Report (10) A� 20fc6 -00333
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FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
• VERIFICATION
., FORM
AquaSAFETM Flow Test Verification Form
Alliance Important Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
system warranty.E-mail or fax completed form
Company Name: ol._ I,11iW wI V\@ to the Uponor Fire Safety Design Department
Contact: f�(}`) 11 ctk .j l at technital.services@uponor.tom or 952.997.1731.
(94 i —'1 3Tt_ 05014 For questions,contact Uponor Technical Services at
Phone: \\I J L J 888.594.7726 or technical.services@uponor.com.`
Fax: Color of test orifice used: 055
Job I lame: R05/00,1(- @Q vok idt Static pressure(not flowing)reading at incoming —
Project Number: >U11111 415 (K-8 B' water supply into home or at main shutoff: b 5 c)>
Job Address: 111111/ S 0) /671 11 .ki'C
� f1 Residual pressure(flowing)reading at incoming water
City: l i X11 supply into home or at main cutoff:
•
State,ZIP: OI 0y .17-i.�� 1 d, 5.i
What time of day was the flow test taken? LI O01(/1
For designs not provided by Uponor,complete the
following information. Flow test method used?VBucket ❑Flow Meter
Designer's Name:
Flow test gpm: )5 i fin
Com an How many gallons of water did the design predict
p y as required? 13 G49Y"4. Pi[A.Ckt
Phone: Did the test meet or exceed design flow?. Yes ❑No
Fax: Which sprinkler did you flow? Number: # 3
Is the warning sign permanently attached close to the Location of head:TOE' t‘obf 611000e 5+0,1.'5
T5
main shutoff valve? ❑Yes ❑No
Date left in service with all valves open:
Was this system required by code?❑Yes ❑No
Test Witnessed and Verified by:
2
Name Signature Occupation Date
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Additional Explanations and Notes
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E Uponor,Inc Tel:800.321.4739
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5925 148th Street West Fax:952.997.1731
1 Apple Valley,MN 55124 USA Web:www.uponor-usa.com