aqua backflow test forms

The advanced tools of the editor will direct you through the editable PDF template. A backflow preventer is an assembly, device, or method that prohibits the backflow of water into potable water supply systems. Each tester must supply a copy of their certification card(s) and their test kit calibration form. Backflow Assembly Test Form. Please contact Gina Enriquez if interested. 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 Choose My Signature. as they can allow contaminants or pollutants to enter the public water system through what is called "backflow". Learn more about Aqua Backflow and Chlorination, Inc. 1-year guarantee. 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 have not tested backflow preventers in Olathe's water service area, please call 847-742-2296 to register. (Non-Residential are required to test their own devices . Temporary Removal Form. Once received by Aqua, a valid medical certificate gives the customer 30 days to pay the bill or to make payment arrangements. Test & Maintenance Report; For Water Customers. Individuals that need to obtain the services of a certified . What is a Cross-Connection? If assembly fails test, complete this section and note repairs: (If Device replaces an existing device, list Serial # of existing device.) . Your community has partnered with BSI Online for backflow test report submittal. 200 E. Berry Street, Suite 130. Frequently Asked Questions and Answers (Form BF-1) I. "Mr. Backflow" Is Ready To Solve Any Backflow Need We're Specialists In Inspecting, Testing, Repairing & Installing Backflow Preventers and Backflow Prevention Devices. Box 62751 Virginia Beach, VA 23466 Riley Fire Protection, LLC 804-335-8257 P.O. Fort Wayne City Utilities. 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 The St Charles Cross Connection Control Program is designed to safeguard public health. 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 At Aqua Backflow and Chlorination, Inc, our priority is to protect public health by managing cross-connection prevention, device maintenance and distribution system . This can allow contaminated or polluted water to flow back into your . . Cross Connection and Backflow Prevention. WHAT SHOULD YOU DO? For affordable backflow testing, give City Backflow Testing a call. Phone. Box 708, . Preventing backflow situations in your home and business. This course will cover the basic information needed to understand the concepts and fundamentals of cross connection control. Welcome, NC 27374. 977 Elizabeth Street. 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. 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. More. Philosophy and Mission. Do not submerge hoses or place them where they could become submerged. Box 337 Stn. To ensure they work correctly, all backflow assemblies must be tested annually with the exception of atmospheric vacuum breakers. All containment assemblies are to be tested upon installation, replacement and annually thereafter on or before annual test due date according to zip code. BSI is fully devoted to helping public water systems with the development, implementation, and maintenance of cross-connection control programs. 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 . Aqua Backflow will contact water customers when backflow testing is due and will also notify them of the new online program. Our goal is to become partners with the testing companies in our communities, and we look forward to working with you. 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 4. If you need your Backflow Preventer tested and certified, please call us at (610) 909-0906 Updates to Test Kit Calibrations/Testing Certifications • Test kits are to be calibrated annually to ensure adequate gauge . 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. Learn more about the new Low Income Household Water Assistance Program (LIHWAP) by viewing our handout. 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. 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 . It can be drawn, typed, or uploaded signatures. This is done through our lawn irrigation testing program where a PWC contractor tests all residential backflow devices. We are offering proctor training. Contractor License #. State College Backflow Prevention Device Report. (2) The completed test (s) must be submitted to Aqua Pennsylvania before the Shut-Off date shown on the "10-Day Shut-Off" notice. 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. Aqua Backflow will contact water customers when backflow testing is due and will also notify them of the new program. 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. By mail: ACO Attention: Collections Department 762 W. Lancaster Avenue Bryn Mawr, PA 19010. Website. 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: Contractor License Exp Date (mm/dd/yyyy) Our staff will review your submission and contact you to request documentation. Backflow Testers. Click to view and read original letter... (3) Aqua Pennsylvania Form - Backflow Prevention Test Certification Report For instructions on how to submit a backflow test/inspection, see On-Line Test Submittal User Guide or backflow test/inspection video. TEST MEASUREMENTS a ve Held at Closed Tight Leaked Did Not Open #2 Shut Off Valve Closed Tight? AquaResource is a web-based Backflow Management Software for water purveyors wanting a robust cross-connection program. Be aware of cross connections, eliminate or isolate them. On Line Test Request One Click ,your done . Weaver Backflow has over 40 years of experience in commercial applications for water backflow preventer services. Suez Cross Connection Control Report. Backflow is when the water in your pipes (the pipes after the water meter) goes backwards (the opposite direction from normal flow). Backflow Prevention Assembly Test and Maintenance Report; Backflow Prevention Assembly Test and Maintenance Report Temporary Removal Form; Permanent Removal Form; Disconnecting & Capping Irrigation Systems 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. 