Report (61) CTed CS* T 2.
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� FIRE SAFETY SYSTEMS
AQUASAFErm FLOW TEST
VERIFICATION
t
FORM
•
AquaSAFErm Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
Company Name: f3/i 41.-er 9114, system warranty.E-mail or fax completed form
to the Uponor Fire Safety Design Department
Contact: 6kti soh .1-1-16,241,5 at technical.services@uponor.com or 952.997.1731.
`��� For questions,contact Uponor Technical Services at
Phone: 888.594.7726 or technical.serrvices@uponor.com.
Fax: n Color of test orifice used: eeei
Job Name: l� 'i- I ' Tom€ — Static pressure(not flowing)reading at incoming
Project Number: 35.7$-p water supply into home or at main shutoff: 1
Job Address: 1(4j Li.. /(A) Cekt5t`1 J
Residual pressure(flowing)reading at incoming water
City: supply into home or at main shutoff: tIS j
State,ZIP:
What time of day was the flow test taken? `cA44.,
For designs not provided by Uponor,complete the
following information. Flow test method used? %1 Bucket CU Flow Meter
Designers Name: Flow test gpm: 3
Company: How many gallons of water did the design predict
as required? 13
Phone:
Did the test meet or exceed design flow? S'r'es CU No
Fax:
Which sprinkler did you flow? Number: 1'2--
Is
Is the warning sign permanently attached close to the Location of head: --ref Poor- Pkte s1-41-
main shutoff valve? L1 .Yes U No
Date left in service with all valves open:
Was this system required by code? Yes Cl No
Npp
Test Witnessed and Verified by:
Name Signature Occupation Date
italictriepirk
0
0
Additional Explanations and Notes
LL
Uponor,Inc.
Tel:800.321.4739
5925148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com