More. Each tester must supply a copy of their certification card(s) and their test kit calibration form. (Non-Residential are required to test their own devices . Aqua Backflow will contact water customers when backflow testing is due and will also notify them of the new program. If you have any questions, please contact KC Water Backflow Division at 816-513-4795 or email at backflow@kcmo.org. There are three variants; a typed, drawn or uploaded signature. Call 614-645-8276 for . Fax. 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. 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. If assembly fails test, complete this section and note repairs: (If Device replaces an existing device, list Serial # of existing device.) If not an annual Test, please select one of the following: New Assembly Remove Assembly Replace Assembly. Note: NAWSC makes every effort to keep the list of certified testers current, however, there may occasionally be inaccurate information on this site. The course will cover topics on: cross connection terminology; where they are found and why do they . Cross Connection and Backflow Prevention. Backflow occurs when a drop in water pressure causes your water to flow in the opposite direction. Aqua Pro: Scott Haisley: 990-8766: purplehaisley@comcast.net: Spokane Backflow Testing: Multiple: 922-8900: Backflow Johnny: John Menetto: 998-5651: menettj@comcast.net: 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. Backflow Testing Schedule. This can allow contaminated or polluted water to flow back into your . AquaAudit is the preferred backflow testing service of building owners and property management companies in the tri-state area and currently provides annual testing throughout the 5 boroughs of New York, The City of White Plains, all of Westchester and Rockland Counties, Long Island and New Jersey. Choose a certified tester - see list below - and schedule a backflow test. Aqua Backflow - Cross Connection Control Operations. 4.32 Laboratory - Approved Testing Page 13 4.33 Point Of Delivery Page 14 X 4.34 Pollution Page 14 X 4.35 Pressure Vacuum Breaker Backsiphonage Prevention Assembly (PVB) Page 14 X . 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. Fort Wayne, Indiana 46802. Real time recording of backflow installation and registration. 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.). as they can allow contaminants or pollutants to enter the public water system through what is called "backflow". If you have questions about registration or test submittal please contact Aqua Backflow at 847-742-2296 or toll-free at 866-777-2124. Weaver Backflow has over 40 years of experience in commercial applications for water backflow preventer services. 598-7251 or request a service using our online form. BOX 568, Albuquerque, NM 87103-0568 Office Phone: Inspector's Phone: Fax: (505) 289-3417 (505) 289-3465 (505) 289-3503 Email: backflow@abcwua.org 50+ years' experience. 18927 Hickory Creek Dr. Suite 220. "Mr. Backflow" Is Ready To Solve Any Backflow Need We're Specialists In Inspecting, Testing, Repairing & Installing Backflow Preventers and Backflow Prevention Devices. Individuals that need to obtain the services of a certified . Aqua Safe Backflow Service (559) 930-0619: Rudy Maldonado: Flow Tech (559) 936-6492: Natalie Travioli: Arrowhead T Water and Sewer . Notification # Manufacturer; Notification # Search. Please select your county from below to view the ASSE Certified Backflow Testers in your area. Permanent Removal Form. Temporary Removal Form. Water Use Survey. Your cooperation and courtesy is appreciated as we perform the required tasks to . 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 Blank form to provide to your certified tester . 3. Property owners are responsible for owning and maintaining the backflow devices while PWC is responsible for ensuring that the backflow device is in working condition. 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: paw.cc@amwater.com; or Mail: Attention: Cross Connection Department 2699 Stafford Ave Scranton, PA 18505 Maintain air gaps on sinks and when using hoses. State College Backflow Prevention Device Report. Please contact Gina Enriquez if interested. The City of Naperville has contracted with Aqua Backflow to manage the City's backflow inspection program. Email: CrossConnectionControl@cityoffortwayne.org. Devices can be tested by any number of certified cross-connection control device inspectors. Survey Form Backflow Solutions 2022-03-02T12:47:15-05:00. . backflow] to download the test report form and email the completed test form to DWQ@waterone.org . +. Backflow Tester Name: Company Name: Personnel Phone: . as they can allow contaminants or pollutants to enter the public water system through what is called "backflow". Company News Hear the most up to date information from about our company. The St Charles Public Works Department can be contacted at 630-377-4405. 