Forms • Padre Dam Municipal Water District, CA • CivicEngage

Backflow Tester Sign-up

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Company Name (Please Include Capitalization and Punctuation)*
Name of Company Account Administrator*
Direct Phone Number of Account Administrator*
Email Address (Will be Used as Login Name)*
Company Mailing Address*
Company Mailing City, State and Zip Code*
Company Phone Number*
Applicant Agrees to: - Submit true and accurate test results. - Perform only current USC approved test procedures and test only USC approved assemblies. - Make only needed repairs or replacements, using manufacturer approved parts or assemblies. - Submit completed test information to Padre Dam through EcosConnect no later than ten days from date of test. - Use test kits that are calibrated according to current USC-FCCCHR specifications and submit copies of current calibrations to Padre Dam as well as add to tester profile. - Maintain valid ABPA, AWWA, and/or ASSE backflow tester certifications and submit copies of current certifications to Padre Dam. - Note on test report any cross-connections or noticeable problems with assembly installation. - Perform work in an ethical, courteous and professional manner. * I agree to the above requirements.

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