Report , * <017 - CO3 �i
•
FIRE SAFETY SYSTEMS
AQUASAFETm FLOW TEST
VERIFICATION
AquaSAFE' Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: _— completed form.Failure to do so nullifies the
system warranty.E-mail or fax completed form
Company Name: _Al I l4rieP T itt lI •
to the Uponor Fire Safety Design Department
Contact: _ °y fi - ^r at technicalservices@uponor.com or 952.997.1731.
Phone-` co%- For questions,contact Uponor Technical Services at
888.594.7726 or technical.services@uponor.com.
Fax:
Color of test orifice used:
Job Name: P 1 c.4 TC ,oe
Static pressure(not flowing)reading at incoming
Project Number: _ C c 3 _ water supply into home or at main shutoff: _ 9S
Job Address: 13093 SW 16c — —_
s7 ���}, Residual pressure(flowing)reading at inco mg water
I'
City: _ Ion
supply into home or at main shutoff: I')
State,ZIP: ®(Z 9 ) ')
For designs not provided by Uponor, complete the What time of day was the flow test taken? ('J('y
following informations. � Flow test method used? Bucket 1 Flow Meter
Designer's Name: _g�,tAt kb-14 2 Flow test gpm:_
Company: d�G _\_ How many gallons of water did the design predict
� � Qq �� as required?
Phone: -t
Did the test meet or exceed design flow? Al'Yes J No
Fax: uu
Which sprinkler did you flow?Number:_p[e
Is the warning sign permanently attached close to the
main shutoff valve? J Yes 4 Noa Location of head:
or\ ,nlslN II
l 1 Date left in service with all valves open: 18
Was this system required by code? Yes No
Test Witnessed and Verified by:
Name Sig ture • Occupatio Dat
hec
4./8
Ob
o — -
•
Additional Explanations and Notes
0
8
LLI
Uponor,Inc. Tel:800.321.4739
e, 5925 148th Street West Fax:952.997.1731
LL Apple Valley,MN 55124 USA Web:www.uponor-usa.com