Report (102) frls ' (2oi7 - 0033 •
UP000(
FIRE SAFETY SYSTEMS
AQUASAFETm FLOW TEST
VERIFICATION
AquaSAFETM Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: _ completed form.Failure to do so nullifies the
Company Name: ,,,,_- . ,� _ system warranty.E-mail or fax completed form
n�_ to the Uponor Fire Safety Design Department
Contact: _. CJr'l( J \trove\ at technical.services@uponor.com or 952.997.1731.
For questions,contact Uponor Technical Services at
Phone _ Lac 888.594.7726 or technical.s{{ervices@uponor.com.
Fax: - Color of test orifice used: giot{'
Job Name: OM f'CWP
Static pressure(not flowing)reading at incoming
Project Number: _ `, _ _ water supply into home or at main shutoff:
Job Address: __1.330 S1,1/ /9..3
j Residual pressure(flowing)reading at incoming water
City: f supply into home or at main shutoff:
State,ZIP: if 9) -
What time of day was the flow test taken? 1' }
For designs not provided by Uponor, complete the
following information. Flow test method used?A4 Bucket Flow Meter
Designer's Name: _ /3fri, fel Flow test gpm: `8
Com an How many gallons of water did the design predict
p i � — — as required? 1")Phone:e: 1 f0-2,1)c 1) S o _ —
Did the test meet or exceed design flow? Ar Yes .7 No
Fax: Which sprinkler did you flow?Number: 1 9
Is the warning sign permanentlyattached clois to the Location of head: _
main shutoff valve? -1 Yes 4 No 9h E'' Me., / —
Date left in service with all valves open: 7//6
Was this system required by code?)4 Yes J No
Test Witnessed and Verified by:
Name Si+at Occupatio Dat
3c tam .a �-. P1 wltht4 l
Additional Explanations and Notes
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Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com