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FIRE SAFETY SYSTEMS
AQUASAFET FLOW TEST
VERIFICATION
FoF:m
AquaSAFETM Flow Test Verification Form
Alliance important:installing contractor Hist submit this
Member ID: completed form.Farre to do so nullifies the
Company Name: A II;ANCL, P(ttw�i h system .iE-rrrait or fax completed form
to the Uponor Fire Safety Design Department
Contact: tole rt Dtsl a,n at technical servicese upoi or.com or 952.997.1731.
SO 3- q - 34°I D For questions,contact Uponor Technical Services at
Phone: 898,594.7726 or technical.servicess@u
ponor.corst.
Fax: Color of test orifice used: 5$
Job Name: I41ht Terrace Static pressure(not flowing)reading at incoming
Project Number: `.' water supply into home or at main shutoff: 3"i if
Job Address: 3 20j(-41°-115‘..44—' - .R€ drudI.pressure(flowing)reading at incomingw water
City: Ti)µ%( supply into home or at main shutoff: (�17
State,ZIP: Oil., g� 3
What time of day was the flow test taken? `0O
For designs not provided by Uponor,complete the
following information. \ Flow test method used? U9 Bucket 0 Flow Meter
Designer's Name: 7 u(„ , Flow test Spm:
Company: a WJ' Now many gallons of water did the design predict
954 997- 5)56 as required?
- co
Phone: Did the test meet or exceed design flow? tiir1'es 0 No
Fax" Which sprinkler did you flow?fNumber: ) n
. I
Is the warning sign permanently attached close to the Location of head: Bed.. 2_
A+-rtt*44 main shutoff valve? 0 Yes C9 n o
Date left in service with all valves open: 9' '`1",
Was this system required by code?leles 0 No
Test Witnessed and Verified by:
Name Signat� 0 ion r Date
0
U
Additional
Explanations and Notes
Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley MN 55124 USA Web:www.upamr}usa com