Backflow Reports

2. 

3. 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.

   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.

5. PLEASE ENTER YOUR CONTACT INFORMATION

7. NAME*

8. COMPANY

10. TELEPHONE*

11. EMAIL*

13. PLEASE ENTER BACKFLOW INFORMATION

15. NAME OF BUSINESS/FACILITY*

17. LOCATION OF BACKFLOW*

    Address, Crossroads, Lat/Long

19. DATE COMPLETED*
    DATE COMPLETED

20. TYPE OF BACKFLOW*
    -- Select One --NEWEXISTINGREPLACEMENT

22. PLEASE UPLOAD THE BACKFLOW REPORT*

24. 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.

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26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit Submit and Print

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