Updates to Test Kit Calibrations/Testing Certifications Test kits are to be calibrated annually to ensure adequate gauge . Backflow Tester Name: Company Name: Personnel Phone: . Notification # Manufacturer; Notification # Search. Click here for facts about chromium and its impact on drinking water. Kent Film Permit Application (PDF) Film Regulations. You can also simply click the required document into this section. as they can allow contaminants or pollutants to enter the public water system through what is called "backflow". Like any mechanical device, they are prone to malfunction due to age, use, manufacturing defects, vandalism, etc. Go to GoogleMap (Non-Residential are required to test their own devices . Water Use Survey. Backflow Prevention Assembly Test Report Providence Water Supply Board 125 Dupont Drive Providence RI 02907 [email protected] - FAX: 401-464-8721 Submit completed Test Report: Mailing Address ServiceAddress Commercial Industrial Residential Municipal Domestic Irrigation Existing New Replaced Removed Fire 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. Our software will help users to be efficient, effective, and save time while managing . BOX 568, Albuquerque, NM 87103-0568 Office Phone: Inspector's Phone: Fax: (505) 289-3417 (505) 289-3465 (505) 289-3503 Email: [email protected] The St Charles Public Works Department can be contacted at 630-377-4405. Aqua Pro: Scott Haisley: 990-8766: [email protected]: Spokane Backflow Testing: Multiple: 922-8900: Backflow Johnny: John Menetto: 998-5651: [email protected]: Choose My Signature. Company News Hear the most up to date information from about our company. There is a $9.95 submission fee for each test. . Devices can be tested by any number of certified cross-connection control device inspectors. 3. Backflow Assembly Test Form. Weaver Backflow has over 40 years of experience in commercial applications for water backflow preventer services. Gettysburg Municipal Authority Backflow test form. iWorQ's Cross-Connection and Backflow Prevention software was created to help meet strict state regulations regarding cross-connection control and to ensure that the city's water supply is protected from harmful contaminants resulting from backflow. Permanent Removal Form. State College Backflow Prevention Device Report. 24 HOUR EMERGENCY SERVICE FOR BACKFLOWS. E-mail. . Backflow Testers. Fax. A backflow preventer is an assembly, device, or method that prohibits the backflow of water into potable water supply systems. 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. The City of Salida has contracted with Aqua Backflow to assist with the Water Utility's Cross Connection Control Program. If not an annual Test, please select one of the following: New Assembly Remove Assembly Replace Assembly. Be aware of cross connections, eliminate or isolate them. Our goal is to become partners with the testing companies in our communities, and we look forward to working with you. Choose a certified tester - see list below - and schedule a backflow test. A signed and dated original must be submitted to the public water supplier for recordkeeping *purposes: ADDRESS OF SERVICE: FACILITY NAME: CONTACT NAME: CONTACT TELEPHONE: Tips on how to fill out the Backflow test form word online: To start the document, utilize the Fill camp; Sign Online button or tick the preview image of the document. iWorQ. Survey Form Backflow Solutions 2022-03-02T12:47:15-05:00. . . Fort Wayne City Utilities. Gainsville, FL 32608. 18927 Hickory Creek Dr. Suite 220. Test reports must be submitted to Fairfield's Water Division. Email: [email protected]. Aqua Backflow can be reached locally at 866-777-2124 with any questions. Address: FMSS Asset ID Number: Location of Assembly: Date of Installation: Incoming Line Pressure: Manufacturer: Model No. Aqua Backflow will contact water customers when backflow testing is due and will also notify them of the new online program. Zip. For affordable backflow testing, give City Backflow Testing a call. Follow the step-by-step instructions below to eSign your backflow paperwork: Select the document you want to sign and click Upload. Test & Maintenance Report. 