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Annual Backflow Preventer Test Report - City of Chilliwack 2026
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- Click ‘Get Form’ to open the Annual Backflow Preventer Test Report in the editor.
- Begin by entering the Facility Name and Address at the top of the form. This information is crucial for identifying the location of the backflow preventer.
- Fill in the Assembly Location and Test Date. Ensure that these details are accurate as they are essential for record-keeping.
- Indicate the Line Pressure and select the appropriate assembly type from options like DCVA, PVBA, RPDA, or DCDA. Specify if it’s for Sprinkler, Boiler, Irrigation, or Domestic use.
- Complete sections regarding Serial No., Type of Test, Make, and Test Equipment used. This information helps in tracking and verifying testing equipment.
- Document results for each check valve under Fixture Isolation and Premise Isolation sections. Record pressures and whether valves passed or failed tests.
- Finally, ensure both Tester Name and Owner's Signature fields are filled out before submitting your report to certify compliance with regulations.
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Related links
May 6, 2017 ANNUAL GAS TEST @ DAY CARE FACILIT. 1909 W BITTERS RD. ARNOLD MOOS 1 DCA backflow. rain sensor will be on the r. 107 W ASHBY PLACE.Read more
If the water source is potable water, check to make sure that the backflow preventer and water meter are connected and ready for operation.