Report (10) . .
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FIRE SAFETY SYSTEMS
AQUASAFE'*'r FLOW TEST
VERIFICATION
IIIIIIIIIIIIIIIIIII
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AquaSAFE�• Flow Test Verification Form
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Alliance
....................
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Member ID: ""s
important:Installing contractor must submit this
Company Name: I j � form.Fa
compto leted so nullifies the
to warranty E-mail or fax completed form
Contact: or
It Pon Fre Safety p yn p�2.997.
Phon L ��`��-`� or
e".._ t Q For questions, 89'/•1731.
✓For question 0 . _Uponor Technical at
Fax: contact,_._.
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Job Name: ?1 rrc� Color of test orifice used: —�l�e'
aStticer pressure(not flowing)reading at Incomin
Project Number: L.,, I
water supply into home or at main shutoff
Job Address: r — _
n_ � � '' __
City. -- sd Residual pressure(flowing)reading at incoming water
State,21P: _ supply into home or at main shutoff:
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For designs not provided by Uponor,complete the What time of day was the flow test taken?
following information. Flow test method used? Bucket Flow Meter
Designer's Name: Flow test gem:_ ski
Company: -"•�•
r How many gallons of water did the design predict
Phone: as required?_(',
Fax: Did the test meet or exceed design flow? ' Yes a No
Is the warning sign permanently attached close to the Which sprinkler did you flow?Number:
main shutoff valve? .1 Yes x No + � Location of head: • r
��t t\1S
Was this system required by code?;/(Yes No•
Date left in service with all valves open:
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Test Witnessed and Verified by:
Name
J Sig ature
I - +I tIFL►�^� _ upatio Dat
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$ Additional Explanations and Notes
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Uponor,Inc
5925 148th Street West Tel:1300.321.4739
Fax:952.997,1731
Apple Valley,MN 55124 USA �
Web:www.uPr-usa.con,
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