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AQUASAFEni FLOW TEST
VERIFICATION
AquaSAFE2'M Flow Test Verification Form
Alliance Important Installing contractor must submit this
Member ID:
completed form.Failure to do so nullifies the
Company Name: rt1 a g system warranty.E-mail or fax completed form
Rokd-0fi
to the Uponor Fiices@re uety Design Department
or 952997.
Contact: _ Y1 at technicalservices@uponor.com or 952.997.1731.
Phone-' c(f rna-1114.6 For questions,contact Uponor Technical Services at
888.594.7726 or techrucal.services@yponor.com.
Fax:
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Color of test orifice used: R1 Ll
ft
Job Name: fec Tecno. e e
Static pressure(not flowing)reading at incomin
Project Number: Let 4 I O water supply into home or at main shutoff:
Job Address: '1> c 5, i cell's.—
City _���Q, O Residual pressure(flowing)reading at incoming water
supply into home or at main shutoff: 60
State,ZIP: 11)11Q)
What time of day was the flow test taken?
For designs not provided by Uponor, complete the '�'���'
following information. Flow test method used? *Bucket 1 Flow Meter
Designer's Name: gtoyA- K d�4 Flow test gpm: ''g
Company: _ re How many gallons of water did the design predict
ICA- ) -S ';,.oas required? 11
Phone: '' `
Did the test meet or exceed design flow? ❑Yes J No
Fax:
Which sprinkler did you flow?Number:
Is the warning sign permanent) attached cle to the
main shutoff valve? .]Yes No (A h ni5� Location of head: -ii t/. (1.
Yes No Date left in service with all valves open: 8i 4
Was this system required by code?
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r Test Nfitnessed and Verified by:
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Name Si atur
c `�' i * r Ocopati� krelf8
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g Additional Explanations and Notes
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i. Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
LL Apple Valley,MN 55124 USA Web•www.uporwr-usa.com