Report (28) �xP 'w� � 4
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MST �,0►'1- 00 402) UP000(
FIRE SAFETY SYSTEMS
AQUASAFETM' FLOW TEST
F. VERIFICATION
AquaSAFE1'M Flow Test Verification Form
Alliance
Important Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
Company Name: /4111am11wmb;>15 _ system warranty.E-mail or fax completed form
,,., to the Uponor Fire Safety Design Department
Contact: POkt 1-*-61 at technicalservices@uponor.com ponorwm or 952.997.1731.
Phone" 932- 419,3- click) For questions,contact Uponor Technical Services at
1388.594.7726 or technicaisenrices@uponow com,
Fax:
Color of test orifice used: R1,14.9.
Job Name: e-c-1-4(25- )i -7-6ntqcQ.
a� Static pressure(not flowing)reading at incomi
Project Number: C water supply into home or at main shutoff:
' Job Address: 1?10 SW Mit_
City:
Residual pressure(flowing)reading at incoming water
•
supply into home or at main shutoff: 60
State,ZIP: O . T
For designs not provided by Uponor,complete the What time of day was the flow test taken? ereD
following information.�Ace/10V---7• Flow test method used? *Bucket Flow Meter
Designer's Name: \ C:'�/' 6-6•4_1'6\__ Flow test gpm:18
Company: _ (,` How many gallorl
Phone: s.. water did the design predict
,•C3?� _ as required?
Did the test;meet or exceed design flow? 4rYes 3 No
Fax:
Which sprinkler did you flow?Numbe
Is the warning sign permanentlx attached close to the R _,gttrril/
main shutoff valve? 4.1 Yes , 'No x , Location of head:
Was this system required by code? Yes No 11
Date left in service with all valves open: '1'�('/
112,m
Test Witnessed and Verified by:
Narr
JteP etS'•‘,il�1,l OcRpatiop Date APti l
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Additional Explanations and Notes
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z Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com