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FIRE SAFETY SYSTEMS
AQUASAFET' FLOW TEST
VERIFICATION
AquaSAFE1'M Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: ____ __ completed form.Failure to do so nullifies the
I' system warranty.E-mail or fax completed form
Company Name: t r
1^ _ to the Uponor Fire Safety Design Department
Contact: Pabe pCs4\ray\ at technical.services@uponor.corn or 952.997.1731.
Phone-
p 3, 111x_Nct- For questions,contact Uponor Technical Services at
888.594.7726 or technical.services@uponor.com.
Fax: pp( --- Color of test orifice used: (:tcvf
Job Name: 1�1Y't'.( 1 tf-'-{`�i4 Static pressure(not flowing)reading at incoming
Project Number: water supply into home or at main shutoff: qc
Job Address: /31-11 5tt) L b , -
Residual pressure(flowing)reading at incoming water
City: supply into home or at main shutoff: 60
State,ZIP: 91C1 --
1 What time of day was the flow test taken? 9s OG
For designs not provided by Uponor, complete the
following information. Flow test method used? X Bucket 7 Flow Meter
pp r
Designer's Name: _ AikM;i ' L t0. Flow test gpm:—_'f 8
Company: _ `!$ tik How many gallons of water did the design predict
— — as required? I-.) _
Phone: s �y{
Did the test meet or exceed design flow? 9'Yes 3 No
Fax: --- Which sprinkler did you flow?Number: 61
Is the warning sign permanently attached close to the Location of head: LCI A,,,.d
main shutoff valve? :..i Yes No f i V
Date left in service with all valves open: )18-f(Bi
Was this system required by code?*Yes 3 No
Test Witnessed and Verified by:
Na a�l -(4'\
Sig
�.�. i/ .',� �occupation� Date
lre
•
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