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VIFIRE SAFETY SYSTEMS
TM AQUASAFE
• FLOW TEST
VERIFICATION
•
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AquaSAFETM Flow Test Verification Form
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Alliance
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Important:Installing contractor must submit this
Member ID:
Company Name: l i e q „�, com� form.Failure to do so nullifies the
., system warranty.E-mail or fax completed form
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Contact: to the Uponor Fire
safety Design Department
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Phone-" at techeid :.. ___nsmom or
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For questions,contact 951997.1731.
Servicesat
Fax: __`_ .594.7726 or tfichakt
Job Name: � T Color of test orifice used: u
� ta nn�
Project Number Static pressure(not flowing)reading at incomin
water supply into home or at main shutoff:
Job Address: Ct i.— _
City: -�- Residual pressure(flowing)reading at incoming water
State,ZIP: supply into home or at main shutoff:
For designs not provided by Uponor, complete the What time of day was the flow test taken?Jeri_
following information. Flow testmethod used, Bucket Flow Meter
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Designer's Name: C Flow test gpm:_
man
How
Company: �
y gallons of water did the design predict
Phone: Q as required.`�
Fax: Did the test meet or exceed design flow?)f Yes :3 No
Is the warning Which sprinkler did you flow?Number:
signpermanent) attached close to the
main shutoff valve? )Yesoy\ . Location of head:
3
Was this systemNo R
required by code?, Yes No
Date left in service with all valves bpen:
E
Test Witnessed and Verified by:
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AYE ,!I, .1.._ pation Dat
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Aortal Explanations and Notes
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Uponor,Inc.
5925 148th Street West Tel:800.321.4739
Fax:952 997,1731
Apple Valley MN 55124 USA
Web:Www.upmwr-usa com