Report (70) tt
' /3. / uponoi
'4.Y ,,`. FIRE SAFETY SYSTEMS
jY ,......0,.; AQUASAFET FLOW TEST
:; . /✓ ri7--e VERIFICATION
', FORM
AC1u.aSAFETM Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
System warranC•
ty. -mall or fax completed form
Company Name: A I Ir0►gtcp PIIMAJei n
to the Uponor The Safety Design Department
Contact teleit Dt5inw4av at technical.serviceseupongr.comor952.997.1731.
Phone: SO$-41)-- 3y°�� For questions,contact Uponor Technical Services at
888.594.7726 or technicai.serviceseuponor.conv
Fax: Color of test orifice used: fSS
,/�
Job Name: tt ,1te/' Te rat4. Static pressure(not flowing)reading at incoming /
Project Number: Wfo
1- 1 water supply into home or at main shutoff: Z-
Job Address: /3 5S1( e e.t....n: 1P e.
Residual pressure(flowing)reading at incgming water
City: T1)µro1 supply into home or at main shutoff: .S.-4/
State,ZIP: 0g-) q y 5
What time of day was the flow test taken? 8'ect
For designs not provided by Uponor,complete the
following information. Flow test method used? m Bucket J Flow Meter
Designer's Name: 13rf!m 4 k .
Flow test gpm: f
Company: u e IAOJ' How many gallons of water did the design predict ,
Gts�_�)- 5 3S a as required? / -
Phone. Did the test meet or exceed design flow? �tfYes 0 No
Fax: Which sprinkler did you flow?Number: H- 9
Is the warning sign permanently attached close to the Location of head: aid. 7
A Tri an4 main shutoff valve? 0 Yes CS No ?
Date left in service with all valves open:
Was this system required by code?al'es 0 No
g Test Witnessed and Verified by:
Name S' natur Occu ion Date
-a Ilti i kV-Gaa�lj�'1 �JPr' S'-2.3---, 7
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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.uponoptisa.corn