Report (7) 11,Sr20161-09131 19 31 11‘) (6y ' AVM'
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Uponor
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a,' FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
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VERIFICATION
f,:i.! ;
ur FORM
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AquaSAFE't'"` Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: nn '�I completed form.Failure to do so nullifies the
Company Name: /T� e1rL e �fZ,t�� �n system warranty. E-mail or fax completed form
V to the Uponor Fire Safety Design Department
Contact: (9H if ),,.. sThOils at technicalservices@uponor.com or 952.997.1731.
C _��!JTl For questions,contact Uponor Technical Services at
Phone: 888.594.7726 or technical.ser ices@uponor.com.
Fax: Color of test orifice used: Pei
Job Name: ��Z/ S 7 �S7 Static pressure(not flowing) reading at incoming t
Project Number: IH/.S( SW l G'1 �f,i_ water supply into home or at main shutoff:
Job Address:
Residual pressure(flowing) reading at incoming water
City: supply into home or at main shutoff: <=4,f
State, ZIP:
What time of day was the flow test taken? d2Jr1''-r.-a
For designs not provided by Uponor, complete the Flow test method used? 'id Bucket U Flow Meter
following information.
Designers Name: Flow test gpm: 13ifp�,
Company: How many gallons of water did the design predict
as required? /3
Phone: Did the test meet or exceed design flow? Yes U No
Fax: Which sprinkler did you 1'1
/flow? Number:
Is the warning sign permanently attached close to the Location of head:)--ti 1i �,v J-8®� 421 ?
main shutoff valve? U Yes U No
Date left in service with all valves open:
Was this system required by code?IYes U No
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Test Witnessed and Verified by:
Name Signature Occupation Date
t n rr - $S �'� ! Qittir,fn— /2d'4/W/,
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£S
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0
0
N
Y
Additional Explanations and Notes
LLI r
Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com
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