977 Elizabeth Street. Backflow occurs when a drop in water pressure causes your water to flow in the opposite direction. Individuals that need to obtain the services of a certified . On Line Test Request One Click ,your done . The St Charles Cross Connection Control Program is designed to safeguard public health. Irrigation Inspection Form. All other containment assembly test reports may be submitted two . Contact Aqua Backflow. For any questions or concerns relating to customer service in Illinois, please call our phone number 877.987.2782. Note: NAWSC makes every effort to keep the list of certified testers current, however, there may occasionally be inaccurate information on this site. : Size: Assembly Type: RP RP Detector DC Detector PVB II. Backflow Testing Schedule. Backflow Prevention - Test and Maintenance Report Forms (PDF) Backflow Prevention - What Does it Mean to You? Welcome, NC 27374. This can allow contaminated or polluted water to flow back into your . Click on the Get form key to open it and move to editing. Click the tab below to schedule a Test and we contact . Credential Lookup - search the CA-NV AWWA database for individuals with specific CA-NV AWWA-issued water industry certifications. BOX 568, Albuquerque, NM 87103-0568 Office Phone: Inspector's Phone: Fax: (505) 289-3417 (505) 289-3465 (505) 289-3503 Email: [email protected] 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. Phone: (260) 427-1234. Fill out all the necessary fields (these are yellowish). Aqua Safe Backflow Service (559) 930-0619: Rudy Maldonado: Flow Tech (559) 936-6492: Natalie Travioli: Arrowhead T Water and Sewer . The City of Naperville has contracted with Aqua Backflow to manage the City's backflow inspection program. NCRWA Backflow Cross Connection Training. backflow] to download the test report form and email the completed test form to [email protected] . 6.3 Backflow Prevention Assembly Tester-Certified Page 32 Page 8 of 42 Updated 11/17/2005 . All inquiries regarding non-testable devices should be forwarded to 1-877-290 . If you don't know the answer to any of the questions, contact Aqua Backflow locally at 847.742.2296 or toll free at 866.777.2124 with any questions. If you are needing to inquire about a new water/sewer tap, please reach out to customer service at 877-987-2782. Email: [email protected] Phone: 913-895-1815 HEADQUARTERS. . Irrigation reports may be submitted five months prior to the scheduled test due date of July 1. For questions on annual testing contact: Aqua Backflow 847-742-2296 for City of Olathe Water Service WaterOne 913-895-1800 for WaterOne Water Service Step Three - Annual Testing/Reporting: . 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 Testing Equipment Serial Number. Backflow Compliance If you have received an ORDER from the Department of Environmental Protection (DEP) informing you that your premises is in need of backflow prevention devices . COMMERCIAL. We are based out of the Chicagoland area and provide services for the entire states of lllinois, Indiana, and Southern WIsconsin. Fee's. Web Sites. Box 638, Rancho Cucamonga, CA 91729. Box 1150 Goochland, VA 23063 Backflow Test Pro, LLC 804-873-8061 3348 Medway Lane Powhatan, VA 23139 These preventers shut off valves so that contaminated water cannot reverse flow due to a loss of water pressure, and they must be tested annually by a certified backflow testing company. 977 Elizabeth Street. Learn more about Aqua Backflow and Chlorination, Inc. 1-year guarantee. Testing request contact form. 06/25/22. Backflow Prevention Assembly Test and Maintenance Report; Backflow Prevention Assembly Test and Maintenance Report Philosophy and Mission. The advanced tools of the editor will direct you through the editable PDF template. At Aqua Backflow and Chlorination, Inc, our priority is to protect public health by managing cross-connection prevention, device maintenance and distribution system . Assemblies possess 2 shut-off valves, 2 check valves, 4 test cocks and are testable in-line. To ensure they work correctly, all backflow assemblies must be tested annually with the exception of atmospheric vacuum breakers. BACKFLOW TEST FORM - TO BE COMPLETED BY A QUALIFIED TESTER The above is certified to be true at the time of the test . Your first step to begin submitting backflow test reports is to complete the fast and easy signup . TESTS AND REPAIRS INFORMATION Frequently Asked Questions and Answers Employers Information on Net Profit JEDD Tax - Kent-Franklin (PDF) Employers Return of Tax Withheld - Form EQR - Kent-Franklin (PDF) Form JR - JEDD Income Tax Business Return - Kent-Franklin (PDF) Instructions - Form EQR - Kent-Franklin (PDF) Filming. 