Report (57) ry2.r�9,4)17- 060.3
u onor
FIRE SAFETY SYSTEMS
r .t r- 7 3, 5 AQUASAFElm FLOW TEST
/ VERIFICATION
.
FORM
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ORiM
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AquaSAFE' Flow Test Verification Form
Alliance Important Installing contractor must submit this
Member ID: y I Id completed form.Failure to do so nullifies the
Company Name: 1411161441C--1411161441C-- Plesystem warranty.Email or fax completed form
oo p to the Opener Fire Safety Design Department
Contact: t? i t Sechniral.services�'uponar com or 952.997.1731.
S 3- 91? - 39/b For questions,contact Uponor Technical Services at
Phone: 0 888.594.7726 or technical.services uponor.con(.
Fax: Color of test orifice used: W(may
Job Name: tvei 7e - Static pressure(not flowing)reading at incoming
Project Number: We t-71J5 water supply into home or at main shutoff:
Job Address: I31s - SV 4 Pc-'9eeN.
Residual pressure(flowing)reading at incoming water
City: 'T j 4 supply into home or at main shutoff:
State,ZIP: OR., /-) e3
What time of day was the flow test taken? 8:40
For designs not provided by Uponor,complete the
following information,lam11,, Flow test method used? Bucket U Flow Meter
Designer's Name: Ft44--Ids a Flow test gpm: IS '-
Company: ttr
�VB/' How many gallons of water did the design predict
as required? /d
Phone: '35 ' 533o Did the test meet or exceed design flow? /mss U No
MFax: Which sprinkler did you flow?Number: w
�� Is the warning sign permanently attached close to the Location of head: 4D
Trim main shutoff valve? U Yes fhul o �i,- ,j}
Date left in service with all valves open: //
Was this system required by code?EIS-es U No
i
Test Witnessed and Verified by:
1
Name Signature Occupation Date ett
cilia.
I
0
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Additional Explanations and Notes
1
Uponor,Inc. Tel•900.321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com
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