Report (37) �: UP0010(
FIRE SAFETY SYSTEMS
AQUASAFETm FLOW TEST
'`'' VERIFICATION
AquaSAFE 1'M Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: / completed form.Failure to do so nullifies the
Company Name: 1ciwt.(e Pt u„my�� SY em warranty.E-mail or fax completed form
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to the Uponor Fire Safety Design Department
Contact: _ (�' Q;5 at technical.services@uponor.com or 952.997.1731.
Phone-_Srq- C.icia„.(fie) For questions,contact Uponor Technical Services at
888.594.7726 or technical.services@uponor.com.
Fax ,i
Color of test orifice used: r 1.,C
Job Name: Q I ire"( "t I f«C/ Static pressure(not flowing)reading at incoming
Project Number: - water supply into home or at main shutoff: `<
Job Address: I "Ifj.) ) S 6613- — —___,—
Residual pressure(flowing)reading at incoming water
City: AP e
q� supply into home or at main shutoff: 6r)
State,ZIP: OP._ I)a ) —_
For designs not provided by Uponor, complete the What time of day was the flow test taken? ).1-/O
following information. Flow test method used? Ai Bucket J Flow Meter
Designer's Name: _ f fe, IC('1 ( _ Flow test gpm: 18
Company: _ tl (TAQ� How many gallons of water did the design predict
�y 11 c, as required? Al
Phone: qSa- `i"1) -S3,0_ Did the test meet or exceed design flow? #Yes No
Fax: i
�
Which sprinkler did you flow?Number: t� I _
Is the warning sign permanently attached close to the
main shutoff valve? J �'�t�Yes _I No ( ► Location of head: ��/e?hiY\', /
c Date left in service with all valves'open: _ 5 [P)
12
Was this system required by code?1 Yes J No
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Test Witnessed and Verified by:
Name Si.nature
�tsl '�'►rc%e . Occupation/ � ` Da
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: _..14.. 196,,,tig+E " yp3-1$
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Additional Explanations and Notes
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z Uponor,Inc. Tel:800.321.4739
3 5925 148th Street West _ Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com