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FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
'';gi, ', )- :' '.'' ,,, ".,;4•'.,','',''', VERIFICATION
FORM
AquaSAFErM Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
Company Name: A 0 14 tv,6,
. (Di (4.5 system warranty.E-mail or fax completed form
to the Uponor Fire Safety Design Department Contact: 61)\.:AIN, \)(.5,...NIV)..5. at tech ical,services@uponor.com or 952.997.1731.
Phone: 5:1 -• 4 93.- 34CP For questions,contact Uponor Technical Services at
888.594.7726 or technical.servigeOuporior.com.
Fax: Color of test orifice used: Rezt --
Job Name: Static pressure(not flowing)reading at incomin
Project Number: U 1 CI Og ia- i -1 water supply into home or at main shutoff:
Job Address: V-IVS &- tlAct.P.
----City: Residual pressure(flowing)reading at inc water
water
1 supply into home or at main shutoff: "
State, ZIP: b?-,—....) CO
What time of day was the flow test taken? 1 I fY>
For designs not provided by Uponor, complete the
following information. Flow test method usedj,16Bucket LI Flow Meter
1 11 Designer's Name: Flow test gpm:
Company: How many gallons of waterfil the design predict
as required?
Phone:
Did the test meet or exceed design flowyq. Yes U No
Fax:
Which sprinkler did you flow? Number: V\— G
Is the warning sign permanently attached close to the Location of head: kAPP€-Q.- IADo
main shutoff valve? '.....1 Yes —.1 No
Date left in service with all valves open:
Was this system required by codeA Yes L.1 No
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Test Witnessed and Verified by:Name \ c- .,rd, 4. v\ ___ _____ _,,...-
SiSt atur .> Opcupation, Date
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.5.. Additional Explanations and Notes
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g Uponor,Inc. Tel:800.321.4739
t 5925148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com