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FIRE SAFETY SYSTEMS
AQUASAFETm FLOW TEST
VERIFICATION
AquaSAFE1,M Flow Test Verification Form
Alliance
Member ID: Important Installing contractor must submit this
completed form.Failure to do so nullifies the
Company Name: Al 1;ay\r PI ° system warranty.Email or fax completed t ��i sst
� Plated form
!),L e�� D,S to the Uponor Fire Safety Design Department
Contact: ►�Cill }\i ,y,, at techhnica
.servicesluponorcorr!or 952.997.1731.
Phone" C61-1193 -2 For questions,contact Uponor Technical Services at
888.594.7726 or technical.serviceseuponor com.
Fax:
t' Color of test orifice used: fl(4,12.
Job Name: 1<)1'Cir {r«qre
Static pressure(not flowing)reading at incomin
Project Number: L-ot) water supply into home or at main shutoff:
Job Address: I 3!3 ScJ �
Cit Residual pressure(flowing)reading at incoming water
y: _&in.yel-
supply into home or at main shutoff: ___LE___________
State,ZIP: G2 1`laQ
What time of day was the flow test taken? i`,
For designs not provided by Uponor, complete the
following information. Flow test method used? ,Bucket ]Flow Meter
Designer's Name: _ Ace'wu— 6-141q — Flow test gpm: I q
Company: _ c- . How many gallons of water did the design predict
Phone:
9 s-,4- cm ,c��e _ as required?
Did the test meet or exceed design flow? ❑Yes J No
Fax !
Which sprinkler did you flow?Number: t-' I
Is the warning sign permanently attached close to the f ilea
main shutoff valve? ..1 Yes ANo Location of head:
dryN�o /
Was this system required by code?0 Yes No Date left in service with all valves open: l�
N
Z
C
m
Test Witnessed and Verified by:
Name S'•na '
/ Occupati n
g
_l� t I�r-/i,nn i is J ccup of Dat
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z
t Additional Explanations and Notes
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2
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z Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA . Web:www.uponor-usa.com