Report (45) . , A ati
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FIRE SAFETY SYSTEMS
1 AQUASAFETM' FLOW TEST
VERIFICATION
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AquaSAFETw Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: completed form.Failure to do so nuDifies the
A�/. t ri�l �asystem warranty.E-mail or fax completed form
Company Name: a e.l Lr' '�'i to the Uponor Fire Safety Design DepartmentContact: (25\642r4:14,4441.40.. at technical.serviceseWonor.cont or 952.997.1731.
Phone: -eft 2—3 y 4 a For questions,contact Uponor Technical Services at
888.594.7726 or techniral.services9tuponor.com.
Fax: R-0
Color of test orifice used: lQCe�S
Job Name: 1\01nQ.f" Texce.x-b Static pressure(not flowing)reading at incoming
Project Number: water supply into home or at main shutoff: p 0
Job Address: 131715L14,45,ewgiwt..-Tft r^•
Residual pressure(flowing)reading at incomin water
City: 9 or supply into home or at main shutoff: SZ-
State,
L
State,ZIP: Via_ cj7223
What time of day was the flow test taken? c1/
For designs not provided by Uponor,complete the
following information. Flow test method used?,Bucket Flow Meter
�•e0 4 � L Flow test gpm:
Designer's Name: n
How many gallons of water did the design predict
Company: LA.4?eit.senrc
as required? l
Phone: (45'2.-49?- 330 Did the test meet or exceed design flow? SillYes 0 No
Fax: i Which sprinkler did you flow?Number: . f
Is the warning sign permanently attached close to the Location of head: r#4./1(rnil,r�
I� la '� main shutoff valve? L7Yes II J 0 Date left in service with all valves open: 9-12.-1',
lI r111 S --- Was this system required by code?®Yes C]No
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L Test Witnessed and Verified by:
1.
Naam�e Sig a OccupatI Date
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Additional Explanations and Notes
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Uponor,inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www uponor'-usa.com