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FIRE SAFETY SYSTEMS
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. AQUASAFETm FLOW TEST
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VERIFICATION
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AquaSAFE' Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID completed form.Failure to do so nullifies the
p system warranty.E-mail or fax completed form
Company Name: t!('��ctt�L�j ��Mil�
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I to the Uponor Fire Safety Design Department
Contact. 3 Y4Z 3`1�/t� at technicalservices@uponor.com or 952.997.1731.
/:moi .y _ �� For questions,contact Uponor Technical Services at
Phone: [ I 888.594.7726 or technical.services@uponor.com.
Fax: r Color of test orifice used:
Job Name:R 4,f' R:oe-, Te41- Static pressure(not flowing)reading at incoming
Project Number: J) CI°664---'‘Q water supply into home or at main shutoff: S2
Job Address: lq243 Sw I0 7
/ Residual pressure(flowing)reading at incoming water
City: � 1 supply into home or at main shutoff: (1.3"
State,ZIP: C9
What time of day was the flow test taken? /00441
For designs not provided by Uponor,complete the
following information. Flow test method used?)(]Bucket ❑Flow Meter
Designer's Name:
Flow test gpm: �
Company: How many gallons of water did the design predict
as required? 13
Phone; Did the test meet or exceed design flow? id Yes ❑No
Fax;
Which sprinkler did you flow? NuumbJer: /E
Is the warning sign permanently attached close to the Location of head: J jff CLet ( )Ltd
main shutoff valve? ❑Yes ❑No
Date left in service with all valves open:
Was this system required by code?❑Yes ❑No
Test Witnessed and Verified by:
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Name �,/ Signature ccupat(in Date
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Additional Explanations and Notes I or 5-7 ,- e
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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