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Backflow test form 2026

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  1. Click ‘Get Form’ to open the backflow test form in the editor.
  2. Begin by entering the Service Name and Service Address, including City, State, and Zip Code. This information identifies the location of the backflow assembly.
  3. Fill in the Account Number and Meter Number along with the Reading to provide specific details about the water service.
  4. Input the Contractor Backflow Tester’s name and their Mailing Address. Ensure you include their Phone number and Orange County Tester I.D. for verification.
  5. Select the appropriate Check Areas (Irrigation, Fire) and Assembly type (e.g., Reduced Pressure, Double Check). Specify if it is Existing or New.
  6. Complete the DEVICE TEST section by filling in details for each valve tested, including results for Closed Tight, Opened at PSID, and any repairs made.
  7. Finally, certify your test by signing and dating where indicated. Don’t forget to add any comments that may be relevant.

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backflow test form pdf

BACKFLOW PREVENTION ASSEMBLY FIELD TEST FORM

BACKFLOW PREVENTION ASSEMBLY FIELD TEST FORM Page. INITIAL TEST Check Valve 1 Check Valve 2 Relief Valve Check Valve 1 Check Valve 2 Relief Valve Bypass.

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