Report (104) ti ; tyK —2oi7 — oog3 Li .
tV000(
FIRE SAFETY SYSTEMS
AQUASAFETm FLOW TEST
VERIFICATION
■
AquaSAFE1M Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
I tLl '„kik system warranty.E-mail or fax completed form
Company Name: Ai
to the Uponor Fire Safety Design Department
Contact: - P e" rt ,.r, at technical.services@uponor.com or 952.997.1731.
Phone7"_=111,-31.19 C For questions,contact Uponor Technical Services at
888.594.7726 or technical.services@uponor.com.
Fax: ----- Color of test orifice used: 11r,A'
r
Job Name: r•-%ler 1 al- air e Static pressure(not flowing)reading at incoming
Project Number: �t3 water supply into home or at main shutoff:
Job Address: Li 4S-141 it — —
Residual pressure(flowing)reading at incoming water
City: _ ,fie_
supply into home or at main shutoff:
State,ZIP: AL. Ma))
What time of day was the flow test taken? 8r. o
For designs not provided by Uponor,complete the
following information. Flow test method used? Bucket J Flow Meter
Designer's Name: _ icf 1°/k .- eaiJQ, Flow test gpm:_ 113
Company: _ r How many gallons of water did the design predict
a qq) -(??� as required? i�
Phone :
Did the test meet or exceed design flow? gl Yes .3 No
Fax: f
-- — Which sprinkler did you flow?Number: tl
Is the warning sign permanent) attached close to the Location of head: &eirt '
main shutoff valve? .]Yes ANo C\g ) j
Date left in service with all valves open: ?/i8 I
Was this system required by code?0 Yes No
Test Witnessed and Verified by:
Name, `
Si. atur- Occupati n Dat
�c 'I� ,v .I if� e1r '),x/874
,.
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Additional Explanations and Notes
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Z Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
.s Apple Valley,MN 55124 USA Web:www.uponor-usa.com