Report , . :1 157-Q6/7 — 00 1110
R
uponoi
FIRE SAFETY SYSTEMS
i _ AQUASAFETM' FLOW TEST
,`= VERIFICATION
FORM
ApiaSETM Flow Test Verification Form
Alliance Important installing contractor must submit this
Member ID: completed form.Faihrre to do so nullifies the
CG Plt ,tai r, warranty.E-mail or fax completed form
Company Name: A 1'
to the Uponor Fire Safety Design Department
Contact Ile,e,+ Dtcltwra,n at technical.servkeseupoi or.eom or 952.997.1731.
Phone: SO 3-H q 1- V4°10 For questions,contact Uponor Technical Services at
888.594.7726 or technicaise+viceseuponor.copl.
Q_
Fax: ,�` Color of test orifice used: SS
Job Name: l�1?e/" Terrace- Static pressure(not flowing)reading at incoming
Project Number: 1.4 1 water supply into home or at main shutoff: sty
Job Address: 1 32025 LJ 4 -�
�c -de pressure(flowing)reading at inakm Ain water
City: TI)LA supply into home or at main shutoff: 'f4e
State,ZIP: eNt-i eta..3
What time of day was the flow test taken? 8°°O
For designs not provided by Uponor,complete the
following information. Flow test method used? e.3 0 Flow Meter 4' t
Designer's Narne: 2r✓1 Kb�t 4tAp1
Company: nfM.r~ ` Flow test gpm: i 7 Now many gallonspf water did the design predict
9s ' ?- S�o as required? /!
Phone: - Did the test meet or exceed design flow? a< 0 No
Fax: Which sprinkler did you ow?Number: I?-- I /
#4 lTPI�� Is the warning signpermanently attached dose to the Location of head: (�t. L.✓
main shutoff valve? Cl Yes i l No G_'„�
Date left in service with all valves open: g—
Was this system required by code?01*Ces 0 No
Test Witnessed and Verified by:
s Name Signator Occup ion Date
I
O
'A
U
I
Additional Explanations and Notes
a
id
Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997,1731
Apple Valley,MN 55124 USA Web:www uponor-usa.com