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. Box 708, . You can also simply click the required document into this section. All containment assemblies are to be tested upon installation, replacement and annually thereafter on or before annual test due date according to zip code. Aqua Backflow Stats Tracking 1 million water customer accounts Tracking hundreds of thousands of backflow preventers Tracking over 6,000 certified backflow testers We opened our doors in 2006 and have NEVER raised our prices! Philosophy and Mission. Cross Connection and Backflow Prevention. Email: DWQ@waterone.org Phone: 913-895-1815 If you have not tested backflow preventers in Olathe's water service area, please call 847-742-2296 to register. As part of this program, all backflow test results must be submitted online at www.TrackMyBackflow.com effective November 15, 2019. Backflow Assembly Test Form. Test forms not submitted in blue will not be accepted. FREE ESTIMATES. . Mail: P.O. Preventing backflow situations in your home and business. NCRWA Backflow Cross Connection Training. Phone. City Forms & Documents. Our software will help users to be efficient, effective, and save time while managing . BSI is fully devoted to helping public water systems with the development, implementation, and maintenance of cross-connection control programs. . Choose My Signature. Follow this steps to e-sign Backflow Test Forms Printable easily: Select the document you want to sign. . Philosophy and Mission. E-mail. At Aqua Backflow and Chlorination, Inc, our priority is to protect public health by managing cross-connection prevention, device maintenance and distribution system . 919-812-2940. Select the types of signatures you need to put. Like any mechanical device, they are prone to malfunction due to age, use, manufacturing defects, vandalism, etc. Created with Raphal 2.0.1. Credential Lookup - search the CA-NV AWWA database for individuals with specific CA-NV AWWA-issued water industry certifications. 50+ years' experience. Do not submerge hoses or place them where they could become submerged. Go to GoogleMap BOX 568, Albuquerque, NM 87103-0568 Office Phone: Inspector's Phone: Fax: (505) 289-3417 (505) 289-3465 (505) 289-3503 Email: backflow@abcwua.org There is a $9.95 submission fee for each test. WHAT SHOULD YOU DO? Your community has partnered with BSI Online for backflow test report submittal. 598-7251 or request a service using our online form. Tester Signature: Date: City Utilities 265 Lexington Court P.O. 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. The City of Salida has contracted with Aqua Backflow to assist with the Water Utility's Cross Connection Control Program. on or available to the property need to comply with backflow prevention codes and complete this form. Go to top Q. Virginia Backflow Service 757-635-3001 P.O. Website. (Form BF-1) I. Aqua Backflow can be reached locally at 866-777-2124 with any questions. Testing request contact form. Water Customers. Temporary Removal Form; Permanent Removal Form; Disconnecting & Capping Irrigation Systems Email: Gina Enriquez. All inquiries regarding non-testable devices should be forwarded to 1-877-290 . Frequently Asked Questions and Answers backflow tester and repair ,Certified Backflow assembly testing in the Enumclaw, Bonney Lake,Auburn,Covington,Buckely,King County,Sumner,Lake Tapps,Puyallup . We are based out of the Chicagoland area and provide services for the entire states of lllinois, Indiana, and Southern WIsconsin. . Waterloo Waterloo ON N2J 4A8 T 519-886-2310 x 30231 F 519-886-5788 Email: backflowprevention@waterloo.ca Click here for facts about chromium and its impact on drinking water. Fee's. Web Sites. . Our goal is to become partners with the testing companies in our communities, and we look forward to working with you. Box 62751 Virginia Beach, VA 23466 Riley Fire Protection, LLC 804-335-8257 P.O. ADA-compliance Note. Backflow occurs when a drop in water pressure causes your water to flow in the opposite direction. Water customers with previously registered backflow . BACKFLOW TEST FORM - TO BE COMPLETED BY A QUALIFIED TESTER The above is certified to be true at the time of the test . Welcome to