Report (3) :
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, E ,, i FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
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;; � VERIFICATION
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AquaSAFE1 Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
Company Name:
LL I r\t1C'-, system warranty.E-mail or fax completed form
(` to the Uponor Fire Safety Design Department
Contact: 1±1)1/4-)IA �'dl5fi,a5 at technical,services@uponor,conn or 952.997.1731.
r,�3.-Lice - )c o For questions,contact Uponor Technical Services at
Phone:axy ,�,,7 594.7726 or technic�al.services@u onor.com.
Fax: ` ' i cts2, �,5 ki d ,
Color of test orifice used: `
Job Name: 113,5 0.> Static pressure(not flowing)reading at Incomin .
Project Number: ti ) (02(05 -'J water supply into home or at main shutoff:
Job Address:
Residual pressure(flowing) reading at incomjng ter
City: 1 I.4i 01?el supply into home or at main shutoff: , 4 7
State,ZIP: _.C)
What time of day was the flow test taken? )a ,•O) R
For designs not provided by Uponor, complete the
following information. Flow test method usedBucket LiFlow Meter
Designer's Name: Flow test gpm: 13
Company: How many gallons of water did tk design predict
as required? 1
Phone: Did the test meet or exceed design flow? S$Yes 0 No
Fax: Which sprinkler did/ ou flow? Number:/H "'1
Is the warning sign permanently attached close to the Location of head: C71�C\ i2
main shutoff valve?..)/Yes CI No
Date left in sentice with all valves open:
Was this system required by code?U Yes Ca No
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Test Witnessed and Verified by:
arra x Signature 0 u ation Date
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• Additional Explanations and Notes
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Uponor,Inc. Tel:800321.4739
5925148th Street West Fax:952.997.1731
I Apple Valley,MN 55124 USA Web:www.uponor-usa.com
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