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FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
VERIFICATION
117 FORM
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AquaSAFE'rm Flow Test Verification Form
Alliance Important Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
Company Name: Asystem warranty.E-mail or fax completed form
-ti 1-4-1,,c,e- f tt.,44,1 Zrb''vj to the Uponor Fire Safety Design Department
Contact: &44-1/4).. -114,-er4it at technicai,services@uponor.corn or 952.997.1731.
Phone: 112--(11.2.--3Ylo For questions,contact Uponor Technical Services at
888.594.7726 or technical.serviceseuponor.coin.
Fax: Color of test orifice used:
Job Name: Static 4'..g.125 ----...12 —ghl"- Static pressure(not flowing)reading at incomir3g,,_ „2
Project Number: h2--3 47S-4 °di( water supply into home or at main shutoff: ....._. ..._
Job Address:
Residual pressure(flowing) reading at incoming water
City: supply into home or at main shutoff:
State, ZIP:
What time of day was the flow test taken?
For designs not provided by Uponor, complete the
Flow test method used? ti-Bucket U Flow Meter
following information.
Flow test gpm:
Designers Name:
How many gallons of water did the design predict
Company. as required? i
Phone: Did the test meet or exceed design flow?Va Yes LI No
Fax: Ii
Which sprinkler did you flow? Number:
Is the warning sign permanently attached close to the Location of head:%tdp
main shutoff valve? LI Yes Li No
Date left in service with all valves open:
Was this system required by code?1$1 Yes D No
.!.
Test Witnessed and Verified by:
i Name Si n.t re ----- .7.7 Occupation Date
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Additional Explanations and Notes
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Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
I Apple Valley, MN 55124 USA Web:www.uponor-usa.com
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