Report (69) ,i Myr 2oi'7-- 002/7
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,,,,,,, L+ Ho 14 FIRE SAFETY SYSTEMS
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' _ AQUASAFETM' FLOW TEST
- VERIFICATION
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FORi'�1
AquaSAFE' Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: i completed form.Failure to do so nullifies the
Company Name: A iiliN ce 1 nii Wi►� system warranty.E-mail or fax completed form
F to the Uponor Fire Safety Design Department
Contact: €I± DICiAr4c,A at tachniaimmicestumnfamin or 951997.1731.
Phone: ',703 994—3410 For questions,contact Uponor Technical Services at
888.594.7726 or technicalservicesSuponor,conl.
Fax:
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1 Color of test orifice used: (1-‘c5Job Name: 'f"t � Static pressure(not flowing)reading at incoming _
Project Number: O) K water supply into home or at main shutoff: ?
Job Address: 130 41) 5V i 614-L cje
Residual pressure(flowing)reading at inco m water
City: cN'rc q supply into home or at main shutoff: 7S VS
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State,ZIP: ®gsI /7o17
What time of day was the flow test taken? S'cti.'.d'i''t
For designs not provided by Uponor,complete the
following information.Q A . Flow test method used? Bucket CI Flow Meter
Designer's Name: t13nct k0 t1& . Flow test gpm: 17 -
Company: �1\�CiVO4� How many gallons of water did the design predict
as required? li
Phone: `ici)"_99)— 53'5Did the test meet or exceed design flow? es ❑No
Fax: Which sprinkler did you flow?Number: //' `
i�yIs the warning sign permanently attached close to the Location of head: /'0C V� n'`
1--1 N►^^-7 4main shutoff valve? ❑Yes tNNo �1-al-)7�c _��
Date left in service with all valves open:
Was this system required by code? es 0 No
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2 Test Witnessed and Verified by:
sNam 1 Signatur_a —1i)'�f, Occupation Date
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Additional Explanations and Notes
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gi Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731 '
Apple Valley,MN 55124 USA Web:www uponor-usa.co n