Report /YlSP.I.�1v 4'1UP000(
'Y: t
FIRE SAFETY SYSTEMS
AQUASAFETM' FLOW TEST
VERIFICATION
AquaSAFE1'M Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: /1 11 �S completed form.Failure to do so nullifies the
Company Name: �t le?wtQ Q f wm hj� ____ system warranty.E-mail or fax completed form
A
~
PP��r1� to the Uponor Fire Safety Design Department
Contact: _ RObe fi r A at technical.services@uponor.com or 952.997.1731.
Phone"_SOS` / (.116 For questions,contact Uponor Technical Services at
888394.7726 or technical.services@uponor.com.
Fax. — —_ Color of test orifice used:
Job Name: 12;of TC1(` Le Static pressure(not flowing)reading at incoming
Project Number: : _ water supply into home or at main shutoff: 95".
Job Address: A-) G) 1 S 1AJ
pResidual pressure(flowing)reading at incoming water
City: __'}f vertcHA supply into home or at main shutoff: 60
State,ZIP: d2 9)0-J --
What time of day was the flow test taken? IOC)
For designs not provided by Uponor,complete the
following information. Flow test method used? Ai Bucket J Flow Meter
l
Designer's Name: _ (01t- Kith 1(e- Flow test gpm: I6
Com an How many gallons of water did the design predict
P y A/ as required? t"
Phone: . -.•961)
Did the test meet or exceed design flow? ; Yes No
Fax: ---- Which sprinkler did you flow?Number: H4)
Is the warning sign permanently attached close to the Location of head: Lo:µrift
main shutoff valve? J Yes 2fl No On Ft'nlS\•\ ,
Date left in service with all valves open: S(
Was this system required by code?4 Yes J No
Test Witnessed and Verified by:
Name Si. ature Occupation Dat
Jjefrkj iPh � �� 1 ,,o&_-_ Pro y ;, 3/
a
•
Additional Explanations and Notes
Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952-997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com
LL