Report (37) mS'T g0I7 ,_ (-) E
()POWFIRE SAFETY SYSTEMS
AQUASAFErm FLOW TEST
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: — f� ��P� pail ,= system warranty.E-mail or fax completed form
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— to the Uponor Fire Safety Design Department
Contact: Ochcit 1'>'sl rN at technical.services@uponor.com or 952.997.1731.
For questions,contact Uponor Technical Services at
Phone-
888.594.7726 or technical.senrices@uponor.com.
Fax:
--- Color of test orifice used: ii rt,c
Job Name: Static pressure(not flowing)reading at incoming
Project Number: _ _ water supply into home or at main shutoff: Q�
Job Address: / 3)1 Ski)
Residual pressure(flowing)reading at incoming water
City: _UPr veu "\ /
supply into home or at main shutoff: h
State,ZIP: OR ')ean
What time of day was the flow test taken? 8C)
For designs not provided by Uponor, complete the
following information. L //�� Flow test method used? ; (Bucket J Flow Meter
Designer's Name: - R f e.uf' K gj . ,, Flow test gpm:_.'18
Company: _ et ‘NOC How many gallons of water did the design predict
Phone: qTa a 9°I')-�33d _ as required? 0
Did the test meet or exceed design flow? Yes .7 No
Fax: 14-1
Which sprinkler did you flow?Number:
Is the warning sign permanently attached close to the Location of head: L aoka ry
main shutoff valve? :]Yes No ?f Rni
Was this system required by code?LW Yes No Date left in service with all valves open: �����/��
5.
Test Witnessed and Verified by:
Name Si natur
Ocupatiowriyn Da e
Additional Explanations and Notes
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LLi
Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com