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, FIRE SAFETY SYSTEMS
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_ . , AQUASAFETM FLOW TEST
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, • - . , -1,,,... VERIFICATION
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FORM
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AquaSAFETM Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
i # ., system warranty.E-mail or fax completed form
Company Name: - ,
‘......... to the Uponor Fire Safety Design Department
Contact: 69 ' ii .,,,. at technicalservicuOuponor,com or 952.997.1731.
For questions,contact Uponor Technical Services at
Phone: ,-Stir — Clq2-- ...,),),..pio 888.594.7726 or technical.services_Awgnor.com.
Fax: Color of test orifice used: gZel
Job Name: -6t11-4-ek--- 4‘;k-"-- 644W--7-4-ri'V'eStatic pressure(not flowing)reading at incoming ...
Project Number: '. .,/,_.„„...25t,__ 1water supply into home or at main shutoff:
Job Address:
Residual pressure(flowing) reading at incomin/wa;er
City: supply into home or at main shutoff: 445 Sy
State, ZIP:
What time of day was the flow test taken? /C7-Att.,
For designs not provided by Uponor, complete the
Flow test method used? 1 Bucket Li Flow Meter
following information.
Flow test gpm: if:5
Designer's Name:
How many gallons of water did the design predict
Company:
as required? /3
Phone:
Did the test meet or exceed design flow? -Yes Ci No
Fax: Which sprinkler did you flow? Number: )1
Is the warning sign permanently attached close to the Location of head: •,,,
# " eco-r- 2-e4( 8te,"rae7--7
main shutoff valve? C..I Yes L.I No
Date left in service with all valves open:
Was this system required by code?S&Yes i..]No
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Test Witnessed and Verified by:
Name Sign. ur A , .0... OccupationDate
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,s Additional Explanations and Notes
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Uponor,Inc. Tel:800,321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com
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