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uponor
FIRE SAFETY SYSTEMS
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. • AQUASAFETM FLOW TEST
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VERIFICATION
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FORM
AquaSAFErM Flow Test Verification Form
Affiance Important:Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
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Company Name: f \\11,) hCC._ 1...V1'035, system warranty.E-mail or fax completed form
to the Uponor Fire Safety Design Department
Contact: Cr)\)''11\ \\inD2-5 -. at technical.services@uponor.com or 952.997.1731.
Phone: 3-0-, - 1193,--3(-\RO For questions,contact Uponor Technical Services at
888.594.7726 or technical.servic7keuponor,com.
Fax:
Color of test orifice used:
Job Name: Static pressure(not flowing)reading at incomin L\
Project Number: VI '. OpZQS —a I water supply into home or at main shutoff: -)
Job Address: 1 IA 1.-4Ck- S' Ude' )64 e-
Residual pressure(flowing)reading at incom4iwater
City: 1 .1...-Pb) supply into home or at main shutoff:
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State, ZIP: (. '?-•••- CO
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What time of day was the flow test taken? la• CVO--
For designs not provided by Uponor, complete the
following information. Flow test method used Bucket UFlow Meter
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Flow test gpm:
Designer's Name:
How many gallons of water did trqesign predict
Company:
as required?
Phone:
Did the test meet or exceed design flowYes U No
Fax: Which sprinkler did you flow? Number:
Is the warning sign permanently attached close to the Location of head: 0 MG 0
main shutoff valve? U Yes U No
Date left in service with all valves open:
Was this system required by cod Yes 3 No
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Test Witnessed and Verified by:
EE ‘4),(HVasnevik c .4?..0,1ze32,6 _,,Sign tyre Occupation Date
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i' Additional Explanations and Notes
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EI Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
jApple Valley,MN 55124 USA Web:vwvw.uponor-usa.com