Report (7) s: 44 -F.2.0(`b -50;3 f
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kiiFIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
'1 ; VERIFICATION
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, FORM
AquaSAFETM Flow Test Verification Form
Alliance Important Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
1
Company Name: 1- t0A-AV!t\-9system warranty.E-mail or fax completed form
Ha to the Uponor Fire Safety Design Department
Contact: KW 1 Ha Ie 1 at technical.services@uponor.com or 952.997.1731.
Phone:
71) -T.3" - 0 5 0L I For questions,contact Uponor Technical Services at
888.594.7726 or technical.services@uponor.com.
Fax: Color of test orifice used: LI t'-,
Job Name: ,® 1�i1�� I?(' (t..Static pressure(not flowing)reading at incoming
Project Number: V.3 water supply into home or at main shutoff: .55
Job Address: lye 3 SW jVii' /fa
Residual pressure(flowing)reading at incoming water
City: i30 supply into home or at main shutoff: 5 Z
State,ZIP: O f erA l `ITZZ4
J What time of day was the flow test taken? rga:)/4t0
For designs not provided by Uponor,complete the
following information. Flow test method used?ABucket ❑Flow Meter
Designer's Name: Flow test gpm: 162
Company: How many gallons of water did the design predict
as required?
Phone: Did the test meet or exceed design flow? 40 Yes`_ ❑No
Fax: Which sprinkler did you flow? Number: 16,
Is the warning sign permanently attached close to the Location of head: UPc&1,ors Gt'd'oG+M
main shutoff valve? ❑Yes ❑No
Date left in service with all valves open:
Was this system required by code?0 Yes 0 No
Test Witnessed and Verified by:
Name Sign J Occupation Date
t-tLA LIAAtZ 7itl,A Ger jo—I—i')
RI MIA PAGUitAGVJ i/✓,/v i.. fi jkir bei I1)--1-19
Additional Explanations and Notes
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! Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
v
1 Apple Valley,MN 55124 USA Web:www.uponor-usa.com