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.). At Aqua Backflow and Chlorination, Inc, our priority is to protect public health by managing cross-connection prevention, device maintenance and distribution system . Welcome to lllinois Backflow Testing (IBT) Here at IBT we provide backflow services for industrial and commercial businesses, as well as residential. City Forms & Documents. Water Customers. Test & Maintenance Report; For Water Customers. Test forms not submitted in blue will not be accepted. Access To On-Line Maps. Backflow Inspector 214-449-8289 BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT The following form must be completed for each assembly tested. For instructions on how to submit a backflow test/inspection, see On-Line Test Submittal User Guide or backflow test/inspection video. Box 337 Stn. Aqua Backflow Prevention Device Test Report. Backflow Prevention Device Test Form MUST BE COMPLETED BY CERTIFIED BACKFLOW DEVICE TESTER Please return completed form by mail or fax to Pennsylvania American Water: Fax: 570-341-3296; Email: [email protected]; or Mail: Attention: Cross Connection Department 2699 Stafford Ave Scranton, PA 18505 Testing of the device(s) must be performed by a Certified Tester, and results must be submitted online to Aqua Backflow by the test due date. BSI is fully devoted to helping public water systems with the development, implementation, and maintenance of cross-connection control programs. Serial No. +. Section Number CROSS CONNECTION CONTROL Ninth Edition USC Manual It will prepare students for training in testing backflow prevention devices or conducting cross-connection surveys. Blank form to provide to your certified tester . Film Permit. Email: [email protected]. Disconnecting and Capping Irrigation Systems. This can allow contaminated or polluted water to flow back into your . Fort Wayne, Indiana 46802. Fort Wayne, Indiana 46802. Congratulations! This is done through our lawn irrigation testing program where a PWC contractor tests all residential backflow devices. Aqua Backflow will contact water customers when backflow testing is due and will also notify them of the new program. Select the types of signatures you need to put. backflow tester and repair ,Certified Backflow assembly testing in the Enumclaw, Bonney Lake,Auburn,Covington,Buckely,King County,Sumner,Lake Tapps,Puyallup . 598-7251 or request a service using our online form. If assembly fails test, complete this section and note repairs: (If Device replaces an existing device, list Serial # of existing device.) TEST MEASUREMENTS a ve Held at Closed Tight Leaked Did Not Open #2 Shut Off Valve Closed Tight? Block Party Application (PDF) Calculate Water & Sewer Bill - City Residents (PDF) Catholic Charities Regional Agency . Survey Form Backflow Solutions 2022-03-02T12:47:15-05:00. . WHAT SHOULD YOU DO? Fort Wayne City Utilities. You will hear back from us within 48 business hours of your request. Any devices that are not tested and submitted by their due date may be subject to disconnection. This protection is achieved through the installation of backflow devices or assemblies after each . 07/30/22. The course will cover topics on: cross connection terminology; where they are found and why do they . Contractor License #. Philosophy and Mission. 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. Mokena, IL 60448 (708) 995-3019. Services. As part of this program, all backflow test results must be submitted online at www.TrackMyBackflow.com effective November 15, 2019. as they can allow contaminants or pollutants to enter the public water system through what is called "backflow". 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. 598-7251 or request a service using our online form. UF TREEO. When this is complete, fill out the Permanent Removal Form and send it with an invoice copy for worked performed to [email protected], or mail it to City of Lawrence Cross Connection Control, P.O. AquaResource is a web-based Backflow Management Software for water purveyors wanting a robust cross-connection program. Please select your county from below to view the ASSE Certified Backflow Testers in your area.