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FIRE SAFETY SYSTEMS
� �,`� AQUASAFETM FLOW TEST
, ' 44"' VERIFICATION
FORM
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AquaSAFE'M Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
b/ ���� �� system warranty.E-mail or fax completed form
Company Name: , to the Uponor Fire Safety Design Department
Contact: by", �r,.,,.,v-j at technicalservices@uponor,com or 952.997.1731.
For questions,contact Uponor Technical Services at
Phone:5�7�-- � 96 For
or technical.services@uponor.com.
Fax: Color of test orifice used:
Job Name: (0$1.,,,kd 4,1.- t.,Lo -r`z-Cr'i 'r Static pressure(not flowing)reading at incoming
Project Number (>Il06 IL' 0 1 water supply into home or at main shutoff: S.1.-
Job Address: 1/ tt) / t i1^ five_
Residual pressure(flowing) reading at incoming water
City: Ti ,"-f`A supply into home or at main shutoff: '1 c
State,ZIP: ®,,
What time of day was the flow test taken?
For designs not provided by Uponor, complete the
following information. Flow test method used? N Bucket U Flow Meter
Designer's Name: Flow test gpm: )3
Company: How many gallons of water did the design predict
as required? ;
Phone: Did the test meet or exceed design flow? i44...YesU No
Fax: Which sprinkler did you flow? Number:
Is the warning sign permanently attached close to the Location of head: jcef,_ .jde_ 4�„
main shutoff valve? U Yes U No
Date left in service with all valves open:
Was this system required by code?U Yes U No
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z Test Witnessed and Verified by:
Naa Si nat re4. Oc pation Date
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Additional Explanations and Notes 60 k 6
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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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