Report (29) •
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FIRE SAFETY SYSTEMS
AQUASAFETm FLOW TEST
VERIFICATION
11111111.1111111.
AquaSAFETM Flow Test Verification'
.................
Form
................................
Alliance ..........................................
Member ID: Important:Installing contractor must submit this
1 completed form.Failure to do so nullifies the
Company Name: - A.CK----e-k30- __ system warranty.E-mail or fax completed Department Contact: to Safety
Uponor FireDesign
at Uichikkenicaommtwalm or 952.997.1731.
Phone:' - �/�a- a11� For questions,contact Uponor Technical Services at
888.594 7726 or
Fax: #finical rvices�
uPono_ room.
Job Name: r • e) Color of test orifice used:
Project Number: er C� Static pressure(not flowing)reading at incoming
_ water supply into home or at main shutoff: �
Job Address: �.
I00, -------
City: _ Residual pressure(flowing)reading at incoming water
State,ZIP: '11 � supply into home or at main shutoff:
_aCi•
For designs not provided by Uponor, complete the What time of day was the flow test taken?_ l` _
following information. Flow test method used? }Bucket ]Flow Meter
Flow test Bpm:_a_
Designer's Name: _ _ • "f a
k_._...___
Company: , 1 How many gallons of water did the design predict
Phone: e - "Q ` as required?_ f1
Fax: _I Did the test meet or exceed design flow? Yes ]No
Which sprinkler did you flow?Number: _
Is the warning sign permanent) attached close{ to the Location of head:
main shutoff valve? ,Yes No OR F i _
c Was this system required by code? Yes No Date left in service with all valves open:
ayN
I' Test Witnessed and Verified by:
Na a f 1 I Sig tur
Yi 0 upati n Date
a
D I
0
N
Additional Explanations and Notes
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LLI
,`r Uponor,Inc. Tel:800321.4739
>05
5925 148th Street West
Apple Valley,MN 55124 USA Fax:952.997.1731
Web:www.uponor-usa.com