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„ ,t, FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
VERIFICATION
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FORM
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AquaSAFETM Flow Test Verification Form
Alliance Important Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
Company Name: RD1._ system warranty.E-mail or fax completed form
'' 't)rnlo�V� to the Uponor Fire Safety Design Department
Contact: kG-1I 11 0,19 } at technical.services@uponor.com or 952.997.1731.
Phone:
(Cl 71)-2-3 5 -050H For questions,contact Uponor Technical Services at
888.594.7726 or technical.services@uponor.com.
Fax: Color of test orifice used: `�7
Job Name: iz sua 1 PA6,..A�/QQ IV,c�- Static pressure(not flowing)reading at incoming�-
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Project Number: 600601 #1.5 (E-S/ i
[ ater supply into home or at main shutoff: .5 t
Job Address: 11-11-1 79 11./V- 11_ . I11 b
Residual pressure(flowing)reading at i c n water
City: 1I q OS supply into home or at main shutoff: Fi r
State,ZIP: Oce3OV\i 9 7-1,2(�1
�/ What time of day was the flow test taken? 1:0 04/4.
For designs not provided by Uponor,complete the
following information. Flow test method used? Bucket 0 Flow Meter
Designer's Name: ' Flow test gpm: d 6PP4
Company: How many gallons of water did the design predict
as required? 1 3 9P" ere.A.c.)* }
Phone: Did the test meet or exceed design flow?; Yes 0 No
Fax: Which sprinkler did you flow? Number:, ' I(0
Is the warning sign permanently attached close to the Location of head:To p '``I(JO( beA` fir
main shutoff valve? 0 Yes U No
Date left in service with all valves open:
Was this system required by code?U Yes 0 No
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Test Witnessed and Verified by:
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Name (I Signature 0 cupation 1r D a
Gl , 0 —� 1
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RA ' rl �' ' MOND a9-30-0
Additional Explanations and Notes
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LL Uponor,Inc. Tel:800321.4739
5925 148th Street West Fax:952.997.1731
1 Apple Valley,MN 55124 USA Web:www.uponor-usa.com