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uponor
FIRE SAFETY SYSTEMS
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AQUASAFETM FLOW TEST
, ,.,.:1 ,-14-Alet mt. 16-,ii'lglaYsvi VERIFICATION
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FORM
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AquaSAFEFM Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
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Company Name: if ttyr
tit4-ce, W'0 _itel system warranty. E-mail or fax completed form
to the Uponor Fire Safety Design Department
Contact: 6.2.'w i-r-, —11471.4-v0 at technical.servicesOuporsor.com or 952.997.1731.
Phone: 5o;—V42 — V40 7or questions,contact Uponor Technical Services at
888.594.7726 or technical,sertticeseuponor.com.
Fax: Color of test orifice used: f- -4t
Job Name: er, 1101.4...k-:a f- gilite-fr-641.2ct- Static pressure(not flowing) reading at incoming
Project Number: 323---75--g 00(4 water supply into home or at main shutoff: .53-f5i
Job Address: •
Residual pressure(flowing)reading at incoming water,
City: _. supply into home or at main shutoff: it',575/
State, ZIP:
What time of day was the flow test taken? / -4-
For designs not provided by Uponor, complete the
following information. Flow test method used?IXBucket LI Flow Meter
Designers Name: Flow test gpm: (3
'
How many gallons of water did the design predict
Company:
as required? 13
Phone:
Did the test meet or exceed design flow? w Yes :I No
Fax: Which sprinkler did you flow? Number: 14.2--
Is the warning sign permanently attached close to the Location of head: Jr...' dira -.4 . —.ILI• 1C...,
main shutoff valve? 1-J Yes Li No
Date left in service with all valves open:
Was this system required by code?*Yes LI No
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Test Witnessed and Verified by:
Name Si 41.. u e -- Occupation Date
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Additional Explanations and Notes
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iF Uponor,Inc.
Tel:800.321.4739
5925 148th Street West
Fax:952.997.1731
1 Apple Valley,MN 55124 USA Web:wwvv.uponor-usa.com