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" '° FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
� ' il,, VERIFICATION
6 ' .5'6 FORM
AquaSAFETM Flow Test Verification Form
Alliance Important Installing contractor must submit this
Member ID: completed form.Failure to do so nullifies the
� system warranty.E-mail or fax completed form
CompanyName: P[j/W to the Uponor Fire Safety Design Department
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Contact: C ViL. --1-1.By,,. at technical.services@uponor.com or 952.997.1731.
For questions,contact Uponor Technical Services at
Phone 'S:r0' 'Val"- 3y')0 888.594.7726 or technical.services@uponor.com.
Fax: ///,/, ����,, Color of test orifice used: r'`'`'
Job Name: "W�� Static pressure(not flowing)reading at incoming
Project Number 3 Z S 5 0I water supply into home or at main shutoff:
Job Address: // / SW iG
Residual pressure(flowing)reading at incoming water
City: supply into home or at main shutoff: yic—f-Sa
State,ZIP:
What time of day was the flow test taken? /47h r-a.
For designs not provided by Uponor,complete the
following information. Flow test method used?vaBucket ❑Flow Meter
Designer's Name: Flow test gpm: i
Company: How many gallons of water did the design predict
as required? /3
Phone: Did the test meet or exceed design flow?NI Yes ❑No
Fax: Which sprinkler did you flow?Number: Z
Is the warning sign permanently attached close to the Location of head: roe Neel- rr [.Cd ,Skb:.,5>
main shutoff valve? ❑Yes ❑No
Date left in service with all valves open:
Was this system required by code?❑Yes ❑No
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Test Witnessed and Verified by:
Name Sign r Occupation Date
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- Additional Explanations and Notes
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Uponor,Inc. � Tel:800.321.4739
I' 5925 148th Street West Fax:952 997.1731
1 Apple Valley,MN 55124 USA Web:www.uponor-usa.com