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City of Sunnyvale CrossConnection Control Program CrossConnection and Backflow Protection Survey Form Name: Company/Organization: Service Address:Type of Business on Property:City:State:Phone:Alternate
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How to fill out cross-connection backflow prevention survey

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How to fill out cross-connection backflow prevention survey

01
To fill out a cross-connection backflow prevention survey, follow these steps:
02
Start by gathering all the necessary information about the premises where the survey will be conducted.
03
Identify potential cross-connection points, such as water supply connections, irrigation systems, swimming pools, or fire sprinklers.
04
Evaluate the potential hazards associated with each cross-connection and determine the level of backflow risk.
05
Use a standardized survey form or template to record the findings and observations at each cross-connection point.
06
Provide detailed descriptions and diagrams of the backflow prevention devices or methods currently in place.
07
Assess the effectiveness of the existing backflow prevention measures and recommend improvements if necessary.
08
Document any non-compliant or high-risk cross-connections that require immediate attention.
09
Verify the accuracy of the collected data and ensure it is properly recorded in the survey form.
10
Submit the completed survey form to the relevant authorities or backflow prevention program coordinator.
11
Keep a copy of the survey for future reference and follow-up inspections.

Who needs cross-connection backflow prevention survey?

01
Anyone responsible for ensuring the safety of drinking water supply systems needs a cross-connection backflow prevention survey. This includes property owners, facility managers, water utility companies, plumbing contractors, and regulatory agencies.
02
Specific industries that may require cross-connection backflow prevention surveys include healthcare facilities, food processing plants, chemical manufacturing plants, swimming pool operators, and fire protection system owners. It is essential for these entities to identify potential cross-connections and implement appropriate backflow prevention measures to protect public health and maintain water quality.
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A cross-connection backflow prevention survey is an assessment designed to identify potential cross-connections in a plumbing system that could result in backflow, preventing contaminants from entering potable water supplies.
Typically, property owners, facility managers, or businesses that have plumbing systems connected to public water supplies are required to file a cross-connection backflow prevention survey.
To fill out a cross-connection backflow prevention survey, one should gather information about the plumbing system, identify cross-connections, document existing backflow prevention devices, and answer all relevant questions on the survey form provided by the local water authority.
The purpose of a cross-connection backflow prevention survey is to ensure the safety of drinking water by identifying potential points of contamination and ensuring proper backflow prevention measures are in place.
The survey must report information such as the location of cross-connections, the types of backflow prevention devices installed, maintenance records, and any observed hazards within the plumbing system.
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