location of head: OpselZ
A4-Tri M4' main shutoff valve? 0 Yes alliTo pe 9/-Z C�/7
Date left in service with all valves open:
Was this system required by code? Yes 0 No
E '
Test Witnessed and Verified by:
Name Srignafu ► Occup ion Date
141;6,Guotioll
a
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.uponar-usa.com