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Backflow Reports

  1. City of El Mirage Logo

  2. USE THIS FORM TO SUBMIT BACKFLOW REPORTS WITHIN THE CITY TO THE PUBLIC WORKS DEPARTMENT

    To protect public health and the integrity of the water distribution system, properly installed and maintained backflow prevention assemblies should be tested annually. Backflow test reports should be submitted to the City within 10 business days. If you have any questions please feel free to contact the Public Works Department.

  3. PLEASE ENTER YOUR CONTACT INFORMATION

  4. PLEASE ENTER BACKFLOW INFORMATION

  5. Address, Crossroads, Lat/Long

  6. Commercial and industrial customers and homes with dedicated landscape meters are required by City Code 50.129 and State Administrative Code rule R18-4-215 to install, test, and maintain backflow prevention assemblies.

  7. Leave This Blank:

  8. This field is not part of the form submission.