18927 Hickory Creek Dr. Suite 220. Backflow Preventers. Fax: (909) 481-4688. 24 HOUR EMERGENCY SERVICE FOR BACKFLOWS. Email: DWQ@waterone.org Phone: 913-895-1815 Annual Testing of Backflow Prevention Assemblies Backflow prevention assemblies are mechanical devices. This protection is achieved through the installation of backflow devices or assemblies after each . The City has contracted with Aqua Backflow for the past several years to track and sends out notices of when backflow devices (cross-connection) need to be tested. Services. 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: We are based out of the Chicagoland area and provide services for the entire states of lllinois, Indiana, and Southern WIsconsin. University of Florida Center for Training Research/Education for Environmental Occupations (TREEO) 3900 SW 63rd Blvd. . . There are three variants; a typed, drawn or uploaded signature. TESTS AND REPAIRS INFORMATION Serial No. Like any mechanical device, they are prone to malfunction due to age, use, manufacturing defects, vandalism, etc. Access To On-Line Maps. Click on the Get form key to open it and move to editing. New Testing Company Signup. Created with Raphaël 2.0.1. 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. Phone: (260) 427-1234. Follow this steps to e-sign Backflow Test Forms Printable easily: Select the document you want to sign. A cross-connection is a physical connection between a possible source of contamination and the public drinking water system . Click the tab below to schedule a Test and we contact . You can also simply click the required document into this section. (1) Have the backflow device (s) tested and/or installed by a certified tester and/or installer. Inquiries regarding your testable backflow device should be directed to BSI Online at 888-966-6050 or support@backflow.com. Box 638, Rancho Cucamonga, CA 91729. Congratulations! AquaResource is a key component to your cross-connection program and is accessible from any smartphone, tablet or computer, with no software to install. 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. ADA-compliance Note. Our software will help users to be efficient, effective, and save time while managing . Fort Wayne, Indiana 46802. Gettysburg Municipal Authority Backflow test form. Test forms not submitted in blue will not be accepted. Please select your county from below to view the ASSE Certified Backflow Testers in your area. Aqua Safe Backflow Service (559) 930-0619: Rudy Maldonado: Flow Tech (559) 936-6492: Natalie Travioli: Arrowhead T Water and Sewer . Gainsville, FL 32608. This can allow contaminated or polluted water to flow back into your . Send your medical certificate. Any devices that are not tested and submitted by their due date may be subject to disconnection. As part of this program, all backflow test results must be submitted online at www.TrackMyBackflow.com effective November 15, 2019. Survey Form Backflow Solutions 2022-03-02T12:47:15-05:00. . Company News Hear the most up to date information from about our company. Use hose bib vacuum breakers on fixtures (hose connections in the basement, laundry room, and on outside . Irrigation reports may be submitted five months prior to the scheduled test due date of July 1. Fee's. Web Sites. 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 : Size: Assembly Type: RP RP Detector DC Detector PVB II. If not an annual Test, please select one of the following: New Assembly Remove Assembly Replace Assembly. Aqua Backflow - Cross Connection Control Operations. 977 Elizabeth Street. as they can allow contaminants or pollutants to enter the public water system through what is called "backflow". Title (inspection.form.1000x1193.jpg \(1000\3271193\)) Author: FREE ESTIMATES. Email: CrossConnectionControl@cityoffortwayne.org. If you are needing to inquire about a new water/sewer tap, please reach out to customer service at 877-987-2782. By fax: 866.780.8301 Download Aqua Ohio's Medical Certificate Form here 6.3 Backflow Prevention Assembly Tester-Certified Page 32 Page 8 of 42 Updated 11/17/2005 . Blank form to provide to your certified tester . Make one easy call - Phone: (614) 882-5700 | Fax: (614) 882-3334 |. If you have questions about registration or test submittal please contact Aqua Backflow at 847-742-2296 or toll-free at 866-777-2124. For any questions or concerns relating to customer service in Illinois, please call our phone number 877.987.2782. Disconnecting and Capping Irrigation Systems. Your cooperation and courtesy is appreciated as we perform the required tasks to . Email: Gina Enriquez. Address: FMSS Asset ID Number: Location of Assembly: Date of Installation: Incoming Line Pressure: Manufacturer: Model No. Call 614-645-8276 for . Click here for facts about chromium and its impact on drinking water. Phone: (260) 427-1234. City Forms & Documents. Fax. Aqua Cross Connection Program; Customer Service Inspections; Endangered Species Compliance; Conservation Forms. HEADQUARTERS. Notification # Manufacturer; Notification # Search. For Backflow Testers. The City of Salida has contracted with Aqua Backflow to assist with the Water Utility's Cross Connection Control Program. 3. For more information on Fairfield's backflow program, including access to blank test report forms We ask for your cooperation with our program and any requests for information that come from Aqua Backflow or . You also may contact the Village of Oak Park Public Works Department at 708.358.5700. 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. 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! All other containment assembly test reports may be submitted two . . Mail: P.O. Test & Maintenance Report. Mokena, IL 60448 (708) 995-3019. BACKFLOW TEST FORM - TO BE COMPLETED BY A QUALIFIED TESTER The above is certified to be true at the time of the test . If you have any questions, please contact KC Water Backflow Division at 816-513-4795 or email at backflow@kcmo.org. NCRWA Backflow Cross Connection Training. The City of Naperville has contracted with Aqua Backflow to manage the City's backflow inspection program. Learn more about Aqua Backflow and Chlorination, Inc. 1-year guarantee. 