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FIRE SAFETY SYSTEMS
; AQUASAFETM FLOW TEST
te- fr VERIFICATION
4 2 FORiM
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AquaSAFE' Flow Test Verification Form
Alliance Important installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
p system warranty.E-mail or fax completed form
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Company Name: iiP<''.n 11,t: , , a, to the Uponor Fire Safety Design Department
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Contact: Y�."' '.iti- V ;11._ t..r\. at technicaiservicesluponar.com or 952.997.1731.
Phone: �'n i, ;>t +:1 For questions,contact Uponor?ethnical Services at
889.594.7726 or technicalserviceseuponor.corn.
Fax: lam Color of test orifice used: q? ,Yv
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Job Name: V' --71-,i,--,.\ Static pressure(not flowing)reading at incoming F.,
Project Number: 1406 A:7/ 1 '
, water supply into home or at main shutoff:
Job Address: 13136 S w 4k e,,1r4- Tell'.
Residual pressure(flowing)reading at incoming water
City: I t .J)\. supply into home or at main shutoff: b
State,ZIP: Of- 1� ,)c)2,
What time of day was the flow test taken? x w
For designs not provided by Uponor,complete the �
following information. Flow test method used? 0 Bucket 0 Flow Meter
Designer's Name:
�� Flow test gpm: r
Company: I;<.F r.f.,-4— 1',1, 1.,. How many gallons of water did the design predict
as required? i i
Phone: 1`,."1-" P-71 r ; _ �
Did the test meet or exceed design flow? 'Yes 0 No
Fax: Which sprinkler did you flow?Number: /I 1
An-tio,_ I the warning sign permanently a shed close to the Location of head: i-4 t&' f,/
main shutoff valve? ❑Yes No • ✓.-
Date left in service with all valves open: / `'' / r
c Was this system required by code?Lf Yes 0 No
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2 Test Witnessed and Verified by:
s NameSignature Occupation Date
I 141 ( r, (.,11 i "--~ \;� b a, , . .? i
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g 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.cwn