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Uponor
-17
FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
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VERIFICATION
FORM
AquaSAFE'FM 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: /Ili Ff to the Uponor Fire Safety Design Department
Contact: &fill at technical. -ry • e no #1.1.or 952.997.1731.
Phone: 2„.`" For questions,contact Uponor Technical Services at
888.594.7726 or technical.serviceseuponor.com.
Fax: Color of test orifice used: ettl
Job Name: . '••••'t--"eff4/t7 Static pressure(not flowing) reading at incoming
Project Number: 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: (-is p5,
State, ZIP:
What time of day was the flow test taken? 1(Dc-,.....1
For designs not provided by Uponor, complete the
Flow test method used? N ucket LI Flow Meter
following information.
Designer's Name: Flow test gpm:
How many gallons of wate did the design predict
Company:
as required?
Phone: Did the test meet or exceed design flow? VI_Yes Cl No
Fax: Which sprinkler did you flow? Number: 4. 2-
Is the warning sign permanently attached close to the Location of head:'l-6j2 417-ove_ il,t)1H5
main shutoff valve? J Yes LI No
Date left in service with all valves open:
Was this system required by code?*Yes U No
Test Witnessed and Verified by:
Name Sign.ture Occupation Date
11,4-Tr c94-41 --,s 471,044„1„4._, te)47/11
Additional Explanations and Notes
Uponor,Inc.
Tel:800.321.4739
5925 148th Street West
Fax:952.997.1731
Apple Valley,MN 55124 USA Web:wvvw.uponor-usa.com