Report (28) •
•
UpOnOir
FIRE SAFETY SYSTEMS
AQUASAFETm FLOW TEST
,H Si o1.orrt- 00 46S VERIFICATION
•
•
AquaSAFETM
Flow Test Verification Form
Alliance Important Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
Company Name: 41/' Pik �; system warranty.E-mail or fax completed form
to the Uponor Fire Safety Design Department
Contact: _Peberf 0141Ma tAA at techni services@u
Phone'' 5'® �.�y�d Uponoroec hor 9525 Services
at- �� For questions,contact Technical Services a
888594.7726 or technical.servicesesuponor com.
Fax:
Color of test orifice used: iQhq {�
Job Name: Qi vex if.CTche<
it
�� Static pressure(not flowing)reading at incoming
Project Number: water supply into home or at main shutoff:_
Job Address: t 199 S,to, 16141.
City:
Residual pressure(flowing)reading at incoming water
supply into home or at main shutoff: `O
State,ZIP: Ole. 9)0a7)
For designs not provided by Uponor,complete the What time of day was the flow test taken? ). CG
following information.n Flow test method used? ,Bucket J Flow Meter
Designers Name: /S fd /'/.(,I/0, Flow test gpm:— he
Company: _ trail —_ How many gallons of water did the design predict
+/ l®r
9ca.g5) as required? /7
Phone: y/
Did the test meet or exceed design flow? iEYes J No
Fax:
Which sprinkler did you flow?Number: /I/
Is the warning sign permanently attached close to the
main shutoff valve? J Yes Ad No Location of head: /�Qrr
Was this system required by code?,'Yes J No Date left in service with all valves open:
Test Witnessed and Verified by:
N
a aSignature
Occupation Dat Jeff? ui1GA� / : /✓/)P1' Nage_
O _
Additional Explanations and Notes
•0
Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com
LL