Backflow & Cross Connection Service Testing 2026

1. Click ‘Get Form’ to open the Backflow & Cross Connection Service Testing document in the editor.
2. Begin by entering the Facility Name and Service Address in the designated fields. This information is crucial for identifying the location of the backflow assembly.
3. Fill out the Device Type, Manufacturer, Model Number, Serial Number, Device Size, and Location. Accurate details ensure proper documentation and compliance.
4. For each check valve listed (Check Valve #1 and Check Valve #2), indicate whether it leaked or held by selecting the appropriate checkbox. Record any relevant pressure readings in the provided spaces.
5. Complete the FINAL TEST section by documenting differential pressures and whether valves opened at specified pressures. Ensure all repairs are noted as required.
6. Finally, have the Tester print their name, sign, and provide their certification number along with company details before submitting the form to Tampa Water Department.

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