Aqua Pro: Scott Haisley: 990-8766: purplehaisley@comcast.net: Spokane Backflow Testing: Multiple: 922-8900: Backflow Johnny: John Menetto: 998-5651: menettj@comcast.net: By mail: ACO Attention: Collections Department 762 W. Lancaster Avenue Bryn Mawr, PA 19010. At Aqua Backflow and Chlorination, Inc, our priority is to protect public health by managing cross-connection prevention, device maintenance and distribution system . Irrigation reports may be submitted five months prior to the scheduled test due date of July 1. Backflow Prevention Assembly Test Report Providence Water Supply Board 125 Dupont Drive Providence RI 02907 backflow@provwater.com - FAX: 401-464-8721 Submit completed Test Report: Mailing Address ServiceAddress Commercial Industrial Residential Municipal Domestic Irrigation Existing New Replaced Removed Fire 598-7251 or request a service using our online form. Box 638, Rancho Cucamonga, CA 91729. The course will cover topics on: cross connection terminology; where they are found and why do they . There is a $9.95 submission fee for each test. Title (inspection.form.1000x1193.jpg \(1000\3271193\)) Author: Be aware of cross connections, eliminate or isolate them. Each tester must supply a copy of their certification card(s) and their test kit calibration form. UF TREEO. 50+ years' experience. Backflow Tester Name: Company Name: Personnel Phone: . As part of this program, all backflow test results must be submitted online at www.TrackMyBackflow.com effective November 15, 2019. Backflow Prevention - Test and Maintenance Report Forms (PDF) Backflow Prevention - What Does it Mean to You? If assembly fails test, complete this section and note repairs: (If Device replaces an existing device, list Serial # of existing device.) Phone: (260) 427-1234. Box 1150 Goochland, VA 23063 Backflow Test Pro, LLC 804-873-8061 3348 Medway Lane Powhatan, VA 23139 Devices can be tested by any number of certified cross-connection control device inspectors. Congratulations! Our goal is to become partners with the testing companies in our communities, and we look forward to working with you. Aqua Backflow - Cross Connection Control Operations. This is done through our lawn irrigation testing program where a PWC contractor tests all residential backflow devices. City Forms & Documents. Please select your county from below to view the ASSE Certified Backflow Testers in your area. State College Backflow Prevention Device Report. More. The advanced tools of the editor will direct you through the editable PDF template. BSI is fully devoted to helping public water systems with the development, implementation, and maintenance of cross-connection control programs. Backflow Preventers. Do not submerge hoses or place them where they could become submerged. Weaver Backflow has over 40 years of experience in commercial applications for water backflow preventer services. The Cross Connection Program is responsible for ensuring potable water provided by the City remains safe throughout the water distribution system and is protected from "backflow events." (an undesirable reversal of potentially contaminated water from a customer to the City's system.). Fee's. Web Sites. Select the types of signatures you need to put. Complete Aqua Backflow in a couple of moments by following the guidelines listed below: Select the document template you want from the library of legal forms. Backflow Prevention Assembly Test Report Return Legible and Satisfactory Reports to: WATER UTILITY AUTHORITY - COMPLIANCE DIVISION CROSS CONNECTION CONTROL OFFICE - SOUTHSIDE WATER RECLAMATION PLANT P.O. Email: DWQ@waterone.org Phone: 913-895-1815 Zip. Fort Wayne City Utilities. At least once every twelve (12) months, each backflow preventer must be tested by an Ohio certified tester, and repaired if needed, to confirm is functioninitg properly. . on or available to the property need to comply with backflow prevention codes and complete this form. Email: CrossConnectionControl@cityoffortwayne.org. Water Customers. Aqua Backflow will contact water customers when backflow testing is due and will also notify them of the new program. This course will cover the basic information needed to understand the concepts and fundamentals of cross connection control. . Aqua Backflow can be reached locally at 866-777-2124 with any questions. The Village of Tequesta maintains an active Cross-Connection Control program following Florida statutes to protect the potable water system from contaminants and pollutants at the point of connection and to ensure that proper backflow preventers are installed where hazards exist. Send your medical certificate. Please contact Gina Enriquez if interested. Phone. It can be drawn, typed, or uploaded signatures. Go to top Q. Permanent Removal Form. The Village of Tequesta maintains an active Cross-Connection Control program following Florida statutes to protect the potable water system from contaminants and pollutants at the point of connection and to ensure that proper backflow preventers are installed where hazards exist. For any questions or concerns relating to customer service in Illinois, please call our phone number 877.987.2782. For Backflow Testers. Aqua Backflow will contact water customers when backflow testing is due and will also notify them of the new online program. Aqua Safe Backflow Service (559) 930-0619: Rudy Maldonado: Flow Tech (559) 936-6492: Natalie Travioli: Arrowhead T Water and Sewer . This protection is achieved through the installation of backflow devices or assemblies after each . The most common type of backflow assembly is a double check valve assembly, which consist of two independent check valves, two resilient seated shut off valves and test cocks. iWorQ. 