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Z FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
VERIFICATION
FORM
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AquaSAFETM Flow Test Verification Form
Alliance Important:Installing contractor must submit this
Member ID: 3005 completed form.Failure to do so nullifies the
Company Name: Stumptown Plumbing Co. system warranty.E-mail or fax completed form
to the Uponor Fire Safety Design Department
Contact: Ryan MacDougall at technical.services@uponor.com or 952.997.1731.
503 380 6273 For questions,contact Uponor Technical Services at
Phone: 888.594.7726 or technical.services@uponor.com.
Fax: Color of test orifice used: (Gi.,5
Job Name: Static pressure(not flowing)reading at incoming
Project Number: water supply into home or at main shutoff: g6
Job Address: II A17 Std L,c .v2-rt
/ Residual pressure(flowing)reading at incoming water
City: "/.I3b, - supply into home or at main shutoff: (45'7-0
State,ZIP: f7 2-7q
What time of day was the flow test taken? 2'
For designs not provided by Uponor, complete the �
following information. Flow test method used? J0Sucket ❑Flow Meter
Flow test gpm: /7-
Designer's Name:
Company: How many gallons of water did the design predict
as required? /7
Phone: Did the test meet or exceed design flow?' 1 Yes ❑No
Fax: Which sprinkler did you flow? Number: kiy
Is the warning sign permanently attached close to the Location of head: 'fiGd.r 2—
main shutoff valve? ❑Yes ❑No
Date left in service with all valves open:
Was this system required by code? Yes ❑No
Test Witnessed and Verified by:
patio Date
N72lkt 1i a lb- 2y
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Additional Explanations and Notes
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Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA Web:www.uponor-usa.com