lllinois Backflow Testing (IBT) Here at IBT we provide backflow services for industrial and commercial businesses, as well as residential. Backflow Testers. AquaResource is a key component to your cross-connection program and is accessible from any smartphone, tablet or computer, with no software to install. Title (inspection.form.1000x1193.jpg \(1000\3271193\)) Author: (1) Have the backflow device (s) tested and/or installed by a certified tester and/or installer. Backflow Prevention - Test and Maintenance Report Forms (PDF) Backflow Prevention - What Does it Mean to You? Be aware of cross connections, eliminate or isolate them. Suez Cross Connection Control Report. Devices do not have shutoff valves and are not testable in-line. Click to view and read original letter (3) Aqua Pennsylvania Form - Backflow Prevention Test Certification Report What is a Cross-Connection? Updates to Test Kit Calibrations/Testing Certifications Test kits are to be calibrated annually to ensure adequate gauge . We are offering proctor training. By mail: ACO Attention: Collections Department 762 W. Lancaster Avenue Bryn Mawr, PA 19010. Inquiries regarding your testable backflow device should be directed to BSI Online at 888-966-6050 or support@backflow.com. Irrigation reports may be submitted five months prior to the scheduled test due date of July 1. This is done through our lawn irrigation testing program where a PWC contractor tests all residential backflow devices. Box 1150 Goochland, VA 23063 Backflow Test Pro, LLC 804-873-8061 3348 Medway Lane Powhatan, VA 23139 All other containment assembly test reports may be submitted two . Kent Film Permit Application (PDF) Film Regulations. GENERAL INFORMATION. Aqua backflow is prevented by the use of backflow preventers, or backflow devices. Assemblies possess 2 shut-off valves, 2 check valves, 4 test cocks and are testable in-line. By fax: 866.780.8301 Download Aqua Ohio's Medical Certificate Form here 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: The advanced tools of the editor will direct you through the editable PDF template. 253-297-4387 . Use hose bib vacuum breakers on fixtures (hose connections in the basement, laundry room, and on outside . The St Charles Cross Connection Control Program is designed to safeguard public health. On Line Test Request One Click ,your done . Test & Maintenance Report. You also may contact the Village of Oak Park Public Works Department at 708.358.5700. Box 638, Rancho Cucamonga, CA 91729. This course will cover the basic information needed to understand the concepts and fundamentals of cross connection control. Aqua Backflow will contact water customers when backflow testing is due and will also notify them of the new online program. Email: CrossConnectionControl@cityoffortwayne.org. Backflow Inspector 214-449-8289 BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT The following form must be completed for each assembly tested. Gainsville, FL 32608. 200 E. Berry Street, Suite 130. Write ID #s on your test forms to make online data entry even easier! 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. Additionally, the City requires annual testing of all commercial backflow assemblies, as stated in the City of Olathe Municipal Code (Section 15.08.090) as well as Kansas State Statute 65-163a. Click the tab below to schedule a Test and we contact . University of Florida Center for Training Research/Education for Environmental Occupations (TREEO) 3900 SW 63rd Blvd. For more information on Fairfield's backflow program, including access to blank test report forms Access To On-Line Maps. HEADQUARTERS. This protection is achieved through the installation of backflow devices or assemblies after each . 4. Aqua Backflow will serve as the primary point of contact for backflow inspections within the City of Naperville and can be contacted at info@AquaBackflow.com or calling (847) 742-2296. Welcome, NC 27374. Aqua Cross Connection Program; Customer Service Inspections; Endangered Species Compliance; Conservation Forms. Backflow Prevention Assembly Test and Maintenance Report; Backflow Prevention Assembly Test and Maintenance Report . If you are ever unsure about which water utility serves the location where you are preforming a backflow preventer test or you need help finding a customer's location, you can find more information through City Utilities' GIS interactive mapping system.If it is your first time using the mapping system, you may call 260-427-2543 to receive basic instruction by phone or . Zip. : Size: Assembly Type: RP RP Detector DC Detector PVB II. 