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 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 . Kent Film Permit Application (PDF) Film Regulations. Aqua Backflow can be reached locally at 866-777-2124 with any questions. At Aqua Backflow and Chlorination, Inc, our priority is to protect public health by managing cross-connection prevention, device maintenance and distribution system . Backflow occurs when a drop in water pressure causes your water to flow in the opposite direction. Backflow Inspector 214-449-8289 BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT The following form must be completed for each assembly tested. 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. You may also search by backflow assembly serial number and building number (address), if you don't have the ID numbers. Virginia Backflow Service 757-635-3001 P.O. 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. Enter your official contact and identification details. Permanent Removal Form. 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. Aqua Backflow Prevention Device Test Report. − +. Credential Lookup - search the CA-NV AWWA database for individuals with specific CA-NV AWWA-issued water industry certifications. Fort Wayne City Utilities. GENERAL INFORMATION. Go to GoogleMap Select the types of signatures you need to put. . Backflow Tester Name: Company Name: Personnel Phone: . . Backflow Prevention - Test and Maintenance Report Forms (PDF) Backflow Prevention - What Does it Mean to You? You will hear back from us within 48 business hours of your request. 07/30/22. Water Customers. Your first step to begin submitting backflow test reports is to complete the fast and easy signup . Aqua Pro: Scott Haisley: 990-8766: purplehaisley@comcast.net: Spokane Backflow Testing: Multiple: 922-8900: Backflow Johnny: John Menetto: 998-5651: menettj@comcast.net: Devices do not have shutoff valves and are not testable in-line. 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 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.). . Irrigation Inspection Form. 06/25/22. 50+ years' experience. Assemblies possess 2 shut-off valves, 2 check valves, 4 test cocks and are testable in-line. The course will cover topics on: cross connection terminology; where they are found and why do they . 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. Cross Connection and Backflow Prevention. Film Permit. It will prepare students for training in testing backflow prevention devices or conducting cross-connection surveys. Philosophy and Mission. Block Party Application (PDF) Calculate Water & Sewer Bill - City Residents (PDF) Catholic Charities Regional Agency . Water Use Survey. Note: NAWSC makes every effort to keep the list of certified testers current, however, there may occasionally be inaccurate information on this site. Testing Equipment Serial Number. . Real time recording of backflow installation and registration. backflow tester and repair ,Certified Backflow assembly testing in the Enumclaw, Bonney Lake,Auburn,Covington,Buckely,King County,Sumner,Lake Tapps,Puyallup . 904-392-9570. Contact Aqua Backflow. 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. . Tester Signature: Date: City Utilities 265 Lexington Court P.O. There is a $9.95 submission fee for each test. 200 E. Berry Street, Suite 130. Aqua Backflow - Cross Connection Control Operations. All inquiries regarding non-testable devices should be forwarded to 1-877-290 . Email: CrossConnectionControl@cityoffortwayne.org. Write ID #s on your test forms to make online data entry even easier! 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. 253-297-4387 . UF TREEO. Devices can be tested by any number of certified cross-connection control device inspectors. Select the category 'My Signature'. Maintain air gaps on sinks and when using hoses. on or available to the property need to comply with backflow prevention codes and complete this form. Backflow occurs when a drop in water pressure causes your water to flow in the opposite direction. Decide on what kind of eSignature to create. Failure to comply with this ordinance is subject to discontinuance of your water service. The St Charles Public Works Department can be contacted at 630-377-4405. Section Number CROSS CONNECTION CONTROL Ninth Edition USC Manual Follow the step-by-step instructions below to eSign your backflow paperwork: Select the document you want to sign and click Upload. 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. Aqua backflow is prevented by the use of backflow preventers, or backflow devices. Irrigation Inspectors. Survey Form Backflow Solutions 2022-03-02T12:47:15-05:00. . Water customers with previously registered backflow . COMMERCIAL. Fill out all the necessary fields (these are yellowish). Test reports must be submitted to Fairfield's Water Division. Box 1150 Goochland, VA 23063 Backflow Test Pro, LLC 804-873-8061 3348 Medway Lane Powhatan, VA 23139 iWorQ. 598-7251 or request a service using our online form. E-mail. Choose a certified tester - see list below - and schedule a backflow test. Go to top Q. 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. Backflow Testing Schedule. Home. Welcome to lllinois Backflow Testing (IBT) Here at IBT we provide backflow services for industrial and commercial businesses, as well as residential. Fort Wayne, Indiana 46802. 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. Create your eSignature and click Ok. Press Done. Testing request contact form. backflow] to download the test report form and email the completed test form to DWQ@waterone.org . 919-812-2940. 50+ years' experience. Zip. Waterloo Waterloo ON N2J 4A8 T 519-886-2310 x 30231 F 519-886-5788 Email: backflowprevention@waterloo.ca

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