919-812-2940. Test & Maintenance Report. Contractor License Exp Date (mm/dd/yyyy) Our staff will review your submission and contact you to request documentation. You also may contact the Village of Oak Park Public Works Department at 708.358.5700. as they can allow contaminants or pollutants to enter the public water system through what is called "backflow". Survey Form Backflow Solutions 2022-03-02T12:47:15-05:00. . 6.3 Backflow Prevention Assembly Tester-Certified Page 32 Page 8 of 42 Updated 11/17/2005 . . 50+ years' experience. Backflow Prevention Assembly Test Report Providence Water Supply Board 125 Dupont Drive Providence RI 02907 backflow@provwater.com - FAX: 401-464-8721 Submit completed Test Report: Mailing Address ServiceAddress Commercial Industrial Residential Municipal Domestic Irrigation Existing New Replaced Removed Fire Notification # Manufacturer; Notification # Search. Email: CrossConnectionControl@cityoffortwayne.org. Send notices to the last backflow tester on record for each backflow assembly due Provide unlimited online access to your database for up-to-the-minute information Many report options for reports to view, save, and/or download Customized reports are easily created per your specifications 253-297-4387 . A cross-connection is a physical connection between a possible source of contamination and the public drinking water system . Serial No. Box 708, . Company News Hear the most up to date information from about our company. A backflow preventer is an assembly, device, or method that prohibits the backflow of water into potable water supply systems. When this is complete, fill out the Permanent Removal Form and send it with an invoice copy for worked performed to MSO@lawrenceks.org, or mail it to City of Lawrence Cross Connection Control, P.O. All other containment assembly test reports may be submitted two . Inquiries regarding your testable backflow device should be directed to BSI Online at 888-966-6050 or support@backflow.com. Backflow Inspector 214-449-8289 BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT The following form must be completed for each assembly tested. Your first step to begin submitting backflow test reports is to complete the fast and easy signup . Irrigation Inspectors. 200 E. Berry Street, Suite 130. +. Choose a certified tester - see list below - and schedule a backflow test. Irrigation Inspection Form. If not an annual Test, please select one of the following: New Assembly Remove Assembly Replace Assembly. If you are needing to inquire about a new water/sewer tap, please reach out to customer service at 877-987-2782. Credential Lookup - search the CA-NV AWWA database for individuals with specific CA-NV AWWA-issued water industry certifications. Home. Backflow Assembly Test Form. Assemblies possess 2 shut-off valves, 2 check valves, 4 test cocks and are testable in-line. E-mail. On Line Test Request One Click ,your done . . Test & Maintenance Report; For Water Customers. Tester Signature: Date: City Utilities 265 Lexington Court P.O. 24 HOUR EMERGENCY SERVICE FOR BACKFLOWS. 07/30/22. Any devices that are not tested and submitted by their due date may be subject to disconnection. Test reports must be submitted to Fairfield's Water Division. . Testing Equipment Serial Number. Block Party Application (PDF) Calculate Water & Sewer Bill - City Residents (PDF) Catholic Charities Regional Agency . For more information on Fairfield's backflow program, including access to blank test report forms (1) Have the backflow device (s) tested and/or installed by a certified tester and/or installer. Use hose bib vacuum breakers on fixtures (hose connections in the basement, laundry room, and on outside . Download Aqua Illinois' Medical Certificate Form here Backflow Test Form Download Backflow Test Form Texas Service Application The below application is for new customers needing to transfer existing services into their name. Failure to comply with this ordinance is subject to discontinuance of your water service. Fort Wayne City Utilities. Disconnecting and Capping Irrigation Systems. All inquiries regarding non-testable devices should be forwarded to 1-877-290 . Mail: P.O. 977 Elizabeth Street. Write ID #s on your test forms to make online data entry even easier! Cross Connection and Backflow Prevention. Fax: (909) 481-4688. For instructions on how to submit a backflow test/inspection, see On-Line Test Submittal User Guide or backflow test/inspection video. AquaResource is a key component to your cross-connection program and is accessible from any smartphone, tablet or computer, with no software to install. Philosophy and Mission. By fax: 866.780.8301 Download Aqua Ohio's Medical Certificate Form here Access To On-Line Maps. Backflow Testers. Backflow Prevention Assembly Test Report Return Legible and Satisfactory Reports to: WATER UTILITY AUTHORITY - COMPLIANCE DIVISION CROSS CONNECTION CONTROL OFFICE - SOUTHSIDE WATER RECLAMATION PLANT P.O. 3. Backflow occurs when a drop in water pressure causes your water to flow in the opposite direction. Learn more about the new Low Income Household Water Assistance Program (LIHWAP) by viewing our handout.