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 If you need your Backflow Preventer tested and certified, please call us at (610) 909-0906 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. 977 Elizabeth Street. Annual Testing of Backflow Prevention Assemblies Backflow prevention assemblies are mechanical devices. 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. . Create your eSignature and click Ok. Press Done. 904-392-9570. Gettysburg Municipal Authority Backflow test form. We ask for your cooperation with our program and any requests for information that come from Aqua Backflow or . 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. Any devices that are not tested and submitted by their due date may be subject to disconnection. Address: FMSS Asset ID Number: Location of Assembly: Date of Installation: Incoming Line Pressure: Manufacturer: Model No. You will hear back from us within 48 business hours of your request. A cross-connection is a physical connection between a possible source of contamination and the public drinking water system . (2) The completed test (s) must be submitted to Aqua Pennsylvania before the Shut-Off date shown on the "10-Day Shut-Off" notice. 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 You may also search by backflow assembly serial number and building number (address), if you don't have the ID numbers. This can allow contaminated or polluted water to flow back into your . Box 337 Stn. For any questions or concerns relating to customer service in Illinois, please call our phone number 877.987.2782. Phone: (260) 427-1234. For Backflow Testers. Home. Failure to comply with this ordinance is subject to discontinuance of your water service. Your first step to begin submitting backflow test reports is to complete the fast and easy signup . Aqua Backflow - Cross Connection Control Operations. 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. Decide on what kind of eSignature to create. 6.3 Backflow Prevention Assembly Tester-Certified Page 32 Page 8 of 42 Updated 11/17/2005 . Irrigation Inspection Form. Test & Maintenance Report; For Water Customers. . Enter your official contact and identification details. Make one easy call - Phone: (614) 882-5700 | Fax: (614) 882-3334 |. 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: It can be drawn, typed, or uploaded signatures. 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. A backflow preventer is an assembly, device, or method that prohibits the backflow of water into potable water supply systems. 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 . 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. At Aqua Backflow and Chlorination, Inc, our priority is to protect public health by managing cross-connection prevention, device maintenance and distribution system . UF TREEO. Survey Form Backflow Solutions 2022-03-02T12:47:15-05:00. . Fax: (909) 481-4688. TESTS AND REPAIRS INFORMATION Click on the Get form key to open it and move to editing. COMMERCIAL. Backflow is when the water in your pipes (the pipes after the water meter) goes backwards (the opposite direction from normal flow). Serial No. For affordable backflow testing, give City Backflow Testing a call. Block Party Application (PDF) Calculate Water & Sewer Bill - City Residents (PDF) Catholic Charities Regional Agency . Film Permit. Once received by Aqua, a valid medical certificate gives the customer 30 days to pay the bill or to make payment arrangements. . The Aqua America - North Carolina partners with Backflow Solutions, Inc. (BSI Online) to assist in cross-connection program management, including mail surveys and annual testing notifications. Learn more about the new Low Income Household Water Assistance Program (LIHWAP) by viewing our handout. . Fort Wayne, Indiana 46802. AquaResource is a web-based Backflow Management Software for water purveyors wanting a robust cross-connection program. Contractor License Exp Date (mm/dd/yyyy) Our staff will review your submission and contact you to request documentation. Fort Wayne City Utilities. Contractor License #. Mokena, IL 60448 (708) 995-3019. Certified Backflow Testers: To receive a login and password, please email a copy of your Tester Certification Card and Gauge Calibration Certificate to ccc@pawsc.com If you have any questions or require assistance, please contact us at 844-605-5213 For instructions on how to submit a backflow test/inspection, see On-Line Test Submittal User Guide or backflow test/inspection video. Aqua Backflow Prevention Device Test Report.