Backflow Prevention Device Test Report - Gloucester County Virginia - gloucesterva 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the 'Name of Premises' and 'Service Address' in the designated fields. This information is crucial for identifying the location of the backflow prevention device.
3. Fill in the 'Use & Location of Device' section, specifying how and where the device is utilized.
4. Complete the device details including 'Manufacturer', 'Model', and 'Serial No.' Ensure you indicate whether it is an Existing, Replacement, or New Device.
5. Record the 'Line Pressure at Time of Test' and check off whether it's an Initial Test, Repairs, or Retest as applicable.
6. For each check valve, answer whether they closed tight and record pressure readings as required. Pay attention to minimum pressure requirements indicated on the form.
7. In the remarks section, provide any additional comments or observations regarding the test results.
8. Finally, ensure that all tester information is filled out accurately including name, signature, license number, and company details before submitting your report.

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