Report (6) 5t
2olq -�13 � I`j tc a lbgthAvt
M5i
v$.
UOflO1
FIRE SAFETY SYSTEMS
AQUASAFETm FLOW TEST
w; ',I,r V E R I F I C A T I O N
c �
� rss, 7
�, ev�" Z FORM
AquaSAFE"M Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
Company Name: ii i,l6'I't,G^e �Lc_y_(a'
system warranty.E-mail or fax completed form
to the Uponor Fire Safety Design Department
Contact: &wi/'i p1, s" j y,,uS at technical.services@uponor,com or 952.997.1731.
Phone( )
/ \ y y _ 3 y to For questions,contact Uponor Technical Services at
1388.594.7726 or technical.seMceseuponor.com.
Fax: ,p Color of test orifice used: `
Job Name: (g vok a/- RI1J 1' k4 eStatic pressure(not flowing) reading at incoming
Project Number: . ) 5 7�S 4 co water supply into home or at main shutoff: SS �a
Job Address: /4efi/ .Sw /&9 /IAL
Residual pressure(flowing) reading at incoming water
City: supply into home or at main shutoff: ySf
State, ZIP:
What time of day was the flow test taken? /19irr�
For designs not provided by Uponor, complete the Flow test method used? 4-Bucket ❑Flow Meter
following information.
Designers Name:
Flow test gpm: 13 �los..
Company: How many gallons of wat r did the design predict
as required? 13
Phone: Did the test meet or exceed design flow? Cit Yes ❑No
Fax: Which sprinkler did
you/flow? Number: ti
Is the warning sign permanently attached close to the Location of head: )-k.d ' ieeleiliter4t
main shutoff valve? ❑Yes ❑No
Date left in service with all valves open:
Was this system required by code?WYes ❑No
A
Test Witnessed and Verified by:
c Name Signature Occupation Date
g.
Additional Explanations and Notes
F_
Uponor,Inc, Tel 800.321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com
a<'