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Report (63) .. ' ill ST2c217 - Do 11 1 li UPOn01 � ¢ r FIRE SAFETY SYSTEMS AQUASAFETM' FLOW TEST r i /7, c:43 VERIFICATION ,,,,,e'..=: FORM rte' AquaSAFE Flow Test Verification Form Alliance important:Installing contractor must submit this Member ID: completed form.Failure to do so nullifies the Company Name: A II'co _ f1,444,4 „._ system warranty.E-mail or fax completed foam enc",-(41- n► to the Uponor Fire Safety Design Department Contact: M � C t wikeN. at iechnicai.servi .com or 952.997.1731. Phone: SO 3- 41) -3 W h 0 For questions,contact Uponor?'ethnical Services at 888.594.7726 or technical services@uponor.cont. Fax: Color of test orifice used: ' Job Name: f I IKf TGgX, Static pressure(not flowing)reading at incomin Project Number: attit 14—)�a•) water supply into home or at main shutoff:___ Job Address: (314'-SV Irl, 1vt_?Qi' Residual pressure(flowing)reading at incomingwater City: Ti)A supply into home or at main shutoff: �O State,ZIP: ©le-, 1?Ad3 What time of day was the flow test taken? `DO For designs not provided by Uponor,complete the following information, [� Flow test method used? C�Bucket C3 Flow Meter Designer's Name: Flow test gpm: IS 4 Company: lir two!' How many gallons of water did the design predict as required? 11 Phone: 9C)- Sy C330 Did the test meet or exceed design flow? ._./ ti/s Yes ❑No Fax: Which sprinkler did yourraaflow?Number: h4 7' is the warning sign permanently attached close to the Location of head: Zd� "" --/ ��Nrti'� main shutoff valve? 0 Yes o�� Date left in service with all valves open: /� '/-1 t Was this system required by code?L5'Yes 0 No 5 a Test Witnessed and Verified by: s Name Signature Occupation Date 3 -( / ` (2Ij -�' 9-) -11 0 0 Additional Explanations and Notes a ij Uponor,Inc. Tel:800.321.4737 9 5925 148th Street West Fax:952.997.1731 ' Apple Valley,MN 55124 USA Web:www.